Emergence of Medetomidine in the Unregulated Drug Supply and Its Association With Hallucinogenic Effects.

Introduction: The unregulated drug supply in the United States is rapidly evolving, and veterinary tranquillisers have emerged as adulterants of concern, especially in illicitly-manufactured fentanyl. Following the proliferation of xylazine, medetomidine, a more potent sedative, has recently appeared in multiple US states. This study describes the characteristics of medetomidine samples from a national mail-based drug checking program and aims to determine whether medetomidine is associated with hallucinogenic effects.

A chain of survival for drug overdose.

Drug overdose is a leading global cause of preventable morbidity and mortality and is closely associated with out-of-hospital cardiac arrest. While the American Heart Association's "chain of survival" has improved outcomes in traditional cardiac arrest, it does not address the unique characteristics and challenges of overdose-related emergencies. In this article, we propose a novel "overdose chain of survival" to emphasize the importance of linking acute care with long-term prevention.

Xylazine and fentanyl co-administration delays wound healing in mice.

Xylazine, a veterinary sedative increasingly found in the unregulated drug supply, is associated with severe skin wounds in humans, particularly when co-used with fentanyl. Despite growing concern, the mechanisms underlying these wounds remain unclear. To investigate how xylazine and fentanyl affect wound healing, we administered subcutaneous injections of saline, xylazine (3.

Sharing Antivaping Social Media Messages.

Purpose: Positive vaping portrayals and marketing from influencers receive billions of views on visual-based social media. Strategies are needed to counter these appeals and encourage sharing about health harms.

Methods: We recruited 712 US young adults (ages 18-25 years) through Cloud Research for our between-persons experiment.

Evaluating Algorithmic Approaches to Uncover Racial, Ethnic, and Gender Disparities in Scientific Authorship.

To explore the capabilities of race/ethnicity and gender prediction algorithms in uncovering patterns of authorship distribution in scientific paper submissions to a major peer-reviewed scientific journal (), we analyzed 17 667 manuscript submissions from the United States between 2013 and 2022. We used machine-learning algorithms to predict corresponding authors' race/ethnicity (Asian, Black, Hispanic, White) and gender categories based on name-derived probabilities to compare the predictive performance of these algorithms and their impact on disparity analysis. Predicted White authors dominated submissions and had the highest acceptance rates (21.

Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time-Series Study, North Carolina, 2014-2019.

Purpose: Impact of policies limiting opioid prescribing for acute and post-surgical pain among racially minoritized populations is not well understood. We evaluated the impact of two North Carolina (NC) policies on outpatient opioid prescribing among injury and surgical patients by race, ethnicity, age, and sex.

Methods: We conducted controlled and single series interrupted time series using electronic health data from two integrated healthcare systems in NC, among > 11 years-old patients having acute injuries and surgery between April 2014 and December 2019.

Social media prompts to encourage intervening with cancer treatment misinformation.

Misinformation about false and potentially harmful cancer treatments and cures are shared widely on social media. Strategies to encourage the cancer community to prosocially intervene, by flagging and reporting false posts, are needed to reduce cancer treatment misinformation. Automated prompts encouraging flagging of misinformation are a promising approach to increase intervening.

Young People Are Willing to Intervene Against Rape Myths Online: A Simulated Social Media Experiment.

Purpose: Social media present opportunities to intervene on harmful rape myth beliefs among adolescents and young adults, such as through digital bystander intervention.

Methods: We conducted a digital experiment to examine young peoples' willingness to intervene on rape myth comments in a simulated social media environment. Participants were adolescents and young adults (n = 712) aged 18-25 years (M = 22.

Designing Positive Psychology Interventions for Social Media: Cross-Sectional Web-Based Experiment With Young Adults With Cancer.

Background: Young adults (ages 18-39 years) with cancer face unique risks for negative psychosocial outcomes. These risks could be lessened with positive psychology interventions adapted for social media if intervention messages encourage intentions to do the activities and positive message reactions and if young adults with cancer perceive few downsides.

Objective: This study aimed to assess whether social media messages from evidence-based positive psychology interventions encouraged intentions to do the intervention activities and intended positive message reactions, overall and among sociodemographic or cancer characteristic subgroups.

Death ORACL: An Algorithm to Predict Death Using Insurance Claims Data.

The inability to identify dates of death in insurance claims data is the United States is a major limitation to retrospective claims-based research. While deaths result in disenrollment, disenrollment can also occur due to changes in insurance providers. We created an algorithm to differentiate between disenrollment from health plans due to death and disenrollment for other reasons.

Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina.

Introduction: Opioid agonist treatment (OAT) is the only treatment for opioid use disorder (OUD) proven to reduce overdose mortality, yet access to this evidence-based treatment remains poor. The purpose of this cross-sectional audit study was to assess OAT availability at residential substance use services in North Carolina.

