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Objective: Recent research has helped to develop a more detailed understanding of many functional neurologic disorders. The aim of this study was to increase our knowledge of functional visual loss and to compare the findings with those of other functional syndromes., Design: Prospective and retrospective observational cohort study., Methods: This study took place at neuro-ophthalmology clinics at 3 major hospitals in London, United Kingdom, over a 12-month period. The study population consisted of 157 participants, 100 with functional visual loss, 21 pathologic control subjects with organic visual loss, and 36 healthy nonpathologic control subjects. All participants had their diagnosis confirmed with a full neuro-ophthalmic examination, neuroimaging, and visual electrophysiology. A full assessment of all participants' medical history was obtained from their general practitioner, and all participants completed a series of questionnaires assessing relevant associations., Results: Data were obtained on 157 participants, 100 with functional visual loss, 21 pathologic control subjects with organic visual loss, and 36 healthy nonpathologic control subjects. Participants with functional visual loss were typically female (74%) with a mean age at vision loss of 40.0 ± 16 years. Sixty-four percent of participants had bilateral vision loss; the remainder, unilateral loss. Twenty-six percent of the total cohort had organic visual loss with functional overlay. Fifty percent of participants with functional visual loss had a preexisting psychiatric diagnosis, the most common being a depressive disorder. Sixty-two percent of participants had an ocular history, and 87% had a previously diagnosed medical illness, most commonly neurologic (45%). Thirty-five percent of participants self-reported at least 1 additional functional symptom., Conclusions: Our population of functional visual loss subjects shares many similarities with the majority of patients with other functional neurologic disorders. They are generally young and female and have a greater than expected rate of psychiatric, medical, and coexisting ocular conditions. We found increased rates of precipitating stressors, clinical depression, and organic eye problems in subjects with functional visual loss., Competing Interests: Footnotes and Disclosure All the authors contributed equally to this work. The authors have no proprietary or commercial interest in any materials discussed in this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background: Evidence suggests that women with breast cancer diagnosed during pregnancy (PrBC) and within 2 years of delivery (PPBC) have similar survival compared to women diagnosed not near pregnancy if adjusted for stage and subtype. To investigate whether this is true for all subtypes and for both pregnancy and post-delivery periods, we examined clinicopathologic features and survival in women with breast cancer by trimesters and 6-month post-delivery intervals., Materials and Methods: Women diagnosed with invasive breast cancer during 1992-2018 at ages 18-44 years were identified in the Swedish Cancer Register, with information on childbirths from the Swedish Multi-Generation Register and clinical data from Breast Cancer Quality Registers. Each woman with PrBC or PPBC was matched 1 : 2 by age and year to comparators diagnosed with breast cancer not near pregnancy. Distributions of stage, grade, and surrogate subtypes were compared. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for breast cancer mortality were estimated using Cox regression., Results: We identified 1430 women with PrBC and PPBC (181 during pregnancy, 499 during the first and 750 during the second year after delivery). Compared to 2860 comparators, women with PrBC and PPBC in the first year after delivery had a significantly higher proportion of luminal human epidermal growth factor receptor 2 (HER2)-positive, HER2-positive and triple-negative tumours, and more advanced stage at diagnosis. After adjustment for age, year, parity, country of birth, hospital region, subtype, and stage, women diagnosed during the second trimester had a worse prognosis than matched comparators (HR 1.8, 95% CI: 1.0-3.2)., Conclusions: Women diagnosed during pregnancy or within the first year after delivery have a worse prognosis than women diagnosed not near pregnancy due to adverse tumour biology and advanced stage at diagnosis. A worse prognosis for women diagnosed during the second trimester remained after multivariable adjustment, possibly reflecting difficulties to provide optimal treatment during ongoing pregnancy., Competing Interests: Disclosure The authors have declared no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: To assess the effectiveness and cost-effectiveness of buprenorphine and methadone treatment in the U.S. if exemptions expanding coverage for substance use disorder services via telehealth and allowing opioid treatment programs to supply a greater number of take-home doses of medications for opioid use disorder (OUD) continue (Notice of Proposed Rule Making, NPRM)., Design Setting and Participants: Model-based analysis of buprenorphine and methadone treatment for a cohort of 100,000 individuals with OUD, varying treatment retention and overdose risk among individuals receiving and not receiving methadone treatment compared to the status quo (no NPRM)., Intervention: Buprenorphine and methadone treatment under NPRM., Measurements: Fatal and nonfatal overdoses and deaths over five years, discounted lifetime per person QALYs and costs., Findings: For buprenorphine treatment under the status quo, 1.21 QALYs are gained at a cost of $19,200/QALY gained compared to no treatment; with 20% higher treatment retention, 1.28 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment, and