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Background The objective of this qualitative study was to better understand the experiences of individuals living with opioid use disorder (OUD) and chronic pain using medical cannabis (MC) for 12 months. Methods Perspectives were captured via 10 key informant interviews conducted after 12 months of treatment with MC Results Key themes identified regarding the reasons for initially pursuing MC included: (1) cannabis supply safety; (2) a desire to reduce or eliminate prescription medication usage for pain, OUD and mood; (3) to induce feelings of calm or relaxation; and (4) to improve levels of chronic pain. At 12 months, key themes identified surrounding their lived experiences with MC use were: (1) reductions in pain levels; (2) positive changes in emotional regulation and mood; (3) improvements in sleep quality and duration; and (4) reductions in cravings to use illicit drugs. The primary concerns expressed by interviewees surrounding MC use at 12 months related to changes in weight and appetite, and the cost of MC products. Conclusions These qualitative data provide targets for future quantitative investigations of the potential mechanisms by which MC can impact recovery in the context of OUD.

To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. Using an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. Of 70,661 patients who were sent research invitations, 1021 (1.44%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79% (n=547) of the participants were app users and, of those, 75.3% (n=412), 50.1% (n=274), and 25.4% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31%) of the participants completed the 4-month online surveys. A total of 33.5% (183/547), 29.3% (157/536), and 27.1% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. EHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use.

Background Poor sleep quality is a commonly reported reason for medical cannabis (MC) use, yet evidence regarding its long-term impact on sleep remains limited. This study evaluated changes in subjective sleep quality over a 12-month period among adults initiating MC treatment in Pennsylvania and explored whether preferred route of administration and referring condition were associated with observed changes. Methods A total of 137 adults newly referred for MC in PA completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and at 3, 6, 9, and 12 months. Linear mixed effects models assessed changes in PSQI global and subscale scores over time. Additional models evaluated whether preferred administration route (oral vs. other) and referring condition (chronic pain, anxiety, PTSD) were associated with differences in observed outcomes. Results Global sleep quality scores, where higher values indicate poorer sleep quality, were significantly higher at baseline than at each follow-up point ( p  < .0001), with no significant differences among follow-up assessments, suggesting early and sustained improvements in self-reported sleep quality. Improvements were observed across all PSQI subscales. No significant relationships were found between sleep quality scores and either administration route or referring condition. Conclusions These findings suggest that MC may be associated with improvements in subjective sleep quality, though its impact did not vary as a function of administration route or primary referring condition. Additional research using objective sleep measures and controlled designs is needed to clarify MC’s role in sleep quality.

Background The psychosocial impact of medical marijuana use is not yet known. This study evaluated short-term changes in health-related quality of life (HRQoL) over the first three months of medical marijuana use. Methods This prospective, observational, longitudinal study followed adults newly recommended for medical marijuana by a physician for any of the more than 20 qualifying medical conditions in Pennsylvania. Participants ( N  = 438) provided their clinical status and demographic information, and completed semi-structured interviews prior to medical marijuana initiation (baseline) and at three months. HRQoL was assessed by the Short Form-36 (SF-36). Paired-samples t -tests evaluated changes in HRQoL over time. Results Participants ( M age = 46.4 years [15.6]; 66.4% female) were mostly commonly referred for medical marijuana to treat anxiety disorders (61.9%) or severe chronic or intractable pain (53.6%). Participants reported rapid and significant improvements in all of the domains of HRQoL from baseline to three months after initiating medical marijuana use (physical functioning, role limitations due to physical health problems, emotional well-being, role limitations due to emotional problems, bodily pain, social functioning, energy/fatigue and general health, P  < .001 for all). Age was negatively predictive of level of improvement over time for the physical functioning ( P  < .0001), role limitations due to physical health problems ( P  < .001), and pain ( P  < .0001) domains after controlling for baseline, with older participants displaying less improvement than younger participants. Conclusions Gains were observed in all HRQoL domains assessed after three months of medical marijuana use. In several domains, age was a significant predictor of degree of improvement.

Formal psychosocial support programs after weight-loss surgery are limited in scope and availability. This randomized pilot study evaluated the feasibility of a postoperative behavioral intervention program. Postoperative weight-loss surgery patients (N = 50) were recruited from February 2017-July 2017 and randomized to a four-month behavioral program or usual care wait-list. Outcomes evaluated in addition to feasibility included health-related quality of life (Short Form -36), psychosocial functioning and adherence. Secondary outcomes included within-group changes for each outcome. Out of eight possible sessions, intervention participants attended a mean of 4.2 sessions. Intervention group participants experienced greater improvements in the social functioning domain of health-related quality of life compared to usual care. Self-reported dietary adherence in the intervention group remained stable, while usual care group dietary adherence declined. Within the intervention group, participants also reported gains in the physical function, pain and general health aspects of quality life from baseline to post-treatment. No differences in weight, mood or other eating behaviors (e.g., loss of control, emotional eating) were evident between groups. Though participation in a postoperative behavioral intervention varied, the program helped participants to maintain aspects of quality of life and self-reported adherence to dietary recommendations. ClinicalTrials.gov NCT03092479.

