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Beyond Fentanyl Test Strips: The Need To Decriminalize All Drug Checking Equipment In Tennessee, Jeremy C. Kourvelas Mph

SMART Policy Briefs

KEY POINTS

• In 2022, Tennessee decriminalized fentanyl test strips (FTS) through Public Chapter 764. Thousands have since been distributed by the state and nonprofit coalitions as a key harm reduction strategy. As of the end of 2023, 44 other states and D.C. had also decriminalized FTS.

• Research indicates that people who use drugs are five times as likely to change their behaviors (including reducing drug use overall) in response to a test result that is positive for fentanyl. People who use methamphetamine are especially likely to change their behaviors.

• However, the law only applies to “narcotic testing equipment used to …

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States’ Covid-19 Restrictions Were Associated With Increases In Drug Overdose Deaths In 2020, Douglas A. Wolf, Shannon M. Monnat, Jennifer Karas Montez, Emily E. Wiemers, Elyse Grossman

Center for Policy Research

Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies …

States’ Covid-19 Restrictions Were Associated With Increases In Drug Overdose Deaths In 2020, Douglas A. Wolf, Shannon M. Monnat, Jennifer Karas Montez, Emily E. Wiemers, Elyse Grossman

Population Health Research Brief Series

Drug overdoses surged in the U.S. during the COVID-19 pandemic. Public health experts raised concerns in the pandemic’s early months about how the pandemic and the policies enacted to stem it might increase overdose risk. This brief summarizes the findings of a paper that used national data to identify how states’ COVID-19 policies affected drug overdose rates among U.S. adults ages 25-64 during the first year of the pandemic. Results show that counties located in states that adopted more aggressive in-person activity restrictions experienced larger increases in 2020 than counties located in states with fewer limitations. State economic support policies …

Sufferance For Snuff Puffs: The Acceptability And Behavior Of Smoking Marijuana And Tobacco Inside The House, Eusabeia Silfanus, Oliver Lopez, Vincent Berardi

Student Scholar Symposium Abstracts and Posters

Secondhand smoke (SHS) released from indoor smoking contributes to household air pollution, releasing large quantities of fine particulate matter which can pose negative health outcomes, especially for developing children who spend most of their time at home. The increased legalization of marijuana increases its recreational and medicinal use along with its acceptability. With tobacco use remaining prevalent, the use of marijuana and/or tobacco remains common and may occur inside the home. Project Fresh Air conducted in San Diego County studies the air quality in households (n = 298) with at least one adult smoking tobacco and/or marijuana living with at …

Older Adults Are At Greater Risk Of Opioid Use Disorder In Communities With High Social Vulnerability, Tse-Chuan Yang, Seulki Kim, Stephen A. Matthews, Carla Shoff

Population Health Research Brief Series

The prevalence of opioid use disorder (OUD) among older adults has increased and imposes a heavy burden on the health care system in the United States. This brief summarizes findings from a study that used data from the Centers for Medicare and Medicaid Services to examine how county characteristics contributed to the prevalence of OUD among Medicare beneficiaries age 65+ in U.S. counties in 2021. They found that the prevalence of OUD among these adults is higher in counties with more place-level social vulnerability (e.g., socioeconomic disadvantage, high housing cost burden).

Telehealth Treatment For Opioid Use Disorder In Missouri’S Urban And Rural Areas Prior To And Since Covid-19, Aurora Rojo, Rashmi Ghonasgi, Zachary Budesa, Rachel Winograd

Undergraduate Research Symposium

Opioid use disorder (OUD) is a chronic health condition that can be adequately treated when individuals have access to needed services. Telehealth services can be delivered remotely through audio-visual technological communications rather than in-person visits, which can greatly improve care accessibility. Following the onset of COVID-19, there were swift clinical and policy adaptations to promote telehealth services across medical and behavioral health fields. This study aims to identify changes in the frequency of telehealth for OUD treatment in Missouri’s rural and urban counties prior to and since the onset of COVID-19. Chi-square tests and analysis of changes between years and …