the strategy dominates the status quo. For methadone treatment under the status quo, 1.11 QALYs are gained at a cost of $17,900/QALY gained compared to no treatment. In all scenarios, methadone provision cost less than $20,000/QALY gained compared to no treatment, and less than $50,000/QALY gained compared to status quo methadone treatment., Conclusions: Buprenorphine and methadone OUD treatment under NPRM are likely to be effective and cost-effective. Increases in overdose risk with take-home methadone would reduce health benefits. Clinical and technological strategies could mitigate this risk., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: To assess the effectiveness and cost-effectiveness of office-based buprenorphine treatment (OBBT) in the U.S., Design Setting and Participants: We performed a model-based analysis of buprenorphine treatment provided in a primary care setting for the U.S. population with OUD., Intervention: Buprenorphine treatment provided in a primary care setting., Measurements: Fatal and nonfatal overdoses and deaths over five years, discounted lifetime quality-adjusted life years (QALYs), costs., Findings: For a cohort of 100,000 untreated individuals who enter OBBT, approximately 9350 overdoses would be averted over five years; of these, approximately 900 would have been fatal. OBBT compared to no treatment would yield 1.07 incremental lifetime QALYs per person at an incremental cost of $17,000 per QALY gained when using a healthcare perspective. If OBBT is half as effective and twice as expensive as assumed in the base case, the incremental cost when using a healthcare perspective is $25,500 per QALY gained. Using a limited societal perspective that additionally includes patient costs and criminal justice costs, OBBT is cost-saving compared to no treatment even under pessimistic assumptions about efficacy and cost., Conclusions: Expansion of OBBT would be highly cost-effective compared to no treatment when considered from a healthcare perspective, and cost-saving when reduced criminal justice costs are included. Given the continuing opioid crisis in the U.S., expansion of this care option should be a high priority., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of interests KH has been supported by the Esther Ting Memorial Professorship at Stanford University School of Medicine and research grants from the US Veterans Administration Health Services Research and Development Service (RCS 04-141-3, HX-12-001, and HX002714-01A2), the US National Institute on Drug Abuse (3UG1 DA015815-17S4 and 2UG1DA015815-19), the US Food and Drug Administration, Wu Tsai Neurosciences Institute, the Silicon Valley Community Foundation, the County of Santa Clara California, and the American Board of Family Medicine. He has received speaking honoraria and travel expenses from the American College of Medical Toxicology, Arizona State University, Barclays Bank, Caron Foundation, the University of Florida, the New York Museum of Modern Art, Syracuse University, West Virginia University School of Medicine, and the West Virginia Medical Professionals Health Program. He has received writing honoraria or royalties from the Association of Psychological Science, American Academy of Political and Social Science, Brookings Institution, Cambridge University Press, and Washington Monthly. He has been a paid consultant to AELIS Pharma, Harvard Medical School, and Harvard University Press. CLS has been employed by Stanford University, the University of California, Los Angeles (UCLA), the Los Angeles County Department of Public Health, Heluna Health, and the Los Angeles LGBT Center. She has received research funding or stipends from the US National Institute on Drug Abuse (K01DA050771, T32DA035165), the RAND Opioid Policy Tools and Information Center), Wu Tsai Neurosciences Institute, and UCLA David Geffen School of Medicine, and speaking honoraria or travel expenses from Emory University, New York University, UCLA, the University of North Carolina at Chapel Hill, the University of Southern California, the University of Pittsburgh, the University of Chicago, the University of Western Ontario, the Nevada State Medical Association, RAND, the University of California, Irvine, the US Centers for Disease Control and Prevention, College on Problems of Drug Dependence, the Conference on Retroviruses and Opportunistic Infections, HIV Research for Prevention, Addiction Health Services Research, and the American Psychopathological Association. CMA has been supported by the Arnold School of Public Health at the University of South Carolina, and by research grants from the US National Institute on Drug Abuse (R01DA034634, K01DA041628, U2CDA050097, R01DA049776, and R01DA052425), the US National Institute on Alcoholism and Alcohol Abuse (R01AA029097 and R01AA029821), and the South Carolina Department of Alcohol and Other Drug Abuse Services, and has been a paid consultant to the Robert Wood Johnson Foundation, RTI International, the Medical University of South Carolina, the State of Pennsylvania Department of Public Health, and the State of Illinois Division of Health Care and Family Services. ASBB has been supported by grants from the US National Institutes for Health (R01 DA045705), the US Veterans Health Administration (IIR 13-322 and C19 21-278), the US Centers for Disease Control and Prevention (U01CE002780), Blue Cross Blue Shield of Michigan, the US Department of Defense, the Patient-Centered Outcomes Research Institute, the Michigan Health Endowment Fund, and the Substance Abuse and Mental Health Services Administration via sub-contracts from the Michigan Department of Health and Human Services, has received speaker honoraria or travel expenses from the Illinois Health and Hospital Association, the International Summit on Suicide Research, the Washington