Methods: We conducted a state-wide inventory of residential substance use service providers in North Carolina and subsequently called all providers identified, posing as uninsured persons who use heroin, seeking treatment services.

Abuse-deterrent formulations and opioid-related harms in North Carolina, 2010-2018.

Abuse-deterrent formulations of opioid analgesics (ADFs) were introduced to reduce opioid-related harms among pain patients, but postmarketing study results have been mixed. However, these studies may be subject to bias from selection criteria, comparator choice, and potential confounding by "indication," highlighting the need for thorough study design considerations. In a sample of privately insured patients prescribed ADF or non-ADF extended-release/long-acting (ER/LA) opioids in North Carolina, we implemented a version of the prevalent new-user design to evaluate the relationship between ADFs and opioid use disorder (OUD, n = 235) and opioid overdose (n = 18) through 6 months of follow-up using inverse probability-weighted cumulative incidence functions and Fine-Gray models.

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to opioid antagonism.

Xylazine is in the unregulated drug supply at increasing rates, usually combined with fentanyl, necessitating understanding of its pharmacology. Despite commentary from politicians, and public health officials, it is unknown how xylazine impacts naloxone efficacy, and. few studies have examined it alone.

"Cookbook medicine": Exploring the impact of opioid prescribing limits legislation on clinical practice and patient experiences.

Opioid dependence and overdose are serious public health concerns. States have responded by enacting legislation regulating opioid-prescribing practices. Through in-depth interviews with clinicians, state officials, and organizational stakeholders, this paper examines opioid prescribing limits legislation (PLL) in North Carolina and how it impacts clinical practice.

Matching study design to prescribing intention: The prevalent new-user design for studying abuse-deterrent formulations of opioids.

Purpose: In drug studies, research designs requiring no prior exposure to certain drug classes may restrict important populations. Since abuse-deterrent formulations (ADF) of opioids are routinely prescribed after other opioids, choice of study design, identification of appropriate comparators, and addressing confounding by "indication" are important considerations in ADF post-marketing studies.

Methods: In a retrospective cohort study using claims data (2006-2018) from a North Carolina private insurer [NC claims] and Merative MarketScan [MarketScan], we identified patients (18-64 years old) initiating ADF or non-ADF extended-release/long-acting (ER/LA) opioids.

Higher First 30-Day Dose of Buprenorphine for Opioid Use Disorder Treatment Is Associated With Decreased Mortality.

Objective: Buprenorphine is a medication for opioid use disorder that reduces mortality. This study aims to investigate the less well-understood relationship between the dose in the early stages of treatment and the subsequent risk of death.

Methods: We used Kentucky prescription monitoring data to identify adult Kentucky residents initiating transmucosal buprenorphine medication for opioid use disorder (January 2017 to November 2019).

Naloxone Accessibility by Standing Order in North Carolina Community Pharmacies.

Background: According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.

Objective: The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC.

Methods: A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023.

Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services.

Background: Overdose deaths involving stimulants and opioids simultaneously have raised the specter of widespread contamination of the stimulant supply with fentanyl.

Methods: We quantified prevalence of fentanyl in street methamphetamine and cocaine, stratified by crystalline texture, analyzing samples sent voluntarily to a public mail-in drug checking service (May 2021-June 2023). Samples from 77 harm reduction programs and clinics originated in 25 US states.

Medications for Opioid Use Disorder and Mortality and Hospitalization Among People With Opioid Use-related Infections.

Background: Severe skin and soft tissue infections related to injection drug use have increased in concordance with a shift to heroin and illicitly manufactured fentanyl. Opioid agonist therapy medications (methadone and buprenorphine) may improve long-term outcomes by reducing injection drug use. We aimed to examine the association of medication use with mortality among people with opioid use-related skin or soft tissue infections.

Reducing the harms of xylazine: clinical approaches, research deficits, and public health context.

Objectives: Xylazine has emerged as a consistent part of the unregulated drug supply in recent months. We discuss major domains of xylazine's harm, current knowledge deficits, clinical and harm reduction strategies for minimizing harm, and xylazine's public health and policy context. As an interdisciplinary team from across the USA, we have pooled our knowledge to provide an overview of xylazine's current and emerging contexts.

Drugs involved in Kentucky drug poisoning deaths and relation with antecedent controlled substance prescription dispensing.

Background: The shift from prescription to illicit drugs involved in drug poisoning deaths raises questions about the current utility of prescription drug monitoring program (PDMP) data to inform drug poisoning (overdose) prevention efforts. In this study, we describe relations between specific drugs involved in Kentucky drug poisoning deaths and antecedent controlled substance (CS) dispensing.

Methods: The study used linked death certificates and PDMP data for 2,248 Kentucky resident drug poisoning deaths in 2021.