Therefore, buprenorphine use could not be included as part of the inclusion criteria for the “picking up medications” outcome. Eighth, the outcome assessed in this study was self-reported service avoidance; self-report may not be reliable, or subject to differences in interpretation of the question. Finally, no hypothesis was specified a priori about which risk factors would be associated with avoiding harm reduction services, and this analysis should be considered exploratory. Despite these limitations, this study provides important new data about avoidance of medication for opioid use disorder and syringe service programs across jurisdictions. It suggests that, other than individual differences in fear of COVID-19 local service and policy contexts were much more important for determining whether people accessed these health and harm reduction services than individual differences in other characteristics between people who use drugs. Findings should inform policy efforts to increase the accessibility and flexibility of these programs: to help navigate the remainder of this pandemic and be better prepared for future disasters that may impede access to essential important public health services. In addition to male and female, TNT Online Survey participants were presented with the following gender identity response options: Transgender; Something else, please describe; and I’m not sure yet. Participant could also choose not to answer the question by leaving the item unmarked. Of the participants who viewed this item, 0.3% left it unmarked; another 5.7% of all participants did not view this item because they closed the survey before completion. For this report,outdoor cannabis grow marked response options other than male or female were combined into a single category.
Among all participants with a marked response, 3.0% indicated that they identified their gender in a way other than male or female. For race/ethnicity, participants were asked whether they were of Hispanic or Latino/Latina/Latinx/Latine origin . Those who indicated yes were classified as Hispanic or Latino regardless of race reported. Participants who selected no to the ethnicity question were classified as Non-Hispanic and were asked to select all races with which they identified from a list of six, including “Other.” If participants selected more than one race, they were classified as “More than one” race. Free-text responses were collected but not recoded. Due to the small number of participants who selected “American Indian / Alaska Native” or “Native Hawaiian / Other Pacific Islander,” these two categories were combined with “Other” into a single category for reporting results in Tables. Throughout the survey, missing data could arise if participants chose to leave a survey item unmarked or if participants closed the survey before completion . In this report, missing values are excluded from prevalence estimates. Thus, for some table rows and columns, the total sample size is less than the total 2021-2022 TNT Online Survey sample due to missing data.All current vapers were asked a series of questions about what substances, such as nicotine, were in the vapes they used. The questions were presented in different parts of the survey. First, current vapers were asked, “In the PAST 30 DAYS, how often did the vapes you used contain nicotine?” Later in the survey, current vapers were also asked, “In the PAST 30 DAYS, did any of the vapes that you used contain nicotine?” These two different ways of asking about nicotine were included in the survey to help understand how question wording might affect the way people answer. Current vapers were also asked, “In the PAST 30 DAYS, did any of the vapes that you used contain the following substances?” and were given a list of substances they could select. Finally, current vapers were asked, “Was there ever a time in the PAST 30 DAYS that you used a vape and were not sure what it contained?” The weighted responses to each of these questions are presented in Table 12. For a comments and recommendations related to designing survey items related to vape contents, see Appendix.JUUL, Puff Bar, Blu, and Vuse were the vape brands participants reported as most popular among their peers.
When asked to select the one brand of their favorite vape advertisement, most participants reported they do not have a favorite advertisement. Indicating the brand of a favorite tobacco advertisement is considered to be a measure of tobacco advertising receptivity and can be used to predict future tobacco use. These results from the TNT Online Survey suggest that most participants were not receptive to vape advertisements. Among all current vapers, it was common to use more than one vape device type during the past 30 days. Puff Bar- like disposable devices and JUUL-like pod devices were the two most commonly used device types. However, nearly half of current vapers reported that at least one time in the past 30 days they used a vape and were not sure what it contained. Besides nicotine, participants reported that the vapes they used sometimes contained marijuana, “vitamins,” and melatonin.All current users of vapes, cigarettes, cigars, hookah, and smokeless tobacco were asked about their use of flavored products in the past 30 days. Please note that flavored cigarette use in this chapter reflects use of menthol-flavored cigarettes . Questions were presented to tobacco product users in different ways. In Version A questions, separately by tobacco product, participants were asked whether any of the products they used in the past 30 days were flavored. In Version B questions, also separately by tobacco product, participants were asked whether the product they usually used were flavored. Participants who indicated that they only used “unflavored” or “tobacco flavored” products or do not know what flavor they used in the past 30 days were considered not to have used flavored products. All other indicated flavors, such as mint, fruit, candy, and “other,” were categorized as flavored product use. The TNT Online Survey did not include flavor questions related to heated tobacco, nicotine pouches, or nicotine tablets, lozenges, or toothpicks. Participants who currently used only these products are not included in this chapter. Table 13 shows the prevalence of current flavored tobacco use among current users of various products. All TNT Online Survey participants were asked to indicate how much they agreed or disagreed with nine different policy statements. Three of the statements related to the sale of tobacco products, and three statements related to the use of tobacco or marijuana products in public places.