State Department of Labor & Industries, the American Psychopathological Association, and the High Intensity Drug Trafficking Area program, has been paid as a consultant by New York University, and has received products from Fitbit at a reduced cost and Headspace for free for research purposes. MLB has been supported by research grants from the US Department of Veterans Affairs and the US National Institute on Drug Abuse (R37-DA15612), and a Koret Foundation gift for Smart Cities and Digital Living, has received travel expenses from the University of Maryland, the University of Auckland, Massachusetts Institute of Technology, the European Working Group on Stochastic Modeling, INSEAD, the University of Michigan, and the University of Oklahoma, and has been a paid consultant to Compass Lexecon and DE Shaw. JPC has received a National Science Foundation EAGER Grant on Detecting and Disrupting Illicit Supply Networks via Traffic Distribution Systems, is a consultant to the RAND Corporation's Drug Policy Research Center, has consulted with or received honoraria from the Actis—Norwegian Policy Network on Alcohol and Drugs, the Arnold Foundation, Bank of Montreal, Boston University, the Foreign Affairs, Justice Research and Statistics Association, Lisbon Addictions Conference, Massachusetts Institute of Technology, National Affairs, the National Institute of Justice, Oxford University Press, Pew, PIRE, the Russell Sage Foundation, Springer Verlag, Stanford University, the US State Department, Texas Research Society on Alcoholism, the US Veteran's Administration, Washington Monthly, and the WT Grant Foundation. JHC has received research support or funding from the US National Institutes of Health and National Library of Medicine (R56LM013365), the Gordon and Betty Moore Foundation (GBMF8040), the US National Science Foundation (SPO181514); Google (SPO13604), the Stanford Clinical Excellence Research Center, the Stanford Department of Medicine and Department of Pathology, and the Stanford Aging and Ethnogeriatrics Research Center (P30AG059307), which is part of the Resource Centers for Minority Aging Research programme led by the US National Institute on Aging at the National Institutes of Health, is the co-founder of Reaction Explorer (which develops and licenses organic chemistry education software), and has been paid consulting or speaker fees by the US National Institute of Drug Abuse Clinical Trials Network, Tuolc, Roche, and Younker Hyde MacFarlane. M-FC has served as president of the Carnegie Endowment for International Peace, a justice of the Supreme Court of California, the Herman Phleger Professor at Stanford Law School, a distinguished visiting jurist at the New York University School of Law, the Castle Distinguished Lecturer in Ethics, Politics, and Economics at Yale University, a member of the President & Fellows of Harvard College (the Harvard Corporation), a member of the board of directors of the William and Flora Hewlett Foundation, a member of the Council of the American Law Institute, chair of the board of directors of the Center for Advanced Study in the Behavioral Sciences, chair of the advisory board of the Seed Initiative at the Stanford Graduate School of Business, and a member of the advisory board at the Stanford Human-Centered Artificial Intelligence Institute. His work has been supported by Stanford Law School and by a grant from the Stanford Human-Centered Artificial Intelligence Institute, and he was previously chair of the advisory board of the AI Now Institute at New York University. YLH has received research grants from the US National Institute on Drug Abuse (DA050323, DA048613, DA008227, DA043247, DA030359, DA037317, and DA15446), research funding from GW Pharmaceuticals, speaking honoraria or travel expenses, or both, from the University of North Carolina, the American Society for the Advancement of Science, the Society for Neuroscience Public Education & Communication Committee, Washington University in St Louis, Temple University, Tufts School of Medicine, Indiana University, the American College of Neuropsychopharmacology, the Iowa Neuroscience Institute, the Franklin Institute, State University of New York Upstate Medical University, the Canadian Consortium for the Investigation of Cannabinoids, the University of Michigan, Cold Spring Harbor Laboratory, the US National Institutes of Health, Penn State Hershey College of Medicine, the US National Academy of Medicine, the Mediterranean Neuroscience Society, the Wu Tsai Neurosciences Institute, Society of Biological Psychiatry, International College of Neuropharmacology, the Federation of European Neuroscience Societies, Gordon Research Conference, the National Institutes of Health Center for Scientific Research Council, and the Society of Neuroscience. DNJ has received research grants from the Canadian Institutes for Health Research and the Ontario Ministry of Health, financial support from the departments of medicine at both the University of Toronto and Sunnybrook Health Sciences Centre, travel expenses or speaking honoraria from Dalhousie University, the University of Ottawa, the University of Saskatchewan, the University of Calgary, the Bloomberg Johns Hopkins School of Public Health, the American College of Physicians, the University of Alabama at Birmingham, the American Society of Nephrology, the Canadian Society of Internal Medicine, the Canadian Anesthesiologists' Society, The Canadian Society of Obstetricians and Gynecologists, the Western Canada Addiction Forum, and the Canadian House of Commons Standing Committee on Health, and payment for expert witness testimony from (and has been retained by) Sanis, a generic drug manufacturer and distributor to provide advice related to an ongoing Canadian class action, and is a volunteer member of Physicians for Responsible Opioid Prescribing. HKK