Substance Use

The use or misuse of substances such as alcohol, tobacco, cannabis (marijuana), stimulants, hallucinogens, and opioids.

Medicaid Expansion Increased Use of Medications for Opioid Use Among Individuals with Criminal Justice Involvement

Apr. 5, 2021

Individuals involved in the criminal justice system have high rates of opioid use disorder (OUD), but frequently have limited options for treatment. The Affordable Care Act’s Medicaid expansion gave states the opportunity to increase coverage for individuals with criminal justice involvement, but whether that translated into increased access to OUD treatment in this population is an open question.

The Fierce Urgency of the Overdose Crisis

Mar. 30, 2021

In the past few months, we have seen what can be accomplished when the federal government marshalls its resources and mobilizes a nation to address a health crisis. While there is no vaccine for the epidemic of overdoses that has claimed more than 80,000 lives in the past year alone, we already have effective treatments for opioid use disorders and proven life-saving strategies. There is an urgent need for federal leadership to address an overdose crisis that has worsened throughout the pandemic.

Ending the Opioid and Overdose Crisis

Mar. 30, 2021

The pandemic has worsened an existing drug overdose crisis that claimed the lives of more than 81,000 people in the U.S. from May 2019-June 2020. As the Biden-Harris administration firms up and implements its proposed response to the opioid epidemic, this brief provides evidence-based recommendations to consider.

We focus our recommendations on the evidence and our experience in three areas: reducing the demand for opioids through policies that increase access to prevention, treatment, and recovery services; reducing the harms from opioid use through strategies that reduce morbidity and mortality; and reducing the supply of opioids through opioid stewardship that limits prescribing by the medical community and promotes adequate pain management. We also address the accountability of the pharmaceutical industry in contributing to the crisis and recommend ways to target settlement funds for maximal impact on the communities most affected.

Opioid Use in Pregnant Women With Mental Health-Related Disabilities

Jan. 10, 2021

Panagiota Kitsantas, Amy R. Adams, Jehanzeb Cheema, Melanie L. Kornides 

Abstract [from journal]

Purpose: The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women.

Methods: We used data from the National Survey on Drug Use and Health 2014-2017 which included 2,888 pregnant women 18 years or older. The WHODAS instrument was utilized to measure disability


Considering the Harms of Our Habits: The Reflexive Urine Drug Screen in Opioid Use Disorder Treatment

Dec. 19, 2020

Utsha G. Khatri, Shoshana V. Aronowitz

Abstract [from journal]

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain


Health Economic Design for Cost, Cost-Effectiveness and Simulation Analyses in the HEALing Communities Study

Dec. 1, 2020

Arnie P. Aldridge, Carolina Barbosa, Joshua A. Barocas, Joshua L. Bush, Jagpreet Chhatwal, Kristin J. Harlow, Ayaz Hyder, Benjamin P. Linas, Kathryn E. McCollister, Jake R. Morgan, Sean M. Murphy, Caroline Savitzky, Bruce R. Schackman, Eric E. Seiber, Laura E. Starbird, Jennifer...

Abstract [from journal]

Background: The HEALing Communities Study (HCS) is designed to implement and evaluate the Communities That HEAL (CTH) intervention, a conceptually driven framework to assist communities in selecting and adopting evidence-based practices to reduce opioid overdose deaths. The goal of the HCS is to produce generalizable information for policy makers and community stakeholders seeking to implement CTH or a similar community intervention. To support this objective, one aim of the HCS is a health economics study (HES), the


Temporal Networks of Tobacco Withdrawal Symptoms During Smoking Cessation Treatment

David Lydon Staley
Nov. 30, 2020

David M. Lydon-Staley, Adam M. Leventhal, Megan E. Piper, Robert A. Schnoll, Danielle S. Bassett

Abstract [from journal]

A recently developed network perspective on tobacco withdrawal posits that withdrawal symptoms causally influence one another across time, rather than simply being indicators of a latent syndrome. Evidence supporting a network perspective would shift the focus of tobacco withdrawal research and intervention toward studying and treating individual withdrawal symptoms and intersymptom associations. Here we construct and examine temporal tobacco withdrawal networks that describe the interplay among withdrawal symptoms across time using


Adolescent E-Cigarette Onset And Escalation: Associations With Internalizing And Externalizing Symptoms

Nov. 3, 2020

Janet Audrain-McGovern, Daniel Rodriguez, Shannon Testa, Emily Alexander, Stephen Pianin

Abstract [from journal]

Purpose: We sought to evaluate if internalizing symptoms (i.e., anxiety and depression) and/or externalizing symptoms (i.e., impulsivity, sensation seeking, and substance use) were risk factors for the onset of 30-day e-cigarette use and escalation in the number of days used across the following 30 months among adolescents.

Methods: Adolescents (N = 1,808) from public high schools outside Philadelphia, PA, completed in-classroom surveys at wave 1 (fall 2016, beginning of ninth grade) and at 6-


A Toxic Blend: Assessing The Effects Of Cross-Source Media Coverage Of Flavored E-Cigarettes On Youth And Young Adult Perceptions

Robert C. Hornik, PhD
Oct. 26, 2020

Ava Kikut, Sharon Williams, Robert Hornik

Abstract [from journal]

Flavored e-cigarettes have received high attention across social and news media. How does exposure to e-cigarette flavors across multiple sources in the media environment influence youth e-cigarette perceptions? To address this question, we identified e-cigarette flavor mentions on 24.3 million Twitter posts and 11,691 longform texts (newspapers, broadcast news, and websites) disseminated over 3 years (2014-2017). During the same period, we measured e-cigarette beliefs through a nationally representative randomly sampled rolling


These Key Telehealth Policy Changes Would Improve Buprenorphine Access While Advancing Health Equity

Sep. 17, 2020

[Original post: Utsha Khatri, Corey S. Davis, Noa Krawczyk, Michael Lynch, Justin Berk, Elizabeth A. Samuels, These Key Telehealth Policy Changes Would Improve Buprenorphine Access While Advancing Health Equity, Health Affairs Blog, September 11, 2020. Copyright ©2020 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]