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The National Institute on Drug Abuse Genetics and Epigenetics Cross‐Cutting Research Team convened a diverse group of researchers, clinicians, and healthcare providers on the campus of the University of California, San Diego, in June 2018. The goal was to develop strategies to integrate genetics and phenotypes across species to achieve a better understanding of substance use disorders through associations between genotypes and addictive behaviors. This conference (a) discussed progress in harmonizing large opioid genetics cohorts, (b) discussed phenotypes that are used for genetics studies in humans, (c) examined phenotypes that are used for genetics studies in animal models, (d) identified synergies and gaps in phenotypic analyses of human and animal models and (e) identified strategies to integrate genetics and genomics data with phenotypes across species. The meeting consisted of panels that focused on phenotype harmonization (Dr. Laura Bierut, Dr. Olivier George, Dr. Dan Larach and Dr. Sesh Mudumbai), translating genetic findings between species (Dr. Elissa Chesler, Dr. Gary Peltz and Dr. Abraham Palmer), interpreting and understanding allelic variations (Dr. Vanessa Troiani and Dr. Tamara Richards) and pathway conservation in animal models and human studies (Dr. Robert Hitzemann, Dr. Huda Akil and Dr. Laura Saba). There were also updates that were provided by large consortia (Dr. Susan Tapert, Dr. Danielle Dick, Dr. Howard Edenberg and Dr. Eric Johnson). Collectively, the conference was convened to discuss progress and changes in genome‐wide association studies. Cates et al present current gaps in the field of genetics of substance use disorders and offer insight as junior members of the field. [ABSTRACT FROM AUTHOR]

Introduction: Current WHO guidelines recommend using methadone or buprenorphine as maintenance treatments for maternal opioid use disorder. However, buprenorphine‐naloxone, with a lower abuse risk than buprenorphine monotherapy or methadone, offers a potentially beneficial alternative, but scientific evidence on its effects on pregnancies, fetuses, and newborns is scarce. This paper compares the outcomes of the pregnancies, deliveries, and newborns of women on buprenorphine‐naloxone, buprenorphine, or methadone maintenance treatments. According to the hypothesis, as a maintenance treatment, buprenorphine‐naloxone does not have more adverse effects than buprenorphine, whereas methadone is more complicated. Material and methods: In this population‐based study, 172 pregnant women on medical‐assisted treatments were followed‐up at Helsinki University Women's Hospital (Finland). Women receiving the same opioid maintenance treatment from conception to delivery and their newborns were included. Consequently, 67 mother–child dyads met the final inclusion criteria. They were divided into three groups based on their opioid pharmacotherapy. The outcomes were compared among the groups and, where applicable, with the Finnish population. Results: The buprenorphine‐naloxone and buprenorphine groups showed similar outcomes and did not significantly differ from each other in terms of maternal health during pregnancies, deliveries, or newborns. Illicit drug use during the pregnancy was common in all groups, but in the methadone group it was most common (p = 0.001). Most neonates (96%) were born full‐term with good Apgar scores. They were of relatively small birth size, with those in the methadone group tending to be the smallest. Of the neonates 63% needed pharmacological treatment for neonatal opioid withdrawal syndrome. The need was lower in the buprenorphine‐based groups than in the methadone group (p = 0.029). Conclusions: Buprenorphine‐naloxone seems to be as safe for pharmacotherapy for maternal opioid use disorder as buprenorphine monotherapy for both mother and newborn. Hence it could be a choice for oral opioid maintenance treatment during pregnancy, but larger studies are needed before changing the official recommendations. Women on methadone treatment carry multifactorial risks and require particularly cautious follow up. Furthermore, illicit drug use is common in all treatment groups and needs to be considered for all patients with opioid use disorder. [ABSTRACT FROM AUTHOR]