Assessment Of Simultaneous Alcohol And Cannabis Use And Its Related Consequences And Cognitions In College Students: A Narrative Review, Jennifer L. Shipley, Abby L. Braitman

Psychology Faculty Publications

As rates of students using cannabis continue to rise, simultaneous use of alcohol and cannabis (such that their effects overlap; commonly referred to as simultaneous alcohol and marijuana [SAM] use) is prevalent among college students who use both substances. Although research focusing on SAM use and related cognitions and consequences continues to grow, there are no common established measures, as approaches vary across studies. This narrative review identifies current methods for assessing SAM use and measures of SAM-related consequences and cognitions (motives and expectancies) among college students, evaluates how they were developed, identifies gaps in the literature, and provides recommendations …

The Federal Government Must Revise Public Housing Policies To Protect Vulnerable Populations From Evictions, Caroline Grabowski

Population Health Research Brief Series

Over 100,000 Americans are now dying from drug overdoses annually, signifying that the goal of the 1986 Anti-Drug Abuse Act (ADAA) to end illicit drug use has not been achieved. What’s more, numerous statutes within the ADAA have created or worsened housing instability among people who use drugs and their families. This is because the ADAA allows public housing officials to use their own discretion when determining evictions and lease refusals and has disproportionately harmed individuals in public housing who did not participate in the drug-related activities that led to their eviction. This brief describes how the ADAA negatively affects …

The Associations Of Parental Smoking, Quitting And Habitus With Teenager E-Cigarette, Smoking, Alcohol And Other Drug Use In Gui Cohort ’98, Salome Sunday, Luke Clancy, Joan Hanafin

Articles

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1–3 of Growing Up in Ireland (Cohort ’98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with …

Selection Homophily And Peer Influence For Adolescents’ Smoking And Vaping Norms And Outcomes In High And Middle-Income Settings, Jennifer M. Murray, Sharon Sánchez-Franco, Olga L. Sarmiento, Erik O. Kimbrough, Christopher Tate, Shannon C. Montgomery, Rajnish Kumar, Laura Dunne, Abhijit Ramalingam, Erin L. Krupka, Felipe Montes, Huiyu Zhou, Laurence Moore, Linda Bauld, Blanca Llorente, Frank Kee, Ruth F. Hunter

Economics Faculty Articles and Research

The MECHANISMS study investigates how social norms for adolescent smoking and vaping are transmitted through school friendship networks, and is the first study to use behavioral economics methodology to assess smoking-related social norms. Here, we investigate the effects of selection homophily (the tendency to form friendships with similar peers) and peer influence (a social process whereby an individual’s behavior or attitudes are affected by peers acting as reference points for the individual) on experimentally measured smoking and vaping norms, and other smoking outcomes, in adolescents from high and middle-income settings. Full school year groups in six secondary schools in Northern …

Treatment For Mental Health And Substance Use: Spillovers To Police Safety, Monica Deza

Center for Policy Research

We study the effect of community access to mental health and substance use treatment on police officer safety, which we proxy with on-duty assaults on officers. Police officers often serve as first-responders to people experiencing mental health and substance use crises, which can place police officers at risk. Combining agency-level data on police officer on-duty assaults and county-level data on the number of treatment centers that offer mental health and substance use care, we estimate two-way fixed-effects regressions and find that an additional four centers per county (the average annual increase observed in our data) leads to a 1.3% reduction …

Association Between Chronic Disease And Substance Use Among Older Adults In Tennessee, Manik Ahuja, Jessica Stamey, Johanna Cimilluca, Kawther Al Skir, Mary K. Herndon, Kathleen Baggett, Thiveya Sathiyasaleen, Praveen Fernandopulle

ETSU Faculty Works

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Design and methods:

A Call To Action: Person-Centered Care Aligned With Reproductive Justice For Incarcerated Pregnant People With Substance Use Disorder, Essence Hairston, Aunchalee El Palmquist, Andrea K. Knittel, Kevin Mensah-Biney, Crystal M. Hayes, Amelia Mack, Hendrée E. Jones