has been supported by grants from the Robert Wood Johnson Foundation (77667, 74275, and 73359), the John Templeton Foundation (52125), the JPB Foundation (1085 and 439), and the Association of State and Territorial Health Officers (1584), has received honoraria from Jefferson University, Jefferson Health, the Perelman School of Medicine at the University of Pennsylvania, MaineHealth Center for Tobacco Independence, Harvard University Memorial Church, the Association of State and Territorial Health Officials, the University of Wisconsin Medical School, Wake Forest Baptist Health (in partnership with Shaw University), the Robert Wood Johnson Foundation advisory committee, the American College of Gastroenterology, and Tufts University School of Medicine, has been a consultant to the Commonwealth Fund, and is a member of the Community COVID Coalition Advisory Group, Phillips Academy Public Health Expert Advisory Panel, the Policy Advisory Group, the board of the Bipartisan Policy Center, the Palliative and Advanced Illness Research Center External Advisory Board (at the Perelman School of Medicine), the American Cancer Society Eastern New England Area Council of Advisors, the American University of Beirut International Advisory Council, the US National Advisory Board, the Culture of Health Year in Review Advisory Committee and Culture of Health as a Business Imperative Initiative of the Robert Wood Johnson Foundation, the editorial board of the Journal of the American Medical Association, the New England Donor Services board of trustees, the Josiah Macy Jr Foundation board of directors, and the Lancet–O'Neill Institute, Georgetown University Commission on Global Health and the Law. EEK has received research funding from the US Department of Veterans Affairs Health Services Research and Development (COR 19-489, 1I01HX003063-01A1, 5I01HX001752-05, 5I01HX002737-02, 5I01HX001288-05, and 5I01HX000911-06), the Patient Centered Outcomes Research Institute (OPD-1511-33052), the US National Center for Complementary and Integrative Health (5R01AT008387-04, 5UH3AT009761- 04/5UG3AT009761-02, and 4UH3AT009765-03/5UG3AT009765-02), and the US National Institute of Diabetes and Digestive and Kidney Diseases (1U01DK123816-01), and travel expenses from the law firm Nix Patterson representing the state of Oklahoma (to serve as an expert witness in support of the state's litigation against opioid manufacturers), the American Society of Health-System Pharmacists, the Association of Academic Physiatrists, the Australian Pain Society, the Cleveland VA Medical Research and Education Foundation, the Duke-Margolis Center for Health Policy, the Foundation for Medical Excellence, the Foundation for Opioid Response Efforts, the Friends of VA Medical Care and Health Research, the Hennepin Healthcare Research Institute, the Indiana Institute for Medical Research, the US National Academies of Medicine, the US National Center for Complementary and Integrative Health, the National Governors Association, the North American Spine Society, the Patient Centered Outcomes Research Institute at Stanford University, the US Food and Drug Administration, and the Washington State Department of Labor & Industries. AL has received consulting fees for her work as a medical expert witness in federal and state litigation against opioid manufacturers, distributors, and pharmacies, book royalties from Johns Hopkins University Press and Dutton Penguin Random House, speaking honoraria or travel expenses, or both, from the Vanderbilt University School of Medicine, the Ohio State University School of Medicine, the University of Kansas School of Medicine (sponsorship of the Alpha Omega Alpha Visiting Professorship), the Oregon Pain Guidance, the Indiana Prosecuting Attorneys Council, the Perrin's Opioid Litigation Conference, the Public Funds Forum, the Baton Rouge Health District, the Montrose Colorado Annual Continuing Medical Education Conference, the PerformRX Pharmacy Benefits Manager Annual Conference, the American Academy of Psychiatry and the Law, the Psych Congress, the 69th Annual Canadian Refresher Course for Family Physicians, the Ohio State University Inter-Professional Summit, the University of Texas, the Geminus Community Partners Annual Conference of Indiana, the National Council on Alcoholism and Drug Abuse, the Stanford Sierra Camp Womens' Alumni Wellness Retreat, the American Psychiatric Association, the Association for Medical Education and Research in Substance Abuse, and the Southwestern Gynecologic Assembly. SCM has been supported by the Redlich Professorship and the Rosekrans Pain Research Endowment Fund at Stanford University School of Medicine and research grants awarded to Stanford University from the US National Institutes of Health (R61NS118651, R03HD094577, R01DA045027, R01NS109450, R01AT008561, K24DA02926207, R01DA035484, and P01AT00665105), the Patient Centered Outcomes Research Institute (PCORI OPD-1610- 370707), the Stanford Wu Tsai Neurosciences Institute, and the University of California, San Francisco–Stanford Center of Excellence in Regulatory Science and Innovation (FDA) (2U01FD005978-06), has received speaking honoraria or travel expenses from Walter Reed, Harvard University, the American Academy of Pain Medicine, Washington University, the US Food and Drug Administration, the US National Institutes of Health, the US National Institute of Neurological Disorders and Stroke, the University of Washington, George Washington University, New York University, Weill Cornell Medical College, Duke University, the University of Utah, the World Institute of Pain, and the Canadian Pain Society, has received payment for testimony (unrelated to opioids) from Lauria Tokunaga Gates and Linn, and has received payment for consulting (unrelated to opioids) from the American Society of Anesthesiology; Favros