The use of peer interviewers with privileged access to a particular population group, which is difficult to reach via more conventional methods, has been acknowledged in recent research. This paper explores a number of key issues relating to the employment of peer interviewers by reflecting on a project designed to explore the views and experiences of parents who use illegal drugs. The project presented the research team with a number of challenges. These included the need to provide on-going support for the interviewers, a sense of distance felt by the researchers from the raw data they collected, and the difficulties of gaining from the skills and experiences of peer interviewers without exploiting their labour. The paper also explores the advantages of involving peer interviewers closely in research work and reflects on the nature and boundaries of expert knowledge that can become evident in such collaborations. The need for a certain amount of flexibility over the roles and domains of control that lay experts and researchers traditionally inhabit is suggested. In conclusion, it is argued that the involvement of peer interviewers in research can be a valuable means of enhancing our knowledge and understanding of a variety of population groups who tend to live beyond the gaze of more orthodox researchers. [ABSTRACT FROM AUTHOR]

Introduction Ukraine's volatile HIV epidemic, one of the largest in Eastern Europe and Central Asia, remains concentrated in people who inject drugs (PWID). HIV prevalence is high (21.3% to 41.8%) among the estimated 310,000 PWID. Opioid agonist therapy (OAT) is the most cost-effective HIV prevention strategy there, yet OAT services are hampered by negative attitudes and frequent harassment of OAT clients and site personnel by law enforcement. This paper examines the various types of police violence that Ukrainian PWID experience and factors associated with the different types of violence, as well as the possible implications of police harassment on OAT retention. Methods In 2014 to 2015, we conducted a cross-sectional survey in five Ukrainian cities with 1613 PWID currently, previously and never on OAT, using a combination of respondent-driven sampling, as well as random sampling. We analysed correlates of police violence by multiple factors, including by gender, and their effects on duration of OAT retention. Self-reported physical and sexual violence by police were the two primary outcomes, while retention on OAT was used as a secondary outcome. Results Overall, 1033 (64.0%) PWID reported being physically assaulted by police, which was positively correlated with currently or previously being on OAT (69.1% vs. 60.2%; p<0.01). HIV prevalence rates were higher in those receiving OAT than those not on OAT (47.6% vs. 36.1%; p<0.01). Police violence experiences differed by sex, with men experiencing significantly more physical violence, while women experienced more sexual violence (65.9% vs. 42.6%; p<0.01). For PWID who had successfully accessed OAT, longer OAT retention was significantly correlated both with sexual assault by police and fewer non-fatal overdoses. Conclusions Police violence is a frequent experience among PWID in Ukraine, particularly for those accessing OAT, an evidence-based primary and secondary HIV prevention strategy. Police violence experiences, however, were different for men and women, and interventions with police that address these sexual differences and focus on non-violent interactions with PWID to improve access and retention on OAT are crucial for improving HIV prevention and treatment goals for Ukraine. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to a critique of their paper on ethical considerations in drug addiction. The paper argued that the desire for heroin or other drugs of abuse is a normal appetitive desire. Heroin addicts are autonomous. For the paper, the authors employed a slim concept of autonomy, a person who is competent, in possession of the relevant facts making a free decision about his life.

Foster care caseloads have nearly doubled over the last three decades. Parental methamphetamine (meth) use grew significantly during the same period. While child welfare workers and law enforcement claim that parental meth use contributes to foster care growth, the evidence for a causal effect has not been determined. This paper presents the first evidence of a causal effect of meth on foster care admissions using two exogenous supply-side interventions in meth markets from the late 1990s for identification. First, we find that restrictions on meth precursor distribution caused meth use (proxied by white meth self-referred treatment cases) to decline 4.1%. Second, using two-stage least squares, we estimate a positive elasticity of foster care cases with respect to meth use of 1.54. We also estimate elasticities of 1.03 and 1.49 for cases of child neglect and parental abuse, respectively. These results suggest that child welfare policies should be designed specifically for the children of meth-using parents. [ABSTRACT FROM AUTHOR]

