Dr. Vest a postdoctoral fellow in the Systems Neuroscience and Pain Lab at the Stanford School of Medicine. As a formerly incarcerated scholar, he is a strong advocate for social justice issues and public policy concerning prison reentry. His dissertation focused on applying advanced latent class analysis to better understand patient groups based upon the experiences of pain and depression during treatment with buprenorphine and naloxone. His other research interests include the intersection of mental health, substance use disorders, poverty, social justice, addiction recovery, pain, and prison reentry.
PhD, Washington State University, Experimental Psychology (2019)
MSc, Washington State University, Experimental Psychology (2016)
Bachelor of Science, Washington State University - Tricities, Psychology (2013)
Associates of Arts, Columbia Basin College, Chemical Dependency Counseling (2011)
Depression, Alcoholics Anonymous Involvement, and Daily Drinking Among Patients with Cooccurring Conditions: A Longitudinal Parallel Growth Mixture Model.
Alcoholism, clinical and experimental research
BACKGROUND: Patients with cooccurring mental health and substance use disorders often find it difficult to sustain long-term recovery. One predictor of recovery may be how depression symptoms and Alcoholics Anonymous (AA) involvement influence alcohol consumption during and after inpatient psychiatric treatment. This study utilized a parallel growth mixture model to characterize the course of alcohol use, depression, and AA involvement in patients with cooccurring diagnoses.METHODS: Participants were adults with cooccurring disorders (n=406) receiving inpatient psychiatric care as part of a telephone monitoring clinical trial. Participants were assessed at intake, 3-, 9-, and 15-month follow-up.RESULTS: A 3-class solution was the most parsimonious based upon fit indices and clinical relevance of the classes. The classes identified were high AA involvement with normative depression (27%), high stable depression with uneven AA involvement (11%), and low AA involvement with normative depression (62%). Both the low and high AA classes reduced their drinking across time and were drinking at less than half their baseline levels at all follow-ups. The high stable depression class reported an uneven pattern of AA involvement and drank at higher daily frequencies across the study timeline. Depression symptoms and alcohol use decreased substantially from intake to 3months and then stabilized for 90% of patients with cooccurring disorders following inpatient psychiatric treatment.CONCLUSIONS: These findings can inform future clinical interventions among patients with cooccurring mental health and substance use disorders. Specifically, patients with more severe symptoms of depression may benefit from increased AA involvement, whereas patients with less severe symptoms of depression may not.
View details for DOI 10.1111/acer.14474
View details for PubMedID 33104268
Steep increases in fentanyl-related mortality west of the Mississippi River: Recent evidence from county and state surveillance.
Drug and alcohol dependence
2020; 216: 108314
BACKGROUND: Overdose deaths from synthetic opioids (e.g., fentanyl) increased 10-fold in the United States from 2013 to 2018, despite such opioids being rare in illicit drug markets west of the Mississippi River. Public health professionals have feared a "fentanyl breakthrough" in western U.S. drug markets could further accelerate overdose mortality. We evaluated the number and nature of western U.S. fentanyl deaths using the most recent data available.METHODS: We systematically searched jurisdictions west of the Mississippi River for publicly available data on fentanyl-related deaths since 2018, the most recent Centers for Disease Control and Prevention (CDC) statistics. Using mortality data from 2019 and 2020, we identified changes in fentanyl-related mortality rate and proportion of fatal heroin-, stimulant, and prescription pill overdoses involving fentanyl.RESULTS: Seven jurisdictions had publicly available fentanyl death data through December 2019 or later: Arizona; California; Denver County, CO; Harris County, TX; King County, WA; Los Angeles County, CA; and Dallas-Fort Worth, TX (Denton, Johnson, Parker, and Tarrant counties). All reported increased fentanyl deaths over the study period. Their collective contribution to national synthetic narcotics mortality increased 371 % from 2017 to 2019. Available 2020 data shows a 63 % growth in fentanyl-mortality over 2019. Fentanyl-involvement in heroin, stimulant, and prescription pill deaths has substantially grown.DISCUSSION: Fentanyl has spread westward, increasing deaths in the short-term and threatening to dramatically worsen the nation's already severe opioid epidemic in the long-term. Increasing the standard dose of naloxone, expanding Medicaid, improving coverage of addiction treatment, and public health educational campaigns should be prioritized.
View details for DOI 10.1016/j.drugalcdep.2020.108314
View details for PubMedID 33038637
Association of State Policies Allowing Medical Cannabis for Opioid Use Disorder With Dispensary Marketing for This Indication.