Objectives Black, indigenous and people of color (BIPOC) remain underrepresented in research occupations. This report discusses a collaboration to train undergraduate BIPOC students in clinical research between a public health institute, two medical schools, and a historically Black College or University (HBCU). This nine-month program trained BIPOC undergraduates in research methodology, psychology, and addiction science, and immersed trainees in real-world research. The program included didactic seminars, experiential activities, and a mentored research project culminating in a poster and oral presentation. Methods Key learnings, program satisfaction survey results, and preliminary outcomes from the first three program cohorts (N = 6 students) are presented. This program addressed several barriers hypothesized to contribute to the limited number of BIPOC students pursuing research careers, including mentorship from BIPOC faculty and financial concerns. Results Students reported moderate to high satisfaction with the program and endorsed gaining new research skills. Limitations and future directions are discussed. Conclusion The expansion of the BIPOC health and research workforce is an urgent priority given the importance of BIPOC professionals to the health of our nation. Trial registration ClinicalTrials.gov Identifier: NCT04650386.

Background Medical cannabis (MC) is approved for the treatment of opioid use disorder (OUD) in Pennsylvania, but little is known about how MC impacts illicit opioid use or the clinical and psychosocial factors including pain severity levels that can precede illicit opioid use. This observational study examined the extent to which changes in rates of illicit opioid use and in pain and psychosocial functioning were observed following the first three months of MC treatment. Methods A referred sample of 47 adults taking buprenorphine/naloxone for OUD with a minimum pain severity rating of 5/10 enrolled from March 2022–April 2023. Participants were recruited from an outpatient MC physician recommender’s office and were offered a discounted MC 1:1 tetrahydrocannabinol:cannabidiol 5 mg:5 mg daily oral capsule. The primary study outcomes were pain severity, self-efficacy and interference, and the rates of illicit substance use as assessed via urine drug screening (UDS). Results Participants (64% male, 49% Black, average age = 44 years) reported significant decreases in pain severity from baseline ( M  = 5.18, SD  = 2.09) to Month 3 ( M  = 4.39, SD  = 2.28), P  < 0.01, Cohen’s d  = 0.54, and pain interference from baseline ( M  = 5.21, SD  = 2.79) to Month 3 ( M  = 4.32, SD  = 2.86), P  < 0.01, Cohen’s d  = 0.47, and increases in pain-related self-efficacy from baseline ( M  = 6.55, SD  = 3.57) to Month 3 ( M  = 8.05, SD  = 3.30), P  < 0.01, Cohen’s d  = 0.44. Rates of opioid use ( X 2 [1] = 4.00, P  = 0.13) did not differ significantly from baseline (16%) to Month 3 (5%). Cravings for opioids were mildly higher at baseline ( M  = 2.15, SD  = 2.88) than at 3-months ( M  = 1.78, SD  = 2.95) but this difference was not statistically significant, P  = 0.49, d  = 0.1. Sleep quality scores improved significantly from baseline ( M  = 12.38, SD  = 4.40) to Month 3 ( M  = 10.95, SD  = 4.95), P  < 0.05, d  = 0.33. Quality of life significantly improved in seven of eight domains ( P  < 0.05). Conclusion MC treatment initiation was associated with reductions in pain severity and interference and improvements in quality of life and sleep quality, but not in illicit opioid use or cravings in adults with chronic pain receiving buprenorphine/naloxone for OUD.

Background Individuals who have substance use disorders may have an elevated risk of suicidality. This study sought to examine the prevalence of, and identify factors associated with, suicidality in adults with opioid use disorder (OUD) initiating office-based buprenorphine treatment. Methods Individuals were eligible to participate if they had OUD and had initiated treatment in the past month. Participants ( n  = 244) completed a semi-structured interview using the Addiction Severity Index—Lite. Results At baseline, 37.70% of participants reported significant thoughts of suicide over their lifetime and 27.46% reported suicidal attempts over their lifetime. Logistic regression analyses were used to identify predictors of lifetime suicidal thoughts and attempts. A history of physical abuse (OR = 4.31, p  < .001), having chronic pain-related conditions (OR = 3.28, p  < .001), a history of depression (OR = 3.30, p  = .001) or anxiety (OR = 7.47, p  = .001), and Latino/a/x ethnicity (OR = 2.66, p  = .01) were associated with an increased risk of lifetime suicidal thoughts. A history of sexual abuse (OR = 2.89, p  = .01), Latino/a/x ethnicity (OR = 4.01, p  < .001), a history of depression (OR = 4.03, p  = .001) or anxiety (OR = 15.65, p  = .007) and having a chronic pain-related condition (OR = 2.43, p  = .01), were associated with an increased risk of lifetime suicide attempts. Conclusions Results demonstrate the high prevalence of suicidal thoughts and attempts among patients initiating buprenorphine. Findings may help to better identify at-risk patients and to inform screening, prevention, and mental health treatment efforts. Trial registration : ClinicalTrials.gov, NCT04650386 (registered 12 December 2020, https://clinicaltrials.gov/ct2/show/NCT04650386 ) and NCT04257214 (registered 5 February 2020, https://clinicaltrials.gov/ct2/show/NCT04257214 ).