School of Social Work Faculty Publications

Although research has proven that jails and prisons are ineffective in preventing or reducing substance use among pregnant people, the USA continues to rely heavily on the criminal legal system as its intervention. Pregnant people with an opioid use disorder are more likely to experience incarceration than pregnant people without an opioid use disorder. In some states, pregnant people are transported from jail to prison through the process of safekeeping in order to receive physical or mental health care that the jail does not provide, despite conviction status. When pregnant and postpartum safekeepers with an opioid use disorder experience incarceration, …

Childhood-Onset Attention-Deficit/Hyperactivity Disorder Exacerbates Opioid Use Disorder Consequences: Mediation By Impulsive Phenotypes, Liam R. Browning, Ciara Cannoy, Tabitha E. H. Moses, Leslie H. Lundahl Phd, David M. Ledgerwood Phd, Mark K. Greenwald Phd

Medical Student Research Symposium

Background: Attention deficit hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes.

Aim: This cross-sectional study examines relationships between childhood ADHD (inferred as predating substance use) and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by foreshortened time perspective and drug-use impulsivity.

Methods: Individuals who report heroin use (N=214) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), …

How Has The Opioid Crisis Affected Health, Health Care Use, And Crime In The United States?, Johanna Catherine Maclean, Justine Mallatt, Christopher J. Ruhm, Kosali Simon

Population Health Research Brief Series

The U.S. opioid crisis is the deadliest drug crisis in the nation’s history and is not abating. This brief summarizes what is known about the relationships between opioid misuse, health, healthcare use, and crime. The authors show that the opioid crisis has led to worsening health, increased mortality, increased healthcare use, and modest increases in crime. In addition, the policies designed to curb opioid misuse and its associated harms have had only limited success.

Opioid Treatment Programs Can Reduce Opioid-Related Emergency Department Visits And Foster Care Placements, Lindsey Rose Bullinger, Vivian Wang, Kenneth A. Feder

Population Health Research Brief Series

The U.S. opioid epidemic has led not only to unprecedented increases in opioid overdoses, functional impairment, and deaths among adults but also harmed children. After lifting a long-standing moratorium on drug treatment programs and increasing the number of medication-assisted opioid treatment programs (OTPs), Indiana saw a decrease in emergency overdose treatments and foster care placements. This brief explores the positive effects of medication-assisted treatments on children and their caregivers and the cost savings for foster care agencies.

Which Demographic Groups And Which Places Have The Highest Drug Overdose Rates In The U.S.?, Shannon M. Monnat

Population Health Research Brief Series

Although the drug overdose crisis has affected all demographic groups and places in the United States, overdose rates are much higher in some sub-populations and places than others. This brief describes demographic and geographic differences in fatal drug overdose rates from 1999-2020. Throughout most of this period, fatal drug overdose rates were highest among young and middle-aged adult White and Native American males and middle-aged and older Black males. Rates have been consistently highest in Appalachia, but in recent years have spread throughout several regions in urban and rural areas alike. Although opioids have been the main contributor, cocaine- and …

Federal Medication-Assisted Treatment Expansion Grants Do Not Reduce Homelessness, Andrew Sullivan, Changwe Park

Population Health Research Brief Series

Medication-assisted treatment (MAT) is an evidence-based intervention that, combined with counseling and behavioral therapies, can effectively treat opioid use disorders. However, MAT is underused due to multiple barriers. To increase access to MAT, the U.S. government awarded grants to local governments and nonprofit organizations to increase and retain the number of people receiving MAT. This brief examined differences in homelessness and employment outcomes between places that received a MAT grant and those that did not. They found that these grants did not reduce homelessness or unemployment rates in the places that received funding and concluded that their effectiveness may have …

The Oxycontin® Reformulation In 2010 Increased States’ Food Insecurity Rates, Colleen Heflin, Xiaohan Sun

