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Over the past several decades, opioid overdose deaths have become an increasing issue in the United States, contributing to the opioid epidemic and challenging the health system and the economy nationwide. This chapter explores the epidemiology of prescribed and non-prescribed opioid use, including initiation, opioid use disorder, and trends over time. The authors begin by introducing opioids, their classification, therapeutic uses, consequences of use, and routes of administration. The authors discuss empirical findings for prescription opioids, heroin, nationwide opioid prescription guidelines, and morbidity/mortality at the individual and societal levels. Lastly, the authors present common comorbidities for persons with opioid use (e.g., other substance use, polysubstance use).

Background Serious psychological distress (SPD) is common among adults who smoke cigarettes and among adults with substance use disorders (SUD). It is unknown whether the burden of SPD is even greater among individuals with both cigarette smoking and SUDs. This study examined the intersectionality of SPD, cigarette smoking, and SUD over time. Methods Data came from annual, cross-sectional, nationally representative samples of the United States (US) National Survey on Drug Use and Health (individuals age 12+). Past-month SPD prevalences were estimated each year from 2008 to 2018 for adults age 18+ with current daily, current non-daily, former, and never cigarette smoking by SUD status (combined n = 441,286). Logistic regression models examined linear time trends of SPD. Results In 2018, SPD was significantly more prevalent among adults in each smoking group with SUD versus those without SUD (daily 29.1% vs. 9.0%, non-daily 23.2% vs. 8.6%, former 19.5% vs. 3.2%, never 16.4% vs. 4.3%). After adjusting for sociodemographics, SPD prevalence increased over time across smoking statuses with a larger change for persons with SUD (AOR=1.07; 95% CI: 1.06, 1.09) vs. no SUD (AOR=1.03; 95% CI: 1.02. 1.04). Conclusions SPD was more than twice as common among adults with SUD who smoke cigarettes compared to those without SUD who do not smoke cigarettes, with the highest prevalence among adults with both SUD and daily smoking. While SPD has increased over time, differences depended on SUD status beyond the effect of cigarette smoking. These results provide further evidence for treating smoking and mental health problems together.

A talented Brazilian physician investigator, Felipe Fregni, is an Associate Professor of Physical Medicine & Rehabilitation and Neurology at Harvard Medical School, where he directs the Neuromodulation Laboratory at the Department of Physical Medicine & Rehabilitation at Spaulding Rehabilitation Hospital & Massachusetts General Hospital. He completed his medical studies, Neurology residency, and a Doctor of Philosophy (PhD) at the University of Sao Paulo and continued on to pursue post­graduate studies as well as a Master of Public Health (MPH) at Harvard Medical School. His philanthropic nature led him to design the Collaborative Learning in Clinical Research Program and the Principles and Practice of Clinical Research course with the Department of Continuing Education at Harvard Medical School to educate on basic and advanced training in clinical trials for physicians around the world. As part of this cour­se, he has reached to physicians and students of graduate and postgraduate studies in the medical field in 30 countries to offer a 9-month collaborative distance-learning course on clinical research. For this interview, he was invited to share his experiences and insight as a physician-scientist from Brazil with medical students worldwide.

Introducing the International Journal of Medical Students, a Platform for Medical Student Research Worldwide.