Law; Fain Anderson VanDerhoef Rosendahl O'Halloran Spillane; Cox, Wootton, Lerner, Griffin & Hansen; Lewis Brisbois Bisgaard & Smith; Muro & Lampe; McCormick Barstow; Schmid & Voiles; and the University of Oklahoma Health Sciences Center. LLO has received travel expenses or honoraria from Cardozo Law School, Claremont McKenna College, Duke University, ETH Zürich, Georgetown University, Harvard University, the Los Angeles Intellectual Property Law Association, Michigan State University, New York University, Northwestern University, the University of Chicago, the University of Houston, the University of Kansas, the University of Nebraska, the University of San Diego, the University of Texas, the University of Villanova, the World Intellectual Property Organization, and Yale University, has received a writing honoraria from the Brookings Institution (to write a policy proposal for the Hamilton Project), and is a paid consultant to the MITRE Corporation (to assist with evaluations of the US Patent and Trademark Office requested by the Department of Commerce). BS has received research support from the US National Institute on Alcohol Abuse and Alcoholism (R01 AA023650 and K23 AA023284), the US National Institute of Drug Abuse (R21 DA043181), the US National Institute of Mental Health (P50MH115838), and the US National Highway Transportation Safety Authority, has received royalties from a software licence to healthStratica, and has several invention disclosures with the University of Pittsburgh for digital behavioral interventions. CT has been supported by the US Department of Veterans Affairs (VA HSR&D IIR 15-298, IIR 18-253, IIR 20-058, and PPO 16-337) and the US National Institutes of Health (NIAAA 1R01AA024136-01).

Background: Effective, evidence-based treatments for opioid use disorder are not equally accessible to Americans. Recent studies have found urban/rural disparities in the driving times to the nearest opioid treatment providers. These disparities may be even worse than currently reported in the literature because patients may not be able to obtain appointments with their nearest provider. We examine the robustness of the opioid treatment infrastructure by estimating how driving times to treatment change as provider availability decreases., Methods: We used public data from the federal government to estimate the driving time from each census tract centroid to the nearest 15 treatment providers. We summarized the median and interquartile range of driving times to increasingly distant providers (i.e., nearest, second nearest, etc.), stratified by urban/rural classification., Results: The median driving time to the nearest provider was greater in rural areas than urban areas for both opioid treatment programs (12 min vs 61 min) and buprenorphine-waivered prescribers (5 min vs 21 min). Importantly, driving times in rural areas increased more steeply as nearer providers became unavailable. For example, the increase in driving time between the nearest provider and the fifth nearest provider was much greater in rural areas than in urban areas for both buprenorphine-waivered prescribers (23 min vs 4 min) and for opioid treatment programs (54 min vs 22 min)., Conclusions: Access to treatment for opioid use disorder is more robust in urban areas compared with rural areas. This disparity must be eliminated if the opioid overdose crisis is to be resolved., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Millions of opioid and benzodiazepine prescriptions are dispensed near end-of-life. After death, patients' unused prescription pills belong to family members, who often save rather than dispose of them. We sought to quantify this exposure in Medicare beneficiaries., Methods: We estimated the share of decedent Medicare beneficiaries who potentially left behind opioid or benzodiazepine pills at the time of death using Part D claims of a 20 % national sample of Medicare beneficiaries between 2006-2015 linked to the National Death Index., Results: We estimated that 1 in 6 Medicare beneficiaries who died between 2006-2015 potentially left behind opioid pills, and 1 in 10 who died between 2013-2015 potentially left benzodiazepines as well. Leftover pills were more common among younger, dually enrolled, and lower-income beneficiaries, as well as beneficiaries living in non-urban areas and those with a history of mental illness, drug use disorders, and chronic pain. North American Natives and Non-Hispanic Whites had higher proportions than Black, Hispanic, and Asian decedents., Conclusions: Opioids and benzodiazepines are commonly left behind at death. Policies and interventions that encourage comprehensive and safe medication disposal after death may reduce risk for intra-household diversion and misuse of prescription opioids and benzodiazepines., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a "fentanyl breakthrough" in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available., Methods: We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl., Results: Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown., Discussion: Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: 12 step mutual help groups are widely accessed by people with drug use disorder but infrequently subjected to rigorous evaluation. Pooling randomized trials containing a condition in which mutual help group attendance is actively facilitated presents an opportunity to assess the effectiveness of 12 step groups in large, diverse samples of drug use disorder patients., Methods: Data from six federally-funded randomized trials were pooled (n = 1730) and subjected to two-stage instrumental variables modelling, and, fixed and random effects regression models. All trials included a 12 step group facilitation condition and employed the Addiction Severity Index as a core measure., Results: The