Caron

Objective The study examined the relationship between pain and craving in the daily lives of patients in residential treatment for prescription opioid use disorder (OUD) and the extent to which the contemporaneous assessment-level association between pain and craving was moderated by individuals’ average pain levels. Methods Participants (n = 73; 33% female, Mage = 30.10) in residential treatment for prescription opioid use disorder were prompted 4 times per day to complete smartphone-based assessments of pain and craving for 12 consecutive days. Using multilevel modeling, we examined the associations of assessment-level craving with assessment-, day-, and person-level pain and the moderation of the assessment-level association by person-level pain. Results There was a significant association between assessment-level pain and craving (B = 0.01, β = 0.12, p < 0.05), controlling for age, biological sex, the day of the study (time in treatment), the time of the day the survey was administered, and whether the participant was treated for chronic pain during the study. During assessments, when participants experienced higher-than-usual pain, they also experienced higher craving on average. Conclusions These results indicate that the experience of higher-than-usual pain, regardless of individual patients’ usual pain levels, is linked to higher contemporaneous craving. This finding supports the importance of assessing and managing pain in the prescription OUD patient’s early treatment experience to help reduce craving and its role in return to illicit use.

BackgroundDespite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment.MethodThis preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2–19), and following (Study Days 20–21) residential treatment.DiscussionThis manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. Trial registration: ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728.Protocol Version10 May 2023

Scholarly activity among family medicine physicians is an important element of military medical readiness, both in terms of required scholarship during training and ongoing scholarship to address ongoing and emergent operational medical threats. Most literature on barriers to scholarly activity are limited to training programs and lack an important element in overcoming barriers-their priority to physicians. This study seeks to address these gaps by identifying prioritized research training needs of military family medicine physicians at all levels of training and practice. An institutional review board (IRB)-approved, cross-sectional, online survey was conducted from January 22, 2019, to February 7, 2020, using a modified version of the Hennessy-Hicks Training Needs Analysis Questionnaire. Respondents ranked their perceived level of skill and need for training for 20 literature-based elements of research success. They also self-identified research experience, level of training, and service membership. One-way analysis of variance to 95% CI was used to compare differences in self-reported research experience, number of peer-reviewed publications, number of external grants, and number of IRB protocols among services (Army, Navy, and Air Force), primary roles (resident, faculty, clinician, and leadership), and gender. Chi-squared tests were used to compare proportional differences, also to 95% CI. Of 124 respondents, most were members of the Air Force (46%), Navy (24%), or Army (13%), serving in clinician (40%) or faculty (32%) roles. Most respondents (67%) reported three or fewer publications and had never been a primary investigator or co-investigator on an external grant. Of the 34 respondents who identified as a faculty at some point in their career, 26 (77%) reported two or more peer-reviewed publications, and 20 (59%) had fewer than six publications. The faculty had significantly more research experience and peer-reviewed publications than residents, clinicians, or leaders (3.92 vs 2.19, 2.24, and 3.40, respectively, P < .001, η2 = 0.22; 5.11 vs 1.13, 2.12, and 4.33, respectively, P < .001, η2 = 0.25). Gender differences in priority ranking were found, but each gender identified the same top three training needs. Among the top 10 training needs for scholarly activity for military family medicine physicians, 7 may be addressed with specific training modules: (1) obtaining funding/grants for research, (2) accessing research resources (e.g., research administrators and other staff, information, equipment, money, and time), (3) establishing a relationship with research mentors, (4) undertaking health promotion studies, (5) designing a research study, (6) writing reports of your research studies, and (7) using technical equipment, including computer software, to find and organize published research or prepare manuscripts. Knowledge of military family medicine physicians' prioritized research training needs enables a focused approach to support an essential component of military medical readiness: primary care scholarship. Addressing these needs may begin with raising awareness of military primary care research network resources. Furthermore, a coordinated effort to develop specific training modules to address needs and ongoing research to identify, target training by audience need, and prioritize needs as they change over time are indicated to ensure that military family medicine physicians maintain and develop a flourishing culture of scholarly engagement.

Estimates of comorbidity of SUD and ADHD in addiction treatment settings range from 30% to 50%.1,2 The Schedule II psychostimulant medications, methylphenidate and dextroamphetamine, generally considered to be safe and effective in treating ADHD in adolescent patients, 4 may be risky for an SUD population since individuals with SUD may have a higher likelihood of abusing or diverting the medications. 17 One hunderd sixty-two adolescent patients admitted to a residential addictions treatment program were administered a structured interview concerning ADHD and psychostimulant abuse as part of the clinical psychological evaluation administered by the staff psychologist. Results indicate 31% of patientshave current ADHD diagnosis and 20% reported illicit diversion of Schedule II medication. One-third of entire adolescent patient population reported prior psychostimulant abuse. Re-sults are discussed in terms of appropriate treatment for adolescents with co-occurring substance abuse or dependence and ADHD.