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Background and Aims: Long‐acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder that is generating positive outcomes. Negative effects are typically mild and transient, but can occasionally be serious, resulting in treatment discontinuation/non‐adherence. This paper aims to analyse patients' accounts of how they felt during the first 72 h after initiating LAIB. Methods: Semi‐structured interviews were conducted (June 2021–March 2022) with 26 people (18 males and 8 females) who had started LAIB within the previous 72 h. Participants were recruited from treatment services in England and Wales and were interviewed by telephone using a topic guide. Interviews were audio‐recorded, transcribed and coded. The concepts of embodiment and embodied cognition framed the analyses. Data on participants' substance use, initiation onto LAIB and feelings were tabulated. Next, participants' accounts of how they felt were analysed following the stages of Iterative Categorization. Results: Participants reported complex combinations of changing negative and positive feelings. Bodily experiences included withdrawal symptoms, poor sleep, injection‐site pain/soreness, lethargy and heightened senses inducing nausea ('distressed bodies'), but also enhanced somatic wellbeing, improved sleep, better skin, increased appetite, reduced constipation and heightened senses inducing pleasure ('returning body functions'). Cognitive responses included anxiety, uncertainties and low mood/depression ('the mind in crisis') and improved mood, greater positivity and reduced craving ('feeling psychologically better'). Whereas most negative effects reported are widely recognized, the early benefits of treatment described are less well‐documented and may be an overlooked distinctive feature of LAIB. Conclusions: During the first 72 h after initiating long‐acting injectable buprenorphine, new patients report experiencing a range of interconnected positive and negative short‐term effects. Providing new patients with information about the range and nature of these effects can prepare them for what to expect and help them manage feelings and reduce anxiety. In turn, this may increase medication adherence. [ABSTRACT FROM AUTHOR]

This paper critically analyses a statement by Australia's National Health and Medical Research Council (NHMRC) on e‐cigarettes in May 2022 that will be used to guide national policy. We reviewed the evidence and the conclusions drawn in the NHMRC Statement. In our view, the Statement is not a balanced reflection of the benefits and risks of vaping because it exaggerates the risks of vaping and fails to compare them to the far greater risks of smoking; it uncritically accepts evidence of harms from e‐cigarettes while adopting a highly sceptical attitude towards evidence of their benefits; it incorrectly claims that the association between adolescent vaping and subsequent smoking is causal; and it understates the evidence of the benefits of e‐cigarettes in assisting smokers to quit. The Statement dismisses the evidence that vaping is probably already having a positive net public health effect and misapplies the precautionary principle. Several sources of evidence supporting our assessment were published after the NHMRC Statement's publication and are also referenced. The NHMRC Statement on e‐cigarettes does not present a balanced assessment of the available scientific literature and fails to meet the standard expected of a leading national scientific body. [ABSTRACT FROM AUTHOR]

Background and aims: Several reports have documented risk factors for opioid use following treatment discharge, yet few have assessed sex differences, and no study has assessed risk using contemporary machine learning approaches. The goal of the present paper was to inform treatments for opioid use disorder (OUD) by exploring individual factors for each sex that are most strongly associated with opioid use following treatment. Design Secondary analysis of Global Appraisal of Individual Needs (GAIN) database with follow‐ups at 3, 6 and 12 months post‐OUD treatment discharge, exploring demographic, psychological and behavioral variables that predict post‐treatment opioid use. Setting One hundred and thity‐seven treatment sites across the United States. Participants: Adolescents (26.9%), young adults (40.8%) and adults (32.3%) in treatment for OUD. The sample (n = 1,126) was 54.9% male, 66.1% white, 20% Hispanic, 9.8% multi‐race/ethnicity, 2.8% African American and 1.3% other. Measurement Primary outcome was latency to opioid use over 1 year following treatment admission. Results: For women, regularized Cox regression indicated that greater withdrawal symptoms [hazard ratio (HR) = 1.31], younger age (HR = 0.88), prior substance use disorder (SUD) treatment (HR = 1.11) and treatment resistance (HR = 1.11) presented the largest hazard for post‐treatment opioid use, while a random survival forest identified and ranked substance use problems [variable importance (VI) = 0.007], criminal justice involvement (VI = 0.006), younger age (VI = 0.005) and greater withdrawal symptoms (VI = 0.004) as the greatest risk factors. For men, Cox regression indicated greater conduct disorder symptoms (HR = 1.34), younger age (HR = 0.76) and multiple SUDs (HR = 1.27) were most strongly associated with post‐treatment opioid use, while a random survival forests ranked younger age (VI = 0.023), greater conduct disorder symptoms (VI = 0.010), having multiple substance use disorders (VI = 0.010) and criminal justice involvement (VI = 0.006) as the greatest risk factors. Conclusion: Risk factors for relapse to opioid use following opioid use disorder treatment appear to be, for women, greater substance use problems and withdrawal symptoms and, for men, younger age and histories of conduct disorder and multiple substance use disorder. [ABSTRACT FROM AUTHOR]