ability of 12 step facilitation to increase mutual help group participation among drug use disorder patients was minimal, limiting ability to employ two-stage instrumental variable models that correct for selection bias. However, traditional fixed and random effect regression models found that greater 12 step mutual help group attendance by drug use disorder patients predicted reduced use of and problems with illicit drugs and also with alcohol., Conclusion: Facilitating significant and lasting involvement in 12 step groups may be more challenging for drug use disorder patients than for alcohol use disorder patients, which has important implications for clinical work and for effectiveness evaluations. Though selection bias could explain part of the results of traditional regression models, the finding that participation in 12 step mutual help groups predicts lower illicit drug and alcohol use and problems in a large, diverse, sample of drug use disorder patients is encouraging., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The U.S. Food and Drug Administration has approved three long-acting medications for opioid use disorder (MOUD): extended-release naltrexone (XR-NTX) in 2010, a subdermal buprenorphine implant in 2016, and a depot buprenorphine injection in 2017. Long-acting MOUD options may improve adherence while reducing diversion, but their availability compared to daily-dosing MOUD has not been well-characterized. The objective of this analysis was to characterize the availability of long-acting MOUD in substance use disorder treatment settings in the United States., Methods: Using the 2017 National Survey on Substance Abuse Treatment Services (N-SSATS) and state-level opioid overdose mortality, we examined associations between state- and facility-level factors and offering long-acting MOUD, which included XR-NTX and the buprenorphine implant. We constructed multivariable mixed logistic regression models for both types of long-acting MOUD., Results: Nationwide, 38% (n = 5141) of substance use treatment facilities provided any kind of MOUD (daily or long-acting). Of these, 62% provided XR-NTX, whereas only 3% offered the buprenorphine implant. Facilities in the East North Central, East South Central, West North Central and Mountain regions had higher odds of offering XR-NTX, as did federally-funded facilities, and facilities in states with the highest opioid overdose mortality rates., Conclusions: In 2017, XR-NTX was available at most of the minority of facilities offering MOUD, but the buprenorphine implant was not. Increasing the availability of MOUD, including long-acting options, is necessary to address unmet need for opioid use disorder treatment., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: For a number of fiscal and practical reasons, data on heroin use have been of poor quality, which has hampered the ability to halt the growing epidemic. Internet search data, such as those made available by Google Trends, have been used as a low-cost, real-time data source for monitoring and predicting a variety of public health outcomes. We aimed to determine whether data on opioid-related internet searches might predict future heroin-related admissions to emergency departments (ED)., Methods: Across nine metropolitan statistical areas (MSAs) in the United States, we obtained data on Google searches for prescription and non-prescription opioids, as well as Substance Abuse and Mental Health Services Administration (SAMHSA) data on heroin-related ED visits from 2004 to 2011. A linear mixed model assessed the relationship between opioid-related Internet searches and following year heroin-related visits, controlling for MSA GINI index and total number of ED visits., Results: The best-fitting model explained 72% of the variance in heroin-related ED visits. The final model included the search keywords "Avinza," "Brown Sugar," "China White," "Codeine," "Kadian," "Methadone," and "Oxymorphone." We found regional differences in where and how people searched for opioid-related information., Conclusions: Internet search-based modeling should be explored as a new source of insights for predicting heroin-related admissions. In geographic regions where no current heroin-related data exist, Internet search modeling might be a particularly valuable and inexpensive tool for estimating changing heroin use trends. We discuss the immediate implications for using this approach to assist in managing opioid-related morbidity and mortality in the United States., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Relative survival ratios (RSRs) can be useful for evaluating the impact of changes in cancer care on the prognosis of cancer patients or for comparing the prognosis for different subgroups of patients, but their use is problematic for cancer sites where screening has been introduced due to the potential of lead-time bias. Lead-time is survival time that is added to a patient's survival time because of an earlier diagnosis irrespective of a possibly postponed time of death. In the presence of screening it is difficult to disentangle how much of an observed improvement in survival is real and how much is due to lead-time bias. Even so, RSRs are often presented for breast cancer, a site where screening has led to early diagnosis, with the assumption that the lead-time bias is small. We describe a simulation-based framework for studying the lead-time bias due to mammography screening on RSRs of breast cancer based on a natural history model developed in a Swedish setting. We have performed simulations, using this framework, under different assumptions for screening sensitivity and breast cancer survival with the aim of estimating the lead-time bias. Screening every second year among ages 40-75 was introduced assuming that screening had no effect on survival, except for