Methylenedioxymethamphetamine (MDMA; 'Ecstasy') is a ring-substituted amphetamine and a popular drug of abuse. In addition to ability to induce euphoria, MDMA abuse is associated with a range of acute and long-term hazardous effects. This paper is focused on once such adverse effect: its ability to negatively impact on functioning of the immune system. Research demonstrates that MDMA has immunosuppressive properties, with both innate and adaptive arms of the immune system being affected. The ability of MDMA to suppress innate immunity is indicated by impaired neutrophil phagocytosis and reduced production of dendritic cell/macrophage-derived pro-inflammatory cytokines including tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-12 and IL-15. MDMA also suppresses innate IFN-gamma production, and considering the role of IFN-gamma in priming antigen-presenting cells, it is not surprising that MDMA reduces MHC class II expression on dendritic cells and macrophages, and inhibits co-stimulatory molecule expression. Paradoxically, studies demonstrate that MDMA elicits pro-inflammatory actions in the CNS by activating microglia, the resident innate immune cells in the brain. In terms of adaptive immunity, MDMA reduces circulating lymphocyte numbers, particularly CD4(+) T-cells; suppresses T-cell proliferation; and skews cytokine production in a Th(2) direction. For the most part, the immunosuppressive effects of MDMA cannot be attributed to a direct action of the drug on immune cells, but rather due to the release of endogenous immunomodulatory substances. In this regard, peripheral beta-adrenoceptors and cholinergic receptors have been shown to mediate some immunosuppressive effects of MDMA. Finally, we discuss emerging evidence indicating that MDMA-induced immunosuppression can translate into significant health risks for abusers. [ABSTRACT FROM AUTHOR]

Background: The current effectiveness of preventative and therapeutic interventions for substance use disorders (SUDs) is less than satisfying. Progress in understanding the processes related to the onset, course, and cessation of SUDs merits top priority, given the high prevalence and the severe negative consequences. Aims: This position paper, after summarizing major factors related to onset and cessation processes, discusses the possible role of cognitive-control dysfunctions in the complex interaction between mechanisms of change (mediators) and risk factors (moderators). Findings: In past decades, research has expanded our knowledge about the impact of SUDs on human behaviour. Formal interventions are effective, but there is limited information about the mechanisms responsible for change during the onset and cessation of SUDs and for individual differences related to them. Preliminary results suggest that impairments in higher order control functions play a role in SUDs. Conclusions: Deficiencies in our understanding of behaviour-change processes during the onset and cessation of SUDs require that research have a different focus. A better understanding of the relevance of impairments in executive-control functions might help to improve formal preventative and therapeutic interventions and social conditions. Such interventions might reduce the chances that a SUD will develop or increase the likelihood of recovery from it. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Truancy is a serious concern that affects most school districts in the United States; however, we do not have accurate estimates of the prevalence of truancy due to inconsistent tracking and reporting practices of schools. As a result, our best current estimates of the national state of truancy may be from self-reported data. In this article, the first objective is to present the prevalence of self-reported recent truancy (ie, truancy within the past 4 weeks) among 8th and 10th grade students. The second objective is to explore associations between recent truant behavior, demographic and family characteristics, school-related risk factors, and drug use. Methods: The 2003 wave of the Monitoring the Future data was analyzed. Logistic regression analysis was used to assess the association between many potential predictors and the probability of recent truancy. Results: Nearly, 11% of 8th graders and over 16% of 10th graders reported recent truancy. Among the most salient predictors of recent truancy were parental education, having large amounts of unsupervised time after school, school disengagement variables (eg, poor grades and low educational aspirations), and drug use. Conclusions: Truancy is a common behavior among adolescents and can have potentially deleterious effects. This paper offers insight into the types of students who may be prone to skipping school and suggests potential target audiences for truancy prevention initiatives. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to advance the methodology for studying service assessment by comparing self-report and agency-generated methods. This study compares 30-day self-reported service use for homeless individuals (N = 229) randomly recruited from a single urban environment (St Louis, Missouri) with similar data collected from a broad array of service agencies providing homeless, substance abuse and outpatient mental health services across the same environment. Comparisons were made between self-report and agency-based data on shelter use, outpatient mental health service use (case management, psychiatric treatment, group therapy), outpatient substance abuse service use (case management, counselling, group therapy) and drop-in/day treatment use. Consistently low levels of kappa scores (all under 0.4) and correlation coefficients (only shelter use demonstrated significant agreement) were found. Findings demonstrated that the two methods of collecting service data are generally not concordant at the individual level. Certain demographic characteristics (increased age, being male, non-white ethnicity) and diagnoses (cocaine abuse/dependence, mania, schizophrenia) were associated with decreased reliability between the two methods of data collection. The two methods of assessment appeared to capture overlapping but not identical information. Each method of assessment has different utility to researchers and providers wishing to assess service use. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article criticizes a paper offering the argument that the addiction-as-compulsion view is false. While there is evidence that addicts retain a scope of choice and action, the dominant view implies that they have impaired autonomy. Addicts often claim that they use against their will. There is evidence that breaking an addiction is difficult and that addicts tend to destroy their lives and the lives of their loved ones.