Population Health Research Brief Series

The massive surge in opioid misuse and overdose over the past three decades has led to major family, economic, and social disruptions in the United States. OxyContin® - a highly potent, extended-release opioid was among the most commonly-abused narcotics throughout the 2000s. After reformulating OxyContin® to make it more difficult to inhale or inject, many people with opioid use disorders switched to using street drugs. The reformulation had many other unanticipated consequences. This brief shows that states with higher initial OxyContin® misuse rates had an increase in food insecurity after OxyContin® reformulation. The authors argue that public policies must consider …

How Has The Opioid Overdose Crisis Affected Child Maltreatment In The U.S.?, Alexander Chapman

Population Health Research Brief Series

This brief summarizes results from a study examining the association between U.S. county-level opioid mortality rates and child maltreatment rates from 2007 to 2017. Places with higher opioid overdose mortality rates have higher rates of child maltreatment. Poverty makes this problem worse - where the proportion of families in poverty increases, the association between fatal opioid overdose rates and child maltreatment also increases. Findings suggest that intervening in opioid use by reducing poverty has the potential to markedly decrease the incidence of child maltreatment.

Over Two-Thirds Of Opioid Overdose Victims In Canada Were Employed Before They Died, Alexander Cheung, Joseph Marchand, Patricia Mark

Population Health Research Brief Series

As in the United States, drug overdose is the leading cause of unnatural death in Canada, with most overdoses involving opioids. The authors of this brief quantify the lost labor productivity from opioid overdoses in Canada. They show that from 2016 to 2019, over two-thirds of opioid overdose victims were working and contributing to the economy before they died, with those employed in construction, trades, and transportation having the highest opioid overdose rates. The authors argue that destigmatizing drug use, ensuring a safe supply, and improving access to medical care and take-home Naloxone kits are critical for reducing overdose deaths.

The Opioid Epidemic Has Disrupted Children’S Living Arrangements, Mónica L. Caudillo, Andres Villarreal, Philip N. Cohen

Population Health Research Brief Series

The contemporary drug overdose crisis has had profound impacts on children and families in the United States. This brief summarizes how children’s living arrangements have changed during the opioid epidemic. The authors find that opioid overdose deaths are associated with decreasing shares of children living with two married parents and increases in shares of children living with unmarried but cohabiting parents, single fathers, and adults other than their parents. These changes have been most pronounced among White children.

U.S. Counties With Higher Drug Overdose Rates Have Lower School Test Scores, Rajeev Darolia, Sam Owens, John Tyler

Population Health Research Brief Series

The impacts of the contemporary U.S. drug overdose crisis on child and family wellbeing have been profound. This brief describes the link between county-level opioid overdose rates and children’s test scores, finding that counties with higher overdose rates have lower average 3^rd and 8th-grade test scores than counties with lower overdose rates. The relationship between higher overdose rates and lower test scores is particularly strong in rural counties. The places with the highest overdose rates and lowest test scores tend to be economically-disadvantaged, suggesting that economic investments may be needed to address the issue.

Counties With Higher Prescription Opioid Presence Have Slower Student Learning Rates, Jessica Drescher, Carrie Townley-Flores

Population Health Research Brief Series

The adverse impacts of the U.S. opioid crisis have been documented in many domains, but surprisingly little attention has been directed to understanding how the opioid crisis has affected children’s educational outcomes. This brief shows that students in counties with high levels of opioid prescribing are learning more slowly over time than their peers in counties with low levels of opioid prescribing. In addition to directing more support to schools, the authors advocate for policies that address the underlying social conditions that lead to prescription opioid misuse.

The U.S. Should Increase Access To Medication For Opioid Use Disorder Among Incarcerated Individuals, Cody Nagle

Population Health Research Brief Series

Opioid Use Disorder (OUD) is among the most common medical diagnoses for people in jails and prisons. Those leaving incarceration without substance use treatment are 40 times more likely than the general public to have a fatal overdose, making it the leading cause of death for people recently released. This brief describes the use of Medication for Opioid Use Disorder (MOUD) and Medication Assisted Treatment (MAT) as realistic and legally protected approaches to reducing overdoses upon exiting incarceration. It also calls for federal regulation and guidance on the use of MOUD in prisons, jails, and drug courts to ensure each …