lead-time bias. Relative survival was estimated both with and without screening to enable quantification of the lead-time bias. Scenarios with low, moderate and high breast cancer survival, and low, moderate and high screening sensitivity were simulated, and the lead-time bias assessed in all scenarios., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Exclusion criteria are an important determinant of the external validity of treatment research findings, yet the prevalence and impact of exclusion criteria have not been studied systematically. Our objective was to describe prevalent exclusion criteria in treatment research on neurological disorders and to analyze their impact on sample representativeness and generalizability of findings., Design: Narrative literature review of studies focusing on treatment for neurological disorders. Studies were identified from PubMed and bibliographies., Results: Eight studies were included in the narrative review: 3 studies focused on Alzheimer's disease/dementia, 2 each focused on traumatic brain injury (TBI) and epilepsy, and 1 focused on amyotrophic lateral sclerosis (ALS). The total number of patients screened across all studies was 20,018, of which 14,721 (73.5%) were excluded. An average of 6 exclusion criteria was applied. The criteria that contributed most to exclusion were the presence of comorbid psychiatric conditions, a history of alcohol or other substance misuse, and cognitive impairments. Women and the elderly were underrepresented among included samples. Race/ethnicity proportions were seldom reported., Conclusion: Exclusion criteria are used extensively in neurological treatment research and prevent about 3 in 4 patients from participating in research. This limits the generalizability of current findings. Further, because excluded individuals are disproportionately from vulnerable populations, extensive exclusion also raises ethical concerns. Exclusion criteria should be used only in cases where there is a strong rationale so that neurological treatment research can make a greater impact on clinical care., (Published by Elsevier Inc.)

The Neck Disability Index (NDI) is a widely used questionnaire in the assessment of disability of neck patients. The aim of this study was to translate the NDI according to established guidelines into German (NDI-G) and to test the psychometric properties. Patients with acute (ACU) and chronic neck pain (CHR) and a healthy control group (HCG) completed the NDI-G twice with a mean test-retest interval of 3 days. The total score of NDI-G showed high reliability (Intraclass correlation coefficient (ICC2,1) = 0.92) and a high Cronbach's alpha (α = 0.96). The minimal detectable change was 7 points. The Bland-Altman plot revealed a small positive systematic error of 1.02 points. The Kruskal-Wallis test showed significant differences in the NDI-G total score among the three groups (χ(2) = 29.77, p < 0.001). Mann-Whitney U tests showed significant differences in the total score between ACU and HCG (p < 0.001), and CHR and HCG (p < 0.001). The factor analysis of NDI-G yielded 2 factors that together explained 67% of the variance. Spearman's phi coefficients showed no correlation between the NDI-G total score and the visual analogue scale (VAS) in the ACU group (phi = 0.23, p = 0.40), and a moderate correlation in the CHR group (phi = 0.55, p = 0.03). The item analysis of the NDI-G revealed moderate to good reliability for all items. Only the item 'work' could differentiate between the ACU and CHR group. The NDI-G emerged from this study as a valid and reliable assessment. Its psychometric properties are comparable with the original version. Thus, the NDI-G is recommended for research and clinical settings in neck pain in German speaking countries., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Debates about which policy initiatives can prevent or reduce the damage that illicit drugs cause to the public good are rarely informed by scientific evidence. Fortunately, evidence-based interventions are increasingly being identified that are capable of making drugs less available, reducing violence in drug markets, lessening misuse of legal pharmaceuticals, preventing drug use initiation in young people, and reducing drug use and its consequences in established drug users. We review relevant evidence and outline the likely effects of fuller implementation of existing interventions. The reasoning behind the final decisions for action might be of a non-scientific nature, focused more on what the public and policy-makers deem of value. Nevertheless, important opportunities exist for science to inform these deliberations and guide the selection of policies that maximise the public good., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Working memory (WM) is the ability to retain task relevant information. This ability is important for a wide range of cognitive tasks, and WM deficits are a central cognitive impairment in neurodevelopment disorders such as attention-deficit/hyperactivity disorder (ADHD). Although WM capacity is known to be highly heritable, most genes involved remain unidentified., Methods: Single nucleotide polymorphisms in genes previously associated with cognitive functions or ADHD were selected for genotyping. Associations of these with WM tasks were investigated in a community sample of 330 children and young adults. One single nucleotide polymorphisms was also investigated in an independent sample of 88 4-year-old children. Furthermore, association between brain structure and activity, as measured by magnetic resonance imaging techniques, and single nucleotide polymorphisms alleles were estimated in 88 participants., Results: Genotype at rs363039, located in the gene coding for synaptosomal-associated protein, 25 kDa (SNAP25) was associated to WM capacity in both samples. Associations in the community sample were also found with measures of other cognitive functions. In addition, this polymorphism affected the gray matter and brain activity in the posterior cingulate cortex, an area included in the so-called default mode network previously correlated to regulation of attention and hypothesized to be implicated in ADHD., Conclusions: A novel gene-brain-behavior network was identified in which a genotype located in SNAP25 affects WM and has age-dependent effects on both brain structure and brain activity. Identifying such networks could be a key to better understanding cognitive development as well as some of its disorders., (Copyright © 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

