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  • JAMA October 11, 2017

    Figure: Opioid Use and Overdose and Fentanyl Drug Reports, 1999-2015

    aSource: National Center for Health Statistics at the US Centers for Disease Control and Prevention. WONDER online database: prescription opioid overdose deaths include fatal overdoses related to natural and semisynthetic opioids or methadone. Illicit opioid-related overdose deaths are related to heroin or synthetic nonmethadone opioids, and some overdose deaths are related to prescribed fentanyl or other prescribed synthetic opioids.bSource: Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. https://www.samhsa.gov/data/population-data-nsduh/reports?tab=38.cSources: Dashed line from 1999 to 2005 (Drug Enforcement Administration. Automation of Reports and Consolidated Orders System: sales to pharmacies, hospitals, and practitioners for codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone. Paulozzi LJ, et al. MMWR Morb Mortal Wkly Rep. 2011;60:1487-1492). Solid line from 2006 to 2015 (QuintilesIMS estimates of opioid prescriptions dispensed in the United States to 59 000 pharmacies, representing 88% of US prescriptions. Guy GP Jr, et al. MMWR Morb Mortal Wkly Rep. 2017;66:697-704).dSource: Drug Enforcement Administration. Fentanyl, 2001-2015. https://www.deadiversion.usdoj.gov/nflis/2017fentanyl.pdf. The number of fentanyl drug reports reflects the number of encounters by law enforcement that tested positive for fentanyl. Therefore, fentanyl drug reports provide an indication of the available supply of illicitly manufactured fentanyl.
  • JAMA January 24, 2017

    Figure: CDC Says More Needle Exchange Programs Needed to Prevent HIV

    Free sterile needles provided through syringe services programs can reduce HIV and hepatitis infections without increasing drug use.
  • JAMA January 10, 2017

    Figure: Year-to-Year Prevalencea of Past-Month Marijuana Useb Among Pregnant and Nonpregnant Women, Overall and by Age, 2002-2014c

    aYear-to-year–adjusted and linear predicted–adjusted prevalence estimates were from log-Poisson regressions. Models controlled for race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other non-Hispanic minorities), family income ($0-$19 999, $20 000-$49 999, $50 000-$74 999, ≥$75 000), age (18-25 years, 26-34 years, 35-44 years), education (Drug Use and Health. Sample size across all years combined: pregnant women (n = 10 587), nonpregnant women (n = 189 923).
  • JAMA August 6, 2014

    Figure 2: Changes in Problem Drug Use Over Time

    The Addiction Severity Index–Lite (ASI) Drug Use composite score accounts for frequency of use and associated problems for all drugs used, excluding alcohol and medications taken as prescribed (range, 0-1; 1 indicates greatest severity).
  • JAMA August 6, 2014

    Figure: Enrollment and Follow-up Flow Diagram for ASPIRE Study of Brief Interventions for Unhealthy Drug Use

    ASSIST indicates Alcohol, Smoking, and Substance Involvement Screening Test, BNI, brief negotiated interview; MOTIV, an adaptation of motivational interviewing.
  • JAMA August 6, 2014

    Figure 1: Participant Flow in the Trial of a Brief Intervention for Problem Drug Use

    aInclusion criteria were age 18 years or older; self-reported use of an illegal drug or nonprescribed medication (ie, problem drug use) at least once in the 90 days before screening; English-speaking and able to read and understand screening and consent forms (sixth-grade literacy); currently receiving and planning to continue care in the clinic; and having telephone or e-mail access to facilitate scheduling follow-up assessments. Exclusion criteria were attendance in formal substance abuse treatment in the past month (excluding self-help groups such as Narcotics Anonymous); high risk of imminent suicide; life-threatening medical illness; severe cognitive impairment; or active psychosis. Data for reasons of exclusion are not available.
  • Screening and Brief Intervention for Drug Use in Primary Care: The ASPIRE Randomized Clinical Trial

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    JAMA. 2014; 312(5):502-513. doi: 10.1001/jama.2014.7862

    Saitz and coauthors tested the efficacy of 2 brief interventions among 528 adults with unhealthy drug use identified by screening in primary care. They compared a brief negotiated interview and an intervention based on motivational interviewing with no brief intervention. In an Editorial, Hingson and Compton discuss the importance of exploring drug use with patients in primary care.