Counselors’ Lived Experience Treating Patients Utilizing Methadone: The Intersection Of Culture, Policy, And Stigma, Kathryn Floyd Eggert

Antioch University Dissertations & Theses

The United States continues to experience unprecedented deaths related to the opioid epidemic. Efforts to address the epidemic remain hampered by war-on-drugs policies that stigmatize people who use drugs and create barriers to accessing evidence-based treatments, particularly methadone maintenance treatments (MMT). Despite 50 years of research regarding MMT, it remains highly regulated, and arguably the most stigmatized treatment. The punitive regulatory structure of MMT remained unchanged until emergency waivers were initiated during the COVID-19 pandemic. The study used an exploratory, critical phenomenological approach to examine the intersection of culture and regulation on the lived experiences of 26 addiction counselors who …

Ptsd And Alcohol Use Disorders Predict The Pace Of Cellular Aging, Sage E. Hawn, Xiang Zhao, Mark W. Miller, Sara Wallander, Christine Govan, Anjanette Stone, Steven A. Schichman, Mark W. Logue, Erika J. Wolf

Psychology Faculty Publications

Advanced epigenetic age is associated with psychopathology and may help to explain the link between psychopathology and physical health morbidity and mortality. Using a longitudinal sample of 171 trauma-exposed Veterans, we modeled the rate of change in epigenetic age across two time points (averaging 5.58 years apart) using two epigenetic age algorithms (GrimAge and Horvath) and tested associations with posttraumatic stress disorder (PTSD), alcohol use disorder (AUD), and depression. Results showed that PTSD (β = .199) and AUD (β = .186) were associated with a quickened pace of epigenetic aging over time (ps < .021). Results replicate and extend prior work and offer foundational support for identifying interventions that slow the pace of biological aging among those with psychopathology.

Health-Related Quality Of Life And Recovery Capital Among Recovery Residents Taking Medication For Opioid Use Disorder In Texas, Elizabeth O Obekpa, Sheryl A Mccurdy, Vanessa Schick, Christine M Markham, Kathryn R Gallardo, Johnny Michael Wilkerson

Journal Articles

BACKGROUND: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL.

METHODS: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted …

Genetic Associations Between Alcohol Phenotypes And Life Satisfaction: A Genomic Structural Equation Modeling Approach, Kaitlin E. Bountress, Shannon E. Cusack, Sage E. Hawn, Andrew Grotzinger, Daniel Bustamante, Robert M. Kirkpatrick, Howard J. Edenberg, Ananda B. Amstadter

Psychology Faculty Publications

Alcohol use (i.e., quantity, frequency) and alcohol use disorder (AUD) are common, associated with adverse outcomes, and genetically-influenced. Genome-wide association studies (GWAS) identified genetic loci associated with both. AUD is positively genetically associated with psychopathology, while alcohol use (e.g., drinks per week) is negatively associated or NS related to psychopathology. We wanted to test if these genetic associations extended to life satisfaction, as there is an interest in understanding the associations between psychopathology-related traits and constructs that are not just the absence of psychopathology, but positive outcomes (e.g., well-being variables). Thus, we used Genomic Structural Equation Modeling (gSEM) to analyze …

Criterion Validity Of Protective Behavioral Strategies For Alcohol Consumption Among College Students, Abby L. Braitman, Amy Stamates, Melissa Colangelo, Sarah J. Ehlke, Jordan Ortman, Kristin E. Heron, Kate B. Carey

Psychology Faculty Publications

Background: Protective behavioral strategies (PBS), or behaviors used to reduce harm associated with alcohol use, are often associated with lower levels of alcohol consumption, lower engagement in high-risk drinking behaviors, and fewer alcohol-related consequences. Although the majority of studies have found significant associations between higher PBS use and lower consumption or consequences, some studies have found nonsignificant or even positive associations. One explanatory hypothesis is that the mixed findings are due to differential content in PBS measures. Objectives: The current study examined the criterion validity of two widely-used PBS measures, the PBSS and the SQ. In a multi-institution online …