In the Wave 2021-2022 summer cycle, participants were asked how much they agreed that certain practices “should NOT be allowed.” In the Wave 2021-2022 winter cycle, these survey questions were modified slightly and asked participants whether these same practices “should end.” Three additional policy statements were worded exactly the same way for all Wave 2021-2022 participants. Table 18 shows how participants responded to the Tobacco Endgame policy statements related to potential restrictions on tobacco sales. Table 19 shows how participants responded to the Tobacco Endgame policy statements related to tobacco or marijuana use in public places, apartment buildings, and flavored tobacco use by youth.The global rise of methamphetamine use could jeopardize current intervention efforts to address the twin epidemics of opioid use disorder and HIV infection. Use of methamphetamine is increasingly common among people with primary OUD. Prevalence of methamphetamine use disorders is increasing in Vietnam,PIPP horticulture raising concerns about increased risk of HIV infection and disruption of the substance use treatment systems, especially methadone programs. Methamphetamine use among people living with HIV could decrease retention in care, hinder medication adherence, accelerate viral replication, and further HIV disease progression. Other countries beyond South-East Asia encounter similar challenges. In low-and-middle-income countries, it is vital to identify cost-effective models of adapted evidence-based practices for addressing substance use disorders. Although there are no approved pharmacological treatments for methamphetamine use, evidence-based behavioral interventions such as motivational interviewing, contingency management, and cognitive behavioral therapy, including Matrix model, have shown efficacy in reducing methamphetamine use. However, we need to identify optimal combinations of EBI for effectiveness and cost effectiveness as many people in treatment face challenges to retention and sustained reductions in use.Motivational interviewing helps individuals to evaluate the pros and cons to change drug use and to develop personalized change behaviors. Motivational interviewing can be used in a single session or in multiple sessions. Polcin et al. compared two motivational interviewing conditions and found that both groups showed significant reductions in methamphetamine use without differences between the two groups. A greater reduction in psychiatric symptoms including anxiety and depression was found among those receiving more motivational interviewing sessions.Contingency management has shown the strongest evidence in treating methamphetamine use disorders. It is also effective in reducing other drug use including alcohol, cannabis, nicotine, and opioids. Contingency management is based on the theory of operant conditioning where incentives are used to strengthen the target behavior such as abstinence, reduction of sexual risk behaviors, or other health-promoting behaviors like retention or adherence to treatment. Contingency management effects are enhanced in combination with other psychosocial interventions or education. A recent meta-analysis shows contingency management is more efficacious than other EBI up to 1 year following the discontinuation of reinforcers.The Matrix model has shown greater reduction in methamphetamine use, risky behaviors, and more days of abstinence compared to non-standardized outpatient treatment approaches.
This intervention combines different elements of effective approaches including cognitive and behavioral treatment using accurate information on the effects of stimulants, relapse prevention skills training, 12-step program participation, and family education. Its manualized treatment protocol ensures fidelity when the model is implemented in different settings.Motivational interviewing helps individuals to evaluate the pros and cons to change drug use and to develop personalized change behaviors. Motivational interviewing can be used in a single session or in multiple sessions. Polcin et al. compared two motivational interviewing conditions and found that both groups showed significant reductions in methamphetamine use without differences between the two groups. A greater reduction in psychiatric symptoms including anxiety and depression was found among those receiving more motivational interviewing sessions.Using SMS text messages with people who use methamphetamine has been shown to reduce methamphetamine use and HIV-related sexual transmission behaviors and increase retention in HIV care among some key populations. Scripted unidirectional texts outperform bidirectional interactive text-messaging conversations in reducing methamphetamine use and HIV sexual risk behaviors and are more cost-effective than inperson therapies. Theory-driven messaging might better benefit people in the early stages of behavior change than people who are already seeking help.Despite some demonstrated efficacy, few studies have shown ways to optimize and combine treatment approaches for methamphetamine use disorders. Qualitative reports show patients found contingency management beneficial when combined with motivational interviewing and cognitive behavioral techniques for methamphetamine use disorders. Combined motivational interviewing and cognitive behavioral treatment show efficacy in reducing methamphetamine use in HIV-positive MSM. Evidence supports combining psychosocial treatment with medication-assisted treatment in people with OUD, but it is unclear whether patients with comorbid methamphetamine use disorder will experience similar benefits. Integrating screening and brief interventions, contingency management or conditional cash transfer, and cognitive behavioral therapy for the management of substance use disorders requires trained health professionals. This is challenging in settings where human resource for mental health/substance use is scarce. Therefore, besides identifying optimal combination of EBI, it is essential to recognize potential barriers to the implementation of these strategies. The study deploys a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness of the proposed adaptive interventions and gather data on the implementation. To evaluate the effectiveness of the interventions, the study employs a Sequential Multiple Assignment Randomized Trial design. In the first phase, participants will be randomized into two front line interventions for 12 weeks. Based on their outcome at the end of this phase, they will be placed or randomized into three adaptive strategies for another 12 weeks . The economic evaluation that addresses Aim 2 aims to weigh public health and societal costs against public health and societal benefits attributed to the interventions of different intensities with a time horizon of 12 months. To address Aim 3, we will conduct an ethnographic evaluation to identify the multi-level factors that influence the adoption and scale-up of the interventions in methadone clinics.