The article, “Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults,” has been published in SAj.

In this commentary, the authors state that adverse childhood experiences (ACEs) predict problematic health outcomes (eg, substance use, mental health) among young adults; whether specific ACEs are differentially associated with specific substance use and mental health symptoms is understudied. Adverse childhood experiences (ACEs) are defined as stressful and/or traumatic experiences that occur before the age of 18 years and consist of abuse (physical, emotional, sexual), neglect (physical, emotional), and household dysfunction (parental incarceration, divorce, substance use, abuse toward mother). ACEs are a common occurrence, with nearly two-thirds of US adults reporting having experienced at least 1 ACE, and most individuals who experience ACEs experience more than one type. Unfortunately, ACEs are associated with a range of problematic health outcomes, including substance use (eg, tobacco, cannabis, alcohol) and mental health conditions (eg, depression, anxiety) during adulthood.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Because lifelong patterns of health behaviors are commonly initiated during young adulthood, understanding unique associations between specific ACE profiles and a range of adverse health outcomes is essential to informing health behavior interventions to offset the risk of negative health patterns throughout the life course. Thus, the twofold aims of the current study were to: (1) identify classes of young adults based on their exposure to ACEs assessed via the widely accepted 10 ACEs items developed by Kaiser Permanente and (2) examine associations between ACEs classes and a range of health outcomes, including substance use (ie, tobacco use and number of products used; cannabis use and hazardous use; alcohol use and binge drinking) and mental health (ie, symptoms of depression and anxiety).”

“Taken together, young adults displayed 4 unique patterns of ACEs, including Low ACEs, Parental abuse, Poor family health and divorce, and High ACEs. All combinations of ACEs were associated with reporting current use of tobacco and cannabis, as well as current depression and anxiety. However, specific combinations of ACEs uniquely predicted more problematic patterns of tobacco and cannabis use, with Parental abuse potentially driving patterns of polytobacco use, Poor family health and divorce driving patterns of hazardous cannabis use, and the combination of Parental abuse and Poor family health and divorce driving binge drinking behaviors. Findings highlight that all combinations of ACEs are associated with problematic health behaviors among young adults, but that young adults may seek out specific substances to cope with their unique experiences of childhood maltreatment. Findings underscore the need for substance use and mental health interventions for young adults to assess the specific types of ACEs experienced during childhood and to tailor treatment for such experiences.”

The article, “Perceiving E-Cigarettes as Safe and Safer Alternative to Cigarettes Among Young Adults,” has been published in SAj.

In this commentary, the authors state that e-cigarettes are the most commonly used tobacco product among youth in the United States. While overall normal cigarette smoking rates have declined over the last decade, the rising popularity of e-cigarettes has led to concern regarding the perpetuation of nicotine use, particularly in younger populations. E-cigarettes are not subject to the same restrictions historically placed on the tobacco industry, allowing for a variety of e-cigarette device types, flavors, and practices to proliferate in the United States. E-cigarettes are often marketed as a smoking cessation tool or harm reduction product, yet young adults rarely use e-cigarettes for these purposes. Rather, e-cigarettes appeal to young adults for a number of reasons, including: sleek design, user-friendly functions, less aversive experiences of taste, smell, and throat irritation compared to cigarettes, appealing flavors (eg, candy, fruit, or chocolate), accessibility to purchase while underage, and convenience and ability to discreetly use in places where cigarette smoking is not permitted. The consequences of e-cigarette use are well-established and include development of nicotine addiction, transition to combustible cigarette use, and adverse respiratory health effects. Despite these known risks, young people often are unaware of the negative consequences associated with e-cigarettes. Studies have shown that young people often believe that e-cigarettes are harmless and are a healthier alternative to cigarettes, and that they cannot become addicted to them. Furthermore, young people often believe that the mid- to long-term effects of e-cigarette use are not yet known, despite evidence to the contrary. Skepticism about e-cigarette harms and safety among young adults is particularly concerning, given the known consequences of e-cigarette use, and thus warrants continued consideration as a significant public health concern. Using one-on-one interviews with young adults who self-reported having recently used e-cigarettes on a regular basis, the authors examined young adult perceptions of e-cigarette use safety and harms.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“While several young adults in our study denied that e-cigarettes were unsafe, others accepted that e-cigarettes were harmful and that they were the “guinea pigs” or early test subjects in proving these harms. Some acknowledged the existence of e-cigarette myths and marketing schemes targeting youth, yet they still continued to use e-cigarettes despite the adverse consequences to their health. Young adults’ denial or defiance of being the e-cigarette “guinea pigs” combined with increased access and exposure to e-cigarettes through peers and online vendors with little self-awareness of their vaping consumption is a deadly combination that can result in higher nicotine exposure and dependence. Given the addictiveness of e-cigarettes and the harm it can cause to a developing brain during adolescence, it is critical for future studies and public health interventions targeting young adults to debunk myths claiming that e-cigarettes are safer than cigarettes and thus not safe to use.”

