Substance Use

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

Should Physicians “Prescribe” Cannabis?

Jan. 21, 2020

Over the last decade, medical cannabis has moved from the fringe to the mainstream—at least in some states. Nearly 900,000 Americans were registered cannabis patients in 2017, which is more than a ten-fold increase since 2009. By the end of 2020, over two-thirds of states and the vast majority of Americans will live in a state with legal access to either medicinal or recreational marijuana.

Offering Payment in Clinical Research: Enrolling Individuals With or at Risk for Opioid Use Disorder

Jan. 10, 2020

Candace Wickliffe, Holly Fernandez Lynch, Emily A. Largent

Abstract [from journal]

Offering payment is an important means of facilitating research participation. Yet, offers of payment raise ethical challenges that may be heightened when prospective participants suffer from or are at risk for opioid use disorder (OUD). We surveyed principal investigators (PIs) conducting research in this population to characterize the relative importance they assign to various ethical and practical factors when designing offers of payment and also analyzed descriptions of payment in both their study advertisements and consent forms. Overall, we


Hospital Financial Incentives to Improve Care After Opioid Overdose

Jan. 6, 2020

Two patients are treated for opioid overdose at two different hospitals, just a few miles apart. The first hospital provides life-saving treatment to reverse the overdose and watches the patient for an hour, discharging them when deemed “medically stable.” The second hospital also provides life-saving treatment but then offers counseling, medication to prevent recurrent overdose and treat opioid withdrawal, and assistance navigating to outpatient treatment for the next day.

Impact of the Young Adult Dependent Coverage Expansion on Opioid Overdoses and Deaths: a Quasi-Experimental Study

Kit Delgado, MD, MS
Jan. 2, 2020

Edouard Coupet Jr, Rachel M. Werner, Daniel Polsky, David Karp, M. Kit Delgado 

Abstract [from journal]

Background: Several policymakers have suggested that the Affordable Care Act (ACA) has fueled the opioid epidemic by subsidizing opioid pain medications. These claims have supported numerous efforts to repeal the ACA.

Objective: To determine the effect of the ACA's young adult dependent coverage insurance expansion on emergency department (ED) encounters and out-of-hospital deaths from opioid overdose.

Design: Difference-in-differences analyses comparing ED encounters and out-of-hospital


Exposure to Intravenous Opioids is Associated With Future Exposure to Opioids in Hospitalized Patients With Inflammatory Bowel Diseases

Shivan J. Mehta, MD, MBA
Dec. 27, 2019

Rahul S. Dalal, Sonali Palchaudhuri, Christopher K. Snider, James D. Lewis, Shivan J. Mehta, Gary R. Lichtenstein

Abstract [from journal]

Backgorund & Aims: Opioid use is associated with increased mortality in patients with inflammatory bowel diseases (IBD). Hospitalized patients with IBD often receive high-potency intravenous opioids (IVOPIs). It is not known whether exposure to IVOPIs affects post-discharge opioid use or complications. We investigated the association between inpatient administration of IVOPIs and a post-discharge opioid prescription (OPIRx) in patients with IBD.

Methods: We performed a retrospective cohort study of 862


Public Libraries as Partners in Confronting the Overdose Crisis: A Qualitative Analysis

Dec. 18, 2019

Margaret Lowenstein, Rachel Feuersteun-Simon, Risha Sheni, Roxanne Dupuis, Eliza Whiteman Kinsey, Xochitl Luna Marti, Carolyn Cannuscio

Abstract [from journal]

Background: The overdose crisis is affecting public libraries. In a 2017 survey of public librarians, half reported providing patrons support regarding substance use and mental health in the previous month, and 12% reported on-site drug overdose at their library in the previous year. Given the magnitude of the overdose crisis and the fact that public libraries host 1.4 billion visits annually, our aim was to understand how libraries currently assist with substance use and overdose and how they can further address these


The Origins of the Opioid Epidemic

Dec. 2, 2019

A state prescription drug policy first adopted in 1939, and last ended in 2004, appears to have influenced where Purdue Pharma chose to market its opioid drug OxyContin upon launch in 1996. The consequences of that decision reverberate to this day, according to a new NBER paper by LDI Senior Fellow Abby Alpert and colleagues, who estimate that states with the prescription policy had 11.4 fewer overdose deaths per 100,000 people in 2017. Let that sink in for a moment. In 2017.

Long-Term Use of Hydrocodone vs. Oxycodone in Primary Care

Dec. 1, 2019

Rebecca Arden Harris, Henry R. Kranzler, Kyong-Mi Chang, Chyke A. Doubeni, Robert Gross

Abstract [from journal]

Background: Hydrocodone and oxycodone are the Schedule II opioids most often prescribed in primary care. Notwithstanding the dangers of prescription opioid use, the likelihood of long-term use with either drug is presently unknown.

Methods: Using a retrospective cohort design and data from a commerical healthcare claims repository, we compared the likelihood of long-term use of hydrocodone and oxycodone in primary care patients presenting with acute back pain. Treatment


Online Reviews of Specialized Drug Treatment Facilities—Identifying Potential Drivers of High and Low Patient Satisfaction

Nov. 21, 2019

Anish K. Agarwal, Vivien Wong, Arthur M. Pelullo, Sharath Guntuku, Daniel Polsky, David A. Asch, Jonathan Muruako, Raina M. Merchant

Background: Despite the importance of high-quality and patient-centered substance use disorder treatment, there are no standardized ratings of specialized drug treatment facilities and their services. Online platforms offer insights into potential drivers of high and low patient experience.

Objective: We sought to analyze publicly available online review content of specialized drug treatment facilities and identify themes within high and low ratings.



When Patients Take Charge of Opioids: Self-Management Concerns and Practices Among Cancer Outpatients in the Context of Opioid Crisis

Nov. 8, 2019

Salimah H. Meghani, Jesse Wool, Jessica Davis, Katherine A. Yeager, Jun J. Mao, Frances K. Barg

Abstract [from journal]

Context: With concerns about opioid prescribing practices prominent in the professional and lay literature, there is less focus on patients’ self-management of opioids for cancer pain and potential safety risks.

Objectives: To investigate reports of opioid self-management practices and concerns among patients undergoing active cancer treatments—a group excluded from the scope of most policy initiatives on prescription opioids