Buprenorphine and methadone are the two established substitution drugs licensed in many countries for the treatment of opioid dependence. Little is known, however, about how these two drugs are applied and how they work in clinical practice. In this paper we present the aims, methods, design and sampling issues of a collaborative multi-stage epidemiological study (COBRA) to address these issues. Based on a nationally representative sample of substitution physicians, the study is designed as an observational, naturalistic study, consisting of three major parts. The first part was a national survey of substitution doctors (prestudy, n = 379 doctors). The second part was a cross-sectional study (n = 223 doctors), which consisted of a target-week assessment of 2m694 consecutive patients to determine (a) the severity and problem profiles and treatment targets; (b) the choice and dosage scheme of the substitution drug; (c) past and current interventions, including treatment of comorbid hepatitis C; and (d) cross-sectional differences between the two drugs with regard to comorbidity, clinical course, acceptance/compliance and social integration. The third part consists of a prospective-longitudinal cohort study of 48 methadone-treated and 48 buprenorphine-treated patients. The cohort is followed up over a period of 12 months to investigate whether course and outcome of the patients differ by type or treatment received in terms of clinical, psychosocial, pharmaco-economic and other related measures. The response rate among substitution doctors was 57.1%; that among eligible patients was 71.7%. Comparisons with the federal registers reveal that the final samples of doctors and patients may be considered nationally representative with regard to regional distribution, training, type of setting as well as the frequency of patients treated with buprenorphine or methadone. The COBRA study provides a unique comprehensive database, informing about the natural allocation and intervention processes in routine care and about the course and outcome of patients treated with buprenorphine or methadone. [ABSTRACT FROM AUTHOR]

Although research has examined the corruptive influences of undercover drug operations on agents (Girodo 1991b; Manning and Reddlinger 1977, 1978), it has not examined the processes by which these influences can be neutralized. In this paper, I address, these neutralization processes through a typology of routine and nonroutine drug-use evasion tactics. Routine tactics involve excuses based on greed, business constraints, and role obligations (occupational, legal, arid interpersonal). Nonroutine tactics involve two components; reverse accusation and simulation. Discussion focuses on excuses where I provide a dramaturgical interpretation that accentuates their deceptive and fraudulent nature, unlike traditional interpretations (e.g., Scott and Lyman 1968) which highlight their role as a reparative technique and aligning action (Margolin 1990). Data were drawn from ethnographic interviews with 35 light undercover narcotics agents located in a moderate-sized midwestern municipality. [ABSTRACT FROM AUTHOR]

We provide an introduction into a highly important research area for the improvement of preventive and therapeutic measures in the field of substance use disorders: a better understanding of core mediators and moderators of change processes, especially during critical phases like onset, progression, cessation and relapse. Based on a brief description of 12 papers on related projects we detail relevant research issues like the role of impaired cognitive control functions or the narrow “window of opportunity” for early interventions during adolescence. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]