“The current study describes accounts from young adults who vape regarding their perceptions of e-cigarette harm and safety. Many of their reasons were grounded in misperceptions rather than empirical studies in the literature, and addressing this misinformation should be a top public health priority to encourage and prevent young people from using e-cigarettes. It is unclear what young adults deem to be definitive and informative research and where they are obtaining their information from, which should be a subject for future research. Future public health interventions could target this discrepancy and better translate and disseminate emerging research to a young adult audience, promote anti-vaping campaigns that are youth-centered, and approach young adults as health-conscious consumers.”

The article, “The FASTER-BUP Study, Extended-Release Injectable Buprenorphine for the Treatment of Opioid Use Disorder Among Individuals at High Risk of Overdose: Protocol for an Observational Prospective Study,” has been published in SAj.

In this commentary, the authors state that North America is facing an unprecedented public health emergency of opioid-related morbidity and mortality. The mortality benefits of oral medication treatment for opioid use disorder (MOUD), such as methadone or buprenorphine, are well documented. However, barriers to access and long-term engagement have prevented maximizing their benefits. Long-acting injectable buprenorphine formulations were developed to address some of the challenges associated with oral MOUD. The “Pilot study to assess the feasibility, efficacy, and safety of extended-release injectable buprenorphine for the treatment of opioid use disorder among individuals at high risk of overdose” (FASTER-BUP) was developed to explore this treatment option in populations at high risk of overdose in a real-world Canadian setting. FASTER-BUP is a 24-week observational prospective study evaluating the feasibility and clinical utility of extended-release injectable buprenorphine (XR-BUP) for the treatment of opioid use disorder (OUD) among 40 adults at high risk of overdose (ie, lifetime history of overdose or a positive urine drug test (UDT) for fentanyl within 30 days prior to screening) in Vancouver, BC. The primary outcome is retention in treatment and secondary outcomes include: use of unregulated opioids, safety, overdose events, treatment satisfaction, changes in drug-related problems, changes in quality of life, opioid cravings, health service utilization, and criminal activity. FASTER-BUP is the first study to explore XR-BUP among individuals at high risk of overdose in a real-world Canadian setting. This commentary provides a brief narrative about the study thus far and presents insights on key adaptations to the study protocol, including those adopted to mitigate recruitment challenges.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Despite its demonstrable efficacy, XR-BUP remains an understudied and underutilized tool with limited programs existing in Canada. In 2018, Health Canada approved one formulation of XR-BUP (ie, Sublocade^TM). The approval of this medication expanded treatment options for individuals with OUD, particularly those for whom medication adherence may pose a challenge. However, there remains a lack of research exploring XR-BUP in real-world Canadian settings and in populations, such as individuals at high risk of overdose, who may benefit most from this treatment. The FASTER-BUP study aims to address this research gap and this narrative provides insight into key adaptations to the study protocol in the hope that it informs future studies.”

