Background and aims Mitragyna speciosa (‘kratom’) contains mu opioid partial agonists. It is widely available, and occasionally used as a home remedy for opioid use disorder. The Drug Enforcement Agency considers kratom a drug of concern; however, prevalence of use and role in drug misuse are unknown. This study aimed to characterize kratom use in the United States. Design Cross‐sectional Survey of Non‐Medical Use of Prescription Drugs (NMURx) Program, 2018 third quarter and 2019 first quarter. Setting A validated non‐probability online survey in the United States. Participants A total of 59 714 respondents aged 18 years or older, weighted to represent the adult US population (n = 252 063 800). Measurements In addition to prevalence of past‐year kratom and other drug use, behavior proportions were estimated. The Drug Abuse Screening Test (DAST‐10) estimated consequences of drug abuse. Findings The estimated prevalence of past‐year kratom use in the adult US population was 0.8% [95% confidence interval (CI) = 0.7–0.9], representing 2 031 803 adults. Life‐time prevalence was 1.3% (95% CI = 1.2–1.4), representing 3 353 624 adults. Kratom users were younger (mean 35 years, P < 0.001), with higher proportions of males (61.0 versus 48.6%, P < 0.001), students (14.1 versus 7.5%, P < 0.001) and health‐care professionals (9.7 versus 4.5%, P < 0.001) and fewer bachelor's/advanced degree graduates (33.4 versus 42.6%, P < 0.001) compared with non‐users. Results were inconclusive on whether there was a difference in kratom use by race, household income or employment status. Among those with past‐year kratom use, 36.7% (95% CI = 32.1–41.3) non‐medically used prescription opioids, 21.7% (95% CI = 18.0–25.5) used illicit opioids, 54.4% (95% CI = 49.5–59.3) used another illicit drug and 67.1% (95% CI = 62.5–71.8) used cannabis. The DAST‐10 profile was more often substantial/severe in kratom users (21 versus 1%, P < 0.001) compared with non‐users. Conclusions Estimated United States past‐year prevalence of kratom use is 0.8%, and kratom users tend to have more serious substance abuse profiles than non‐users or users of cannabis, alcohol or cigarettes. To our knowledge, this is the first description of kratom use at the national level.
Background: Alarms have been raised that COVID-19 may disproportionately affect certain populations with substance use disorders, particularly Opioid Use Disorder (OUD), however warnings have largely focused on social risks such as reduced availability of services. Objectives: This commentary highlights three plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19. Results: Opioid-related respiratory depression may amplify risks of hypoxemia from COVID-19 viral pneumonia. Complex opioid immune modulation may impact host response to COVID-19, though the effect direction and clinical significance are unclear. Drug-drug interactions may affect individuals with OUD who are co-administered medications for OUD and medications for COVID-19, particularly due to cardiac adverse effects. Conclusions/Importance: There are plausible biological mechanisms for potentially worsened outcomes in patients with OUD who contract COVID-19; these mechanisms require further study, and should be considered in individuals with OUD.
R apid COVID-19 vaccine development and uptake are critical to mitigating the ongoing epidemic. Current vaccine candidates are at various stages of development and regulatory approval. These vaccines are broadly considered safe, though adverse effects have not yet been fully characterized. In this study we present the first description of thyroiditis linked to SARS-CoV-2 vaccination.A 57-year-old woman with no medical history received the first dose of the Pfizer-BioNTech SARS-CoV-2 vaccine 34 days before presentation, with associated fatigue, nausea, chills, and myalgias lasting 1.5 days. She received the second dose 13 days before presentation, and within 24 hours had recurrence of her symptoms associated with new progressive anterior neck pain and swelling. She was referred to the hospital by her outpatient provider for thyrotropin (TSH) 0.009 lU/mL, thyroxine (T4) free 2.6 ng/dL, and T4 total 17.4 mcg/dL (outpatient normal ranges [NRs] unavailable). On hospital arrival, she was febrile to 38.3°C with a pulse of 137 beats/min. Examination revealed right thyroid gland enlargement with diffuse tenderness, and no proptosis, lid lag, or periorbital edema. Laboratories showed TSH <0.008 lU/mL (NR: 0.4-4.2), free T4 1.92 ng/dL (NR: 0.8-1.5), triiodothyronine (T3) total 137 ng/dL (NR: 87-178) with thyrotropin receptor antibody <1.10 U/L (NR: 0-1.75), thyroid stimulating immunoglobulin <0.10 U/L (NR: 0-0.55), thyroid peroxidase antibody <0.5 U/mL (NR: 0-5.6), and thyroglobulin antibody 3.4 U/mL (NR: 0-4.1). Thyroid ultrasound showed an asymmetrically enlarged hypervascular heterogeneous right thyroid lobe suggestive of thyroiditis. She was treated with propranolol and ibuprofen and later started on prednisone as an outpatient.There is likely a causal relationship between this patient's thyroiditis with thyrotoxicosis and the COVID-19 mRNA vaccine, given the condition's temporal relationship with the vaccine in a previously healthy patient with no alternative suspected cause. We reviewed the Vaccine Adverse Event Reporting System for thyroid dysfunction after the COVID-19 vaccine, and there is one case (922030) of a 46-year-old woman of ''thyroiditis with hyperthyroidism,'' who developed fever, neck pain, and tachycardia 10 days postvaccine (1). Cases 1039886 and 984402 have insufficient information but may involve postvaccine hyperthyroidism. Rare reports have linked subacute thyroiditis to varying influenza vaccines (2-4), and immune dysregulation has been
Background and Aims Increased alcohol consumption has been proposed as a potential consequence of the coronavirus disease 2019 (COVID‐19) pandemic. There has been little scrutiny of alcohol use behaviors resulting in hospital visits, which is essential to guide pandemic public policy. We aimed to determine whether COVID‐19 peak restrictions were associated with increased hospital visits for alcohol use or withdrawal. Secondary objectives were to describe differences based on age, sex and race, and to examine alcohol‐related complication incidence. Design Multi‐center, retrospective, pre–post study. Setting New York City health system with five participating hospitals. Participants Adult emergency department encounters for alcohol use, alcoholic gastritis or pancreatitis or hepatitis, alcohol withdrawal syndrome, withdrawal seizure or delirium tremens. Measurements Age, sex, race, site and encounter diagnosis. Encounters were compared between 2019 and 2020 for 1 March to 31 May. Findings There were 2790 alcohol‐related visits during the 2019 study period and 1793 in 2020, with a decrease in total hospital visits. Of 4583 alcohol‐related visits, median age was 47 years, with 22.3% females. In 2020 there was an increase in percentage of visits for alcohol withdrawal [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI) = 1.07–1.67] and withdrawal with complications (aOR = 1.40, 95% CI = 1.14–1.72), and a decline in percentage of hospital visits for alcohol use (aOR = 0.70, 95% CI = 0.59–0.85) and use with complications (aOR = 0.71, 95% CI = 0.58–0.88). It is unknown whether use visit changes mirror declines in other chief complaints. The age groups 18–29 and 60–69 years were associated with increased visits for use and decreased visits for withdrawal, as were non‐white race groups. Sex was not associated with alcohol‐related visit changes despite male predominance. Conclusions In New York City during the initial COVID‐19 peak (1 March to 31 May 2020), hospital visits for alcohol withdrawal increased while those for alcohol use decreased.
This study is the first to measure SpCO during active smoking in an uncontrolled environment. It suggests 80% of smokers have SpCO ≤ 5%, but potentially lends support for the current 9% as a threshold, depending on clinical context.
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