JAMA network open
2020; 3 (7): e2010001
Importance: Misinformation about cannabis and opioid use disorder (OUD) may increase morbidity and mortality if it leads individuals with OUD to forego evidence-based treatment. It has not been systematically evaluated whether officially designating OUD as a qualifying condition for medical cannabis is associated with cannabis dispensaries suggesting cannabis as a treatment for OUD.Objective: To examine whether state-level policies designating OUD a qualifying condition for medical cannabis are associated with more dispensaries claiming cannabis can treat OUD.Design, Setting, and Participants: This cross-sectional, mixed-methods study of 208 medical dispensary brands was conducted in 2019 using the brands' online content. The study included dispensaries operating in New Jersey, New York, and Pennsylvania, where OUD is a qualifying condition for medical cannabis, and in Connecticut, Delaware, Maryland, Ohio, and West Virginia, where this policy does not exist.Exposures: Presence of OUD on the list of qualifying conditions for a state's medical cannabis program.Main Outcomes and Measures: Binary indicators of whether online content from the brand said cannabis can treat OUD, can replace US Food and Drug Administration-approved medications for OUD, can be an adjunctive therapy to Food and Drug Administration-approved medications for OUD, or can be used as a substitute for opioids to treat other conditions (eg, chronic pain).Results: After excluding duplicates, listings for nonexistent dispensaries, and those without online content, 167 brands across 7 states were included in the analysis (44 [26.3%] in states where OUD was a qualifying condition and 123 [73.7%] in adjacent states). A dispensary listed in a directory for West Virginia was not operational; therefore, comparison states were Connecticut, Delaware, Maryland, and Ohio. In policy-exposed states, 39% (95% CI, 23%-55%) more dispensaries claimed cannabis could treat OUD compared with unexposed states (P<.001). For replacing medications for OUD and being an adjunctive therapy, the differences were 14% (95% CI, 2%-26%; P=.002) and 28% (95% CI, 14%-42%; P<.001), respectively. The suggestion that cannabis could substitute for opioids (eg, to treat chronic pain) was made by 25% (95% CI, 9%-41%) more brands in policy-exposed states than adjacent states (P=.002).Conclusions and Relevance: In this study, state-level policies designating OUD as a qualifying condition for medical cannabis were associated with more dispensaries claiming cannabis can treat OUD. In the current policy environment, in which medical claims by cannabis dispensaries are largely unregulated, these advertisements could harm patients. Future research linking these policies to patient outcomes is warranted.
View details for DOI 10.1001/jamanetworkopen.2020.10001
View details for PubMedID 32662844
Coping Motives Mediate the Relationship Between Borderline Personality Features and Alcohol, Cannabis, and Prescription Opioid Use Disorder Symptomatology in a Substance Use Disorder Treatment Sample
PERSONALITY DISORDERS-THEORY RESEARCH AND TREATMENT
2020; 11 (3): 230–36
Borderline personality disorder and substance use disorder co-occur at a high rate. However, little is known about the mechanisms driving this association. This study examined substance use motives for 3 common substance use disorders among 193 individuals in substance use disorder treatment. We found that the coping motive consistently mediated the relationship between borderline personality and alcohol, cannabis, and prescription opioid use disorders. For this substance use disorder treatment sample, our findings support the self-medication model of substance use, and that interventions aimed at coping-related substance use would be helpful among these patients. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
View details for DOI 10.1037/per0000385
View details for Web of Science ID 000526037300008
View details for PubMedID 31815505
View details for PubMedCentralID PMC7156315
Parallel modeling of pain and depression in prediction of relapse during buprenorphine and naloxone treatment: A finite mixture model.
Drug and alcohol dependence
2020; 209: 107940
BACKGROUND: Relapse is common in treatment for opioid use disorders (OUDs). Pain and depression often co-occur during OUD treatment, yet little is known about how they influence relapse among patients with a primary diagnosis of prescription opioid use disorder (POUD). Advanced statistical analyses that can simultaneously model these two conditions may lead to targeted clinical interventions.METHOD: The objective of this study was to utilize a discrete survival analysis with a growth mixture model to test time to prescription opioid relapse, predicted by parallel growth trajectories of depression and pain, in a clinical sample of patients in buprenorphine/naloxone treatment. The latent class analysis characterized heterogeneity with data collected from the National Institute of Drug Abuse Clinical Trials Network project (CTN-0030).RESULTS: Results suggested that a 4-class solution was the most parsimonious based on global fit indices and clinical relevance. The 4 classes identified were: 1) low relapse, 2) high depression and moderate pain, 3) high pain, and 4) high relapse. Odds ratios for time-to-first use indicated no statistically significant difference in time to relapse between the high pain and the high depression classes, but all other classes differed significantly.CONCLUSION: This is the first longitudinal study to characterize the influence of pain, depression, and relapse in patients receiving buprenorphine and naloxone treatment. These results emphasize the need to monitor the influence of pain and depression during stabilization on buprenorphine and naloxone. Future work may identify appropriate interventions that can be introduced to extend time-to-first prescription opioid use among patients.
View details for DOI 10.1016/j.drugalcdep.2020.107940
View details for PubMedID 32135429
Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System.