“FASTER-BUP is among the first to explore XR-BUP among individuals at high risk of overdose in the Canadian context. Adaptable study materials and partnering with AMCT permitted critical shifts to the study protocol, thus resulting in increased recruitment efforts and study enrollment. This study will generate important preliminary data which will support the development of a larger effectiveness clinical trial evaluating XR-BUP in real-world settings. Ultimately, findings from this study will inform interventions to address Canada’s worsening opioid epidemic.”

The article, “Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models,” has been published in SAj.

In this commentary, the authors state that novel adulterants and synthetic substances are rapidly infiltrating the US and international drug supply. Efforts to reduce the overprescription of opioids, compounded by increased pressure from law enforcement, have led to shifts in the US drug market and forced people to seek illicit sources which are at risk of adulteration. This shifting drug landscape has resulted in an increasingly dangerous and unregulated supply. Initially an adulterant to heroin, fentanyl, a potent synthetic opioid, has now largely replaced heroin as the dominant illicit opioid in the US. This shift has resulted in an exponential rise in fatal overdoses and other drug-related harms. As the addiction care community continues to navigate the challenges posed by fentanyl, the nation must now adapt to yet another emerging substance, xylazine, contaminating the illicit drug supply.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Public health threats significantly affect population health, and early effective distribution of information is critical to enhance clinical response capabilities. In the context of the evolving supply to date, avenues for timely continuing and interprofessional dissemination of information for those in practice have been limited. Providers can seek opportunities for collaborative learning during annual national conferences that require membership or payment; or self-directed learning using emerging literature that requires practical and contextual translation; or rely on freestanding online resources, webinars, or courses, which may exclude the voice of the harm reduction community. Brief, interactive, didactic-based trainings have been effective and are valuable mechanisms to distribute information and implement practices in this field. In the rapidly evolving space of new psychoactive substances, peer-reviewed statistical and clinical evidence takes time to accrue. A significant body of current working knowledge from those with lived experience and professional exposure is communicated through professional and informal networks, including social media, and can be used to address urgent and novel substance-related harms. We describe our experience and lessons learned leveraging a robust existing training and technical assistance (TTA) model to disseminate education and information about xylazine as an emerging threat in the absence of robust clinical guidelines and a peer-reviewed evidence base.”

“Our responsive educational training on xylazine had broad reach and impact allowing for timely dissemination of information. By leveraging a flexible TTA model, our team was able to provide accessible education with free CEC to a diverse group of professionals and community members. Post-training participant feedback was critical to facilitate adaptation of content and aid development of needed resources for the field. By pairing information gathered from literature and nontraditional sources with established clinical protocols and harm reduction strategies from the field, we were able to provide tangible education. The added benefit of working with a robust TTA team allowed us to proactively update information in real time that participants could consider implementing in their own practices—all before literature and official public health guidance became accessible.”

The article, “Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions,” has been published in SAj.

In this commentary, the authors state that an alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention.

In the AUTHORS’ OWN WORDS, they relate the importance of their work:

“Building on prior analyses demonstrating the effectiveness of alcohol text message interventions versus control condition in reducing HED at three month follow-up, this exploratory study examined baseline participant characteristics that predicted HED at three months using PRE. To our knowledge, this is the first use of PRE to identify prediction rules for a digital alcohol intervention. Identifying prediction rules can increase understanding of “for whom” the intervention has effects, and indicate features important to predicting the main intervention outcome. The PRE model included treatment assignment as a confirmatory rule known to predict outcome, and generated information on the baseline characteristics most important to predicting HED at three months to aid model interpretation. This data-driven approach maximized predictive accuracy while minimizing complex rule structure, to generate a set of rules that could be readily understood by clinicians to support young adult HED intervention.”

“This exploratory study identified 12 rules based on a small set of six baseline variables and intervention status (seven total features) that predict HED days at three month follow-up. Future possible clinical application might involve computerized assessment of key baseline predictors of intervention effects on HED days, which include drinking pattern, negative urgency, perceived number of friends who get drunk weekly, and perceived risk of possible HED-related consequences. The rules balance prediction performance and ease of interpretation to estimate short-term HED outcome among young adults exposed to a text message intervention.”