Few studies have evaluated weight change in patients who initiate medical marijuana treatment to address diagnosed health concerns. The objective of this study was to examine whether patients initiating medical marijuana use for a qualifying health condition experienced changes in health and biopsychosocial functioning over time, including weight gain or loss. Specifically, this observational, longitudinal study evaluated changes in the body mass index (BMI) of adults with co-morbid obesity (body mass index [BMI] ≥ 30 kg/m 2 ) and severe obesity (BMI ≥ 40 kg/m 2 ) who were starting medical marijuana treatment for any of the 23 qualifying medical conditions at one of three dispensaries in Pennsylvania. Height and weight measurements were collected at baseline (prior to medical marijuana use) and then 90 days (± 14 days) later. Participants included in analyses ( n  = 52, M  = 55.0 ± 13.6 years, 59.6% female) had a mean baseline BMI of 36.2 ± 5.4 kg/m 2 and the majority sought medical marijuana for chronic pain (73.1%). No significant change in BMI was observed from baseline to month three ( p  > 0.05) in the sample. Additionally, no significant change in BMI was observed in the subset of patients with severe obesity ( n  = 12, p  > 0.05). Our findings are limited by low follow-up rates and convenience sampling methodology but may help to mitigate weight gain concerns in the context of medical marijuana use.

There is growing interest in identifying and recruiting research participants from health systems using electronic health records (EHRs). However, few studies have described the practical aspects of the recruitment process or compared electronic recruitment methods to in-person recruitment, particularly across health systems.BACKGROUNDThere is growing interest in identifying and recruiting research participants from health systems using electronic health records (EHRs). However, few studies have described the practical aspects of the recruitment process or compared electronic recruitment methods to in-person recruitment, particularly across health systems.The objective of this study was to describe the steps and efficiency of the recruitment process and participant characteristics by recruitment strategy.OBJECTIVEThe objective of this study was to describe the steps and efficiency of the recruitment process and participant characteristics by recruitment strategy.EHR-based eligibility criteria included being an adult patient engaged in outpatient primary or bariatric surgery care at one of 5 health systems in the PaTH Clinical Research Network and having ≥2 weight measurements and 1 height measurement recorded in their EHR within the last 5 years. Recruitment strategies varied by site and included one or more of the following methods: (1) in-person recruitment by study staff from clinical sites, (2) US postal mail recruitment letters, (3) secure email, and (4) direct EHR recruitment through secure patient web portals. We used descriptive statistics to evaluate participant characteristics and proportion of patients recruited (ie, efficiency) by modality.METHODSEHR-based eligibility criteria included being an adult patient engaged in outpatient primary or bariatric surgery care at one of 5 health systems in the PaTH Clinical Research Network and having ≥2 weight measurements and 1 height measurement recorded in their EHR within the last 5 years. Recruitment strategies varied by site and included one or more of the following methods: (1) in-person recruitment by study staff from clinical sites, (2) US postal mail recruitment letters, (3) secure email, and (4) direct EHR recruitment through secure patient web portals. We used descriptive statistics to evaluate participant characteristics and proportion of patients recruited (ie, efficiency) by modality.The total number of eligible patients from the 5 health systems was 5,051,187. Of these, 40,048 (0.8%) were invited to enter an EHR-based cohort study and 1085 were enrolled. Recruitment efficiency was highest for in-person recruitment (33.5%), followed by electronic messaging (2.9%), including email (2.9%) and EHR patient portal messages (2.9%). Overall, 779 (65.7%) patients were enrolled through electronic messaging, which also showed greater rates of recruitment of Black patients compared with the other strategies.RESULTSThe total number of eligible patients from the 5 health systems was 5,051,187. Of these, 40,048 (0.8%) were invited to enter an EHR-based cohort study and 1085 were enrolled. Recruitment efficiency was highest for in-person recruitment (33.5%), followed by electronic messaging (2.9%), including email (2.9%) and EHR patient portal messages (2.9%). Overall, 779 (65.7%) patients were enrolled through electronic messaging, which also showed greater rates of recruitment of Black patients compared with the other strategies.We recruited a total of 1085 patients from primary care and bariatric surgery settings using 4 recruitment strategies. The recruitment efficiency was 2.9% for email and EHR patient portals, with the majority of participants recruited electronically. This study can inform the design of future research studies using EHR-based recruitment.CONCLUSIONSWe recruited a total of 1085 patients from primary care and bariatric surgery settings using 4 recruitment strategies. The recruitment efficiency was 2.9% for email and EHR patient portals, with the majority of participants recruited electronically. This study can inform the design of future research studies using EHR-based recruitment.