The Internet is increasingly important for many cancer survivors because it provides access to the latest information on cancer treatments and also allows them to receive support by participating in online cancer support groups. Unfortunately, little is known about why African-American cancer survivors are underrepresented in online cancer support groups. This article reviews the relevant literature and discusses three possible explanations for why African Americans are underrepresented in online cancer support groups: the digital divide/digital inequality, preferences for face-to-face support or culture-specific online support, and trust concerns. We conclude that a health inequity exists with regard to the utilization of information that can be obtained from online cancer support groups. However, with regard to the potential benefits of the psychosocial and emotional support aspect of online cancer support groups, a health inequity may not exist, as African Americans have other preferred avenues for obtaining needed support, and there is no evidence that this is detrimental to their health.

Retention in Opioid Agonist Therapy (OAT) is associated with reductions in substance use, HIV risk behavior, and criminal activities in opioid dependent patients. To improve the effectiveness of treatment for opioid dependence, it is important to identify predisposing characteristics and provider-related variables that predict retention in OAT. Participants include 258 veterans enrolled in 8 outpatient methadone/l-alpha-acetylmethadol (LAAM) treatment programs. Signal detection analysis was utilized to identify variables predictive of 1-year retention and to identify the optimal cut-offs for significant predictors. Provider-related variables play a vital role in predicting retention in OAT programs, as higher methadone dose (> or =59 mg/day) and greater treatment satisfaction were among the strongest predictors of retention at 1-year follow-up.

Background: Both clinicians and researchers have expressed doubt that opiate dependent patients with significant pain can be effectively treated in methadone maintenance treatment (MMT) programs; however, little research exists on this topic. Patients who report significant pain in the month preceding entry to MMT present with a distinct and more severe pattern of polysubstance use, medical and psychosocial problems than do those without pain. The present study investigated the 1-year treatment outcomes of MMT patients with opiate dependence and pain., Methods: Analyses were based on a national sample of 200 patients presenting in MMT programs for treatment of opiate dependence. Substance use and related problems were measured at treatment entry and 12 months later. Patients reported pain severity over the month preceding treatment entry., Results: Compared to patients without significant pain, patients who reported significant pain at baseline (n = 103) showed similar substance-related functioning, but poorer psychosocial functioning at 1 year., Conclusions: Patients with and without significant pain experience comparable reductions in substance use when provided with standard care in MMT programs. However, additional medical and/or mental health treatment is needed for their pain and other problems.

Although pain problems are prevalent in substance use disorder (SUD) patients, the special treatment needs of SUD patients with pain have not been investigated. This study examines the problems and behaviors associated with reported pain among veterans treated at eight opioid substitution treatment clinics. Patients reporting pain had more severe medical and psychiatric problems and greater health care utilization. Pain was associated with an increased propensity for misuse of substances with analgesic effects, suggesting that ongoing pain contributes to an altered and more severe pattern of drug-seeking behavior. Patients without pain rarely abused sedatives or opioid medication, indicating that misuse of these substances is unique to co-morbid pain and SUD patients. Patients reporting pain did not differ from patients without pain in use of heroin, alcohol, cocaine or in injection practices, demonstrating that they are truly SUD patients in need of SUD treatment. Pain complicates the treatment of SUD and should be addressed as an important co-morbidity during treatment.

Little research has examined the relationship of substance abuse patients' prior Alcoholics Anonymous (AA) affiliation to important treatment-related variables. This study of 927 individuals seeking treatment in public, health maintenance organization (HMO) and private-for-profit medical programs, found that 82.8% of patients presented at treatment with a history of AA affiliation. Degree of prior AA affiliation was significantly associated with more extensive prior utilization of formal and informal helping resources, current seeking of treatment in the public sector, having low income, being divorced/separated and having more severe alcohol, employment/support and psychiatric problems. Implications for service delivery and future research are discussed.