Background and aim: People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re‐evaluate risk and behaviours, reducing the incidence of HCV re‐infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care. Methods: Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings. Results: Thirty‐two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over‐arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities. Conclusions: Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care. [ABSTRACT FROM AUTHOR]

Aims: To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs and experiences. Methods: Six medical, allied health and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar and the Cochrane Library) were systematically searched in a time frame between January and April 2021 to identify original peer‐reviewed articles describing qualitative findings related to substance use among refugees (alcohol, illicit drugs, tobacco and prescription drugs). Study selection, critical appraisal and detailed extraction were performed via the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Extension for Systematic Reviews (PRISMA) (2018). Three independent reviewers selected the relevant abstracts and articles. Synthesis of the evidence identified prominent themes relating to the context and consequences of substance use. Results: Twenty‐six studies were included in this review. Twenty‐three studies applied qualitative methods and three applied mixed methods. Synthesis of the evidence from the included studies resulted in four main findings: there is a considerable susceptibility of refugees to substance use and SUDs; the harmful consequences of substance use are complicated by the social insecurities of refugees; there are rather high barriers to treatment and health facilities for refugees in many host countries; and there is a strong need to improve effective access to treatment, interventions and prevention approaches. Conclusions: Refugees are at high risk for substance use and substance use disorders and often face high barriers to treatment and interventions in host countries. [ABSTRACT FROM AUTHOR]

Background and Aims: People with mental ill health are more likely to smoke and experience smoking-related harm than those without. Switching from combustible tobacco to lower-risk nicotine-containing products may be of benefit; however, misperceptions of harm may prevent their use. We aimed to assess, among adults with and without mental ill health, (1) perceptions of harm from nicotine and relative harm and addictiveness of different nicotine-containing products and (2) sources of information associated with harm perceptions. Design: Cross-sectional study. Setting and Participants: On-line survey of adults (n = 3400) who smoke cigarettes and/or use e-cigarettes, or have recently stopped, in the United Kingdom. Measurements: Outcomes: harm perceptions of nicotine; relative perceived harm and addictiveness of different nicotine-containing products; sources of information for harm perceptions of nicotine, cigarette smoking and e-cigarettes. Demographics: sex, age, education, ethnic group and region. Other measures: self-reported smoking, vaping and mental health status. Analyses: frequencies and logistic regressions adjusting for demographic/other measures. Findings: Among those with serious mental distress (versus no/low mental distress): 9.6% [13.9%, adjusted odds ratio (aOR) = 0.69, 95% confidence interval (CI) = 0.50-0.97] correctly identified that none/a very small amount of the health risks of smoking cigarettes come from nicotine; 41.7% (53.5%, aOR = 0.67, 95% CI = 0.54-0.84) perceived e-cigarettes and 53.2% (70.3%, aOR = 0.62, 95% CI = 0.50-0.77) perceived nicotine replacement therapy to be less harmful than cigarettes; and 42.1% (51.3%, aOR = 0.77, 95% CI = 0.62-0.95) perceived e-cigarettes as being less likely than cigarettes to cause cancer, 35.4% (45.5%, aOR = 0.71, 95% CI = 0.57-0.88) heart attacks and 34.9% (42.3%, aOR = 0.80, 95% CI = 0.64-0.99) lung problems. The most popular sources of information for cigarette smoking, e-cigarettes and nicotine were scientific experts' opinions and media reports, with little variation by mental distress. Conclusions: Among adults with a history of tobacco and/or e-cigarette use, those with serious mental distress appear to have less accurate harm perceptions of nicotine and nicotine-containing products than those with no/low distress, despite reporting similar sources of information. [ABSTRACT FROM AUTHOR]

Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use. Design: Using data from the restricted-access National Survey on Drug Use and Health, Prescription Drug Abuse Policy System and the US Census, we applied two-way fixed-effects models to determine whether naloxone access laws decreased perceived risk of any heroin use or regular heroin use. We used Bayes factors (BFs) to confirm evidence for null findings. Setting: United States. Participants: A total of 884 800 respondents aged 12 and older from 2004 to 2016. Measurements: A binary indicator of whether a state implemented naloxone access laws was regressed on respondent-perceived risk of (1) any heroin use and (2) regular heroin use. Ratings of perceived risk were assessed on a scale of 1 (none) to 4 (great risk). Findings: In all instances, the BFs support evidence for the null hypothesis. Across models with three distinct specifications of naloxone access laws, we found no evidence of decreased risk perceptions, as confirmed by BFs ranging from 0.009 to 0.057. Across models of specific vulnerable subgroups, such as people who use opioids (BFs = 0.039-0.225) or young people (BFs = 0.009-0.158), we found no evidence of decreased risk perceptions. Across diverse subpopulations by gender (BFs = 0.011-0.083), socio-economic status (BFs = 0.015-0.168) or race/ethnicity (BFs = 0.016-0.094), we found no evidence of decreased risk perceptions. Conclusions: There appears to be no empirical evidence that implementation of naloxone access laws has adversely affected perceptions of risk of heroin in the broader US population or within vulnerable subgroups or diverse subpopulations. [ABSTRACT FROM AUTHOR]

Background and aims: Hepatitis C virus (HCV) treatment is essential for eliminating HCV in people who inject drugs (PWID), but has limited coverage in resource‐limited settings. We measured the cost‐effectiveness of a pilot HCV screening and treatment intervention using directly observed therapy among PWID attending harm reduction services in Nairobi, Kenya. Design We utilized an existing model of HIV and HCV transmission among current and former PWID in Nairobi to estimate the cost‐effectiveness of screening and treatment for HCV, including prevention benefits versus no screening and treatment. The cure rate of treatment and costs for screening and treatment were estimated from intervention data, while other model parameters were derived from literature. Cost‐effectiveness was evaluated over a life‐time horizon from the health‐care provider's perspective. One‐way and probabilistic sensitivity analyses were performed. Setting Nairobi, Kenya. Population PWID. Measurements Treatment costs, incremental cost‐effectiveness ratio (cost per disability‐adjusted life year averted). Findings The cost per disability‐adjusted life‐year averted for the intervention was $975, with 92.1% of the probabilistic sensitivity analyses simulations falling below the per capita gross domestic product for Kenya ($1509; commonly used as a suitable threshold for determining whether an intervention is cost‐effective). However, the intervention was not cost‐effective at the opportunity cost‐based cost‐effectiveness threshold of $647 per disability‐adjusted life‐year averted. Sensitivity analyses showed that the intervention could provide more value for money by including modelled estimates for HCV disease care costs, assuming lower drug prices ($75 instead of $728 per course) and excluding directly‐observed therapy costs. Conclusions: The current strategy of screening and treatment for hepatitis C virus (HCV) among people who inject drugs in Nairobi is likely to be highly cost‐effective with currently available cheaper drug prices, if directly‐observed therapy is not used and HCV disease care costs are accounted for. [ABSTRACT FROM AUTHOR]

Background and aims: The vaping rate among US teenagers has doubled in the last 2 years, which may be explained in part by teenagers' optimism that they would have relatively little trouble in quitting. The aim of this study was to estimate the extent to which teenagers exhibited optimism bias, what characteristics are associated with optimism bias and which factors are related to respondents' perceptions of how hard it would be for them to quit. Design A national, on‐line, cross‐sectional survey in 2018 using quota sampling. Setting: United States. Participants: Respondents were 1610 teenagers aged 14–18 years who had ever tried or heard of JUULs or e‐cigarettes generally. Measurements Optimism bias was defined as respondents' perceptions of their own difficulty quitting vaping compared with that of an average US person of their own age. Linear regression was used to examine associations between respondents' characteristics with both optimism bias and their own perceived difficulty quitting vaping. Findings More than 60% of teenagers were optimistically biased about their ability to quit vaping. Smoking (b = −0.69, P < 0.01) and JUULing (b = −0.62, P < 0.01) were negatively associated with optimism bias but reduced‐price school lunch eligibility (0.27, P = 0.02) and school satisfaction were positively associated (b = 0.05, P = 0.02). Smoking (b = 0.85, P < 0.01) was associated with an increased perception of the difficulty of quitting. That association was negative for black respondents (b = −0.81, P = 0.01) and those eligible for reduced‐priced lunches (b = −0.48, P = 0.01), and positive for Hispanic respondents (b = 0.47, P = 0.04). Conclusions: On average, US teenagers appear to show optimism bias about their ability to quit vaping, which decreases with smoking and vaping and increases with eligibility for reduced‐price school lunches. [ABSTRACT FROM AUTHOR]