Journal of urban health : bulletin of the New York Academy of Medicine
People in prison are particularly vulnerable to infectious disease due to close living conditions and the lack of protective equipment. As a result, public health professionals and prison administrators seek information to guide best practices and policy recommendations during the COVID-19 pandemic. Using latent profile analysis, we sought to characterize Texas prisons on levels of COVID-19 cases and deaths among incarcerated residents, and COVID-19 cases among prison staff. This observational study was a secondary data analysis of publicly available data from the Texas Department of Criminal Justice (TBDJ) collected from March 1, 2020, until July 24, 2020. This project was completed in collaboration with the COVID Prison Project. We identified relevant profiles from the data: a low-outbreak profile, a high-outbreak profile, and a high-death profile. Additionally, current prison population and level of employee staffing predicted membership in the high-outbreak and high-death profiles when compared with the low-outbreak profile. Housing persons at 85% of prison capacity was associated with lower risk of COVID-19 infection and death. Implementing this 85% standard as an absolute minimum should be prioritized at prisons across the USA.
View details for DOI 10.1007/s11524-020-00504-z
View details for PubMedID 33337529
Do We Know Enough to Prescribe Opioid-Agonist Therapies to Adolescents With Problematic Opioid Use? A Commentary on Camenga et al. (2019)
JOURNAL OF STUDIES ON ALCOHOL AND DRUGS
2019; 80 (4): 406–7
View details for Web of Science ID 000485639400003
Borderline Personality Disorder Features and Risk for Prescription Opioid Misuse in a Chronic Pain Sample: Roles for Identity Disturbances and Impulsivity.
Journal of personality disorders
Although borderline personality disorder (BPD) is associated with both chronic pain and substance abuse, little research examines how BPD features in chronic pain patients may constitute a risk factor for misuse of prescription opioids, and no prior research has examined which particular component(s) of BPD might put chronic pain patients at risk-an oversight that undermines prevention and treatment of such problematic opioid use. In a cross-sectional study of patients in treatment for chronic pain (N = 147), BPD features were associated with several measures of prescription opioid misuse, even controlling for pain severity and interference. Specifically, the identity disturbances and self-harmful impulsivity facets of BPD were most consistently associated with opioid misuse, and exploratory analyses suggested that these factors may be interactive in their effects. Together, these results suggest that BPD features-especially unstable identity and self-harmful impulsivity-play a unique role in problematic prescription opioid use in chronic pain settings.
View details for DOI 10.1521/pedi_2019_33_440
View details for PubMedID 31609188
Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex.
2018; 87: 46–54
Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.
View details for DOI 10.1016/j.addbeh.2018.06.015
View details for PubMedID 29945027
Borderline Features and Prescription Opioid Misuse in a Substance Use Disorder Treatment Sample.
Substance use & misuse
2018; 54 (1): 166–75
An association between borderline personality disorder (BPD) and substance use disorders has been well established. However, very little is known about the relationship between BPD and prescription opioid misuse, specifically.The relationship between borderline personality disorder features and prescription opioid misuse was examined in a sample of 208 substance use disorder treatment patients in the outpatient level of care.Controlling for use of alcohol and cannabis, as well as other relevant covariates, we found that BPD features were associated with age of first use of prescription opioids, prescription opioid use disorder symptom count, lifetime use, past 12-month use, problem use, and cravings. Additionally, we found that BPD features were not associated with greater use of medically necessary opioid pain killers as prescribed by a physician; rather the association with BPD was in the greater likelihood of misuse (non-prescribed) of prescription opioid pain killers. The self-harm/impulsivity facet of BPD was most strongly associated with prescription opioid-related variables. Conclusions/Importance: These findings suggest that BPD is related to prescription opioid misuse, above and beyond the tendency to use other drugs of abuse, and that the self-harm impulsivity facet appears to be driving this relationship.
View details for DOI 10.1080/10826084.2018.1512626
View details for PubMedID 30375912
Impulsivity and risk for prescription opioid misuse in a chronic pain patient sample.
2016; 60: 184–90
Misuse of, and addiction to, prescription opioid pain relievers is a growing concern, in both non-clinical samples and chronic pain patients receiving opioid analgesic therapy. Research is needed to identify which patients may be more prone to misuse or dependence on opioids in a chronic pain treatment setting. Based on literature showing the role of impulsivity in substance use disorders generally, we predicted that impulsivity may also be important to understanding which individuals may be at risk for opioid misuse when opioids are prescribed for pain. The present study examined associations between impulsivity facets and measures of prescription opioid misuse and symptoms. Four facets of impulsivity were examined: urgency, sensation seeking, lack of premeditation, and lack of perseverance. 143 patients receiving treatment for chronic pain at a regional pain clinic completed a series of questionnaires including the UPPS and measures of opioid risk and misuse. Consistent with predictions, urgency was associated with risk for future misuse (β=0.246, p<0.05), current misuse (β=0.253, p<0.01), and symptoms of current opioid use disorder (OUD; β=0.206, p<0.05). Sensation seeking was also associated with current misuse (β=0.279, p<0.01). These results suggest that identifying facets of impulsivity is important to understanding and assessing for risk of prescription opioid misuse in the context of chronic pain treatment. These data indicate that patients who react impulsively to negative mood states and cravings may be especially prone to developing aberrant use patterns when taking prescription opioids. This is the first known study to identify the role of urgency in predicting risk for OUDs in chronic pain patients.
View details for DOI 10.1016/j.addbeh.2016.04.015
View details for PubMedID 27156219