  • Screening and Brief Intervention and Referral to Treatment for Drug Use in Primary Care: Back to the Drawing Board

    Abstract Full Text
    JAMA. 2014; 312(5):488-489. doi: 10.1001/jama.2014.7863
  • Brief Intervention for Problem Drug Use in Safety-Net Primary Care Settings: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA. 2014; 312(5):492-501. doi: 10.1001/jama.2014.7860
  • Screening for Drug Use

    Abstract Full Text
    JAMA. 2009; 301(20):2085-2085. doi: 10.1001/jama.2009.714
  • JAMA January 14, 2009

    Figure: Proposed Network of Brain Circuits Involved With Addiction

    Circuits work together and change with experience. Each is linked to an important concept: reward (saliency), motivation (drive), memory (learning associations), inhibitory control (conflict resolution), mood (well-being), and interoception (internal awareness). Size of circuit ovals indicates influence in determining behavioral outcomes. Thicker line weights indicate greater influence on regulation of the circuit. A, In a nonaddicted person the decision to consume a drug (same process pertains for natural rewards) is a function of the balance between the expected pleasure (based on past experience or memory), alternative stimuli (this includes internal states such as mood and interoception but also alternative external rewards), and potential negative outcomes that oppose the motivation to take the drug (inhibitory control exerted by prefrontal cortex) and stop the drug use. B, During addiction, the enhanced value of the drug in the reward, motivation, and memory circuits overcomes the inhibitory control exerted by the prefrontal cortex, thereby favoring a positive feedback loop initiated by the consumption of the drug and perpetuated by enhanced activation of the motivation/drive and memory circuits. Decreased sensitivity to rewards also raises the hedonic threshold, disrupting mood and increasing the saliency values of drugs and behaviors temporarily associated with relief from the dysphoria. Learning and conditioning result in an enhanced interoceptive awareness of discomfort and the associated desire for the drug (craving). Absence of lines from inhibitory control circuit to reward and motivation circuits indicates loss of regulation.
  • Alcohol and Other Drug Use Among Victims of Motor-Vehicle Crashes—West Virginia, 2004-2005

    Abstract Full Text
    JAMA. 2007; 297(17):1873-1874. doi: 10.1001/jama.297.17.1873
  • Shift Seen in Patterns of Drug Use Among Teens

    Abstract Full Text
    JAMA. 2006; 295(6):612-613. doi: 10.1001/jama.295.6.612
  • JAMA June 22, 2005

    Figure: In-Hospital Mortality Rates Among Patients With Health Care–Associated Staphylococcus aureus Endocarditis

    Includes both nosocomial and nonnosocomial health care–associated infections, community-acquired injection drug use–associated S aureus endocarditis, and community-acquired noninjection drug use–associated S aureus endocarditis by geographic region.
  • JAMA May 19, 2004

    Figure: Predicted Change in Annual Days Supplied When Co-payments Double by Drug Class and Population

    The percentage change in per-member annual days supplied when co-payments increase by 100% in the average 2-tier plan is shown. This plan has retail co-payments of $6.31 for generics and $12.85 for brand-name drugs and has an index value of 168. For each chronically ill subpopulation, we estimated the change in drug use within class (eg, use of antidepressants by depressed patients) and outside of class (eg, use of all other medications by depressed patients) when co-payments increase by 100%. NSAIDs indicates nonsteroidal anti-inflammatory drugs.
  • JAMA March 5, 2003

    Figure 4: Mean Change From Baseline in Angina Severity, Measures in Quality of Life, and Anti-anginal Drug Use Over Time in Both Treatment Groups

    Angina Canadian Cardiac Society class and Rose score: 4 indicates pain at rest and 0 indicates no pain. Duke Activity Status Index scored on a scale from 0 to 58 with higher scores indicating a more favorable status. Short Form 36 (SF 36) items (general health and vitality) scored on a scale from 0 to 100 with higher scores indicating a more favorable status. After 6 months, angina relief and improvement in quality of life was significant for both treatment groups vs baseline (all P<.05) but greater after invasive therapy management. After 1 year, anginal and quality of life status of optimized medical patients approached that of invasive patients, but anti-anginal drugs remained fewer. P values are for between-group comparisons at 6 and 12 months. Error bars indicate SE.
  • Escalation of Drug Use in Early-Onset Cannabis Users vs Co-twin Controls

    Abstract Full Text
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    JAMA. 2003; 289(4):427-433. doi: 10.1001/jama.289.4.427
  • Improving Drug Use in Elderly Patients: Getting to the Next Level

    Abstract Full Text
    JAMA. 2001; 286(22):2866-2868. doi: 10.1001/jama.286.22.2866
  • JAMA January 24, 2001

    Figure 1: Time Series and Prepolicy Control and Postpolicy Cohort Design

    The first 3 months of the time series and of an individual's enrollment in the public plan were excluded because prescriptions filled prior to these dates were unknown and created artificially low values for monthly drug use. The month immediately prior to policy implementation also was excluded because of possible prescription stockpiling.
  • JAMA March 17, 1999

    Figure 2: Illicit Opioid Use

    Top, Self-reported illicit opioid use across time as assessed by the drug use questionnaire. Results shown are for the retained sample and represent the number of times illicit opioids were used in each prior week. Values for the baseline period (BL) represent the week prior to admission and are unadjusted means. All other values represent adjusted means. Bottom, Percentage of opioid-positive urine samples across time for the same sample. Urine specimens were collected twice per week, and results were summarized in 3-week blocks. Results shown are adjusted means.