Opioids During Hospitalization Linked to Post-Discharge Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh

Dr. Donohue

Dr. Julie Donohue, Ph.D.
Professor, Department of Health Policy and Management
Vice Chair for Research
Graduate School of Public Health
University of Pittsburgh

MedicalResearch.com: What is the background for this study?

Response: The opioid epidemic is exacting a significant burden on families, communities and health systems across the U.S. Prescription and illicit opioids are responsible for the highest drug overdose mortality rates ever recorded. We know from previous studies that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until our study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital.

My colleagues and I reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014. Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average.

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Opioid ‘Deaths of Despair’ Don’t Explain Mortality Gap

MedicalResearch.com Interview with:

Arline T. Geronimus Sc.D Professor, Health Behavior and Health Education School of Public Health Research Professor Population Studies Center Institute for Social Research University of Michigan Member, National Academy of Medicine

Dr. Geronimus

Arline T. Geronimus Sc.D
Professor, Health Behavior and Health Education
School of Public Health
Research Professor
Population Studies Center
Institute for Social Research
University of Michigan
Member, National Academy of Medicine 

MedicalResearch.com: What is the background for this study?

Response: The gap in life expectancy between less and more educated Americans grew over the last 30 years, a deeply troubling fact. We are alone among western nations in these trends. We aimed to determine what causes of death account for this growing educational gap in life expectancy and whether the gap has continued to grow in the most recent years.

Disturbingly, we found the educational gap in life expectancy has continued to grow.

Why? A common theory is that this growing inequality is due to the opioid epidemic. Some even speculate that the less educated are dying from a composite of what they call “deaths of despair” – opioid and other drug overdose, suicide and alcoholic liver disease – with the theory being that as less educated and working class Americans have faced job loss and stagnating wages, they experience hopelessness and despair and turn to drugs, alcohol, or even suicide to ease or end their pain and feelings of hopelessness.

However, while opioid, suicide and alcoholic liver disease deaths have increased among white youth and young adults and is cause for concern, this does not imply that these deaths should be grouped together as “deaths of despair” (DOD) or that they explain the growing educational gaps in life expectancy across all groups – men, women, whites, blacks, or older as well as younger adults.

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Even if Opioids Relieve Pain, They Don’t Necessarily Improve Sleep

MedicalResearch.com Interview with:

Dr-Nicole Tang

Dr. Tang

Nicole Tang, D.Phil, C.Psychol (Reader)
Department of Psychology
Warwick Sleep and Pain Lab
University of Warwick

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current guidelines recommend non-opioid therapy as the preferred treatment of chronic non-malignant (CNP) pain, with opioids reserved to situations “when benefits for pain and function are expected to outweigh risks” [1,10]. Whilst the effectiveness of opioid therapy is usually measured in terms of pain outcomes, less is known about its effect on day-to-day functions.

A particular function of concern to patients with chronic non-malignant pain
is the ability to get a good night’s sleep.

The current systematic review has identified a set of papers with relevant outcomes regarding the effect of opioid therapy on sleep quality and sleep architecture in CNP patients. It
extends our understanding from the drug’s respiratory depression effect in healthy
individuals to the potential risks and utility of opioid therapy for chronic non-malignant pain
patients with sleep disturbances.

Whilst the narrative synthesis and the exploratory meta-analysis of a subset of data both suggest that the use of opioid therapy is associated with an overall report of sleep quality improvement, such an improvement is not consistently replicated across studies
or substantiated by improvements in sleep parameters linked to deeper and better-sleep quality. Moreover, the improvement may be accompanied by undesirable side effects and increased daytime sleepiness that contradict with the very idea of improved
sleep quality. We are also painfully aware of the methodological limitations of the studies reviewed; their exposure to different sources of biases has heightened the risk of result inflation.

To many patients with chronic non-malignant pain, improved sleep is a top priority
when evaluating the performance of a new drug and non-drug intervention.

If we were to advance our current understanding of the
opioid-sleep relationship, future trials need to be designed with
this interdisciplinary question in mind such that validated measures
of sleep can be incorporated as an outcome measure alongside pain.

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Older Adults Using More Cannabis But Still Fear Stigma

MedicalResearch.com Interview with:

Julie Bobitt, PhD Director Interdisciplinary Health Sciences College of Applied Health Sciences University of Illinois at Urbana Champaign Champaign, IL  61820

Dr. Bobitt

Julie Bobitt, PhD
Director
Interdisciplinary Health Sciences
College of Applied Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL  61820

MedicalResearch.com: What is the background for this study?

Response:  Older adults are using cannabis at an increasing rate but little is known about their attitudes about, and experiences – including outcomes- with, recreational and medical cannabis use. We believed a qualitative study, where we conducted focus group interviews, would provide a novel perspective to our understanding and help to identify the most salient themes concerning the use of medical and recreational cannabis by adults aged 60 and older living in Colorado.

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Cesarean Section: Multimodal Program Using Non-Opioid EXPAREL Reduced Pain and Need for Opioids After Surgery

MedicalResearch.com Interview with:
Ashraf Habib, MDChief of the Division of Women’s Anesthesia and Professor of AnesthesiologyDuke University Ashraf Habib, MD
Chief of the Division of Women’s Anesthesia
Professor of Anesthesiology
Duke University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a multicenter study conducted in 13 clinical sites in the United States enrolling patients undergoing elective Cesarean-section and receiving spinal anesthesia. 186 patients were enrolled and randomized to receive EXPAREL, a long-acting, non-opioid option to manage postsurgical pain, administered via transversus abdominis plane (TAP) field block, mixed with plain bupivacaine or TAP block with plain bupivacaine alone. A TAP block numbs the nerves that supply the abdominal wall. We presented the data at the 51st Annual Meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) in Phoenix, AZ.

We aimed to collect clinical evidence that a multimodal postsurgical pain regimen using a TAP block with EXPAREL (bupivacaine liposome injectable suspension) together with regularly scheduled acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce opioid consumption more so than a standard multimodal pain control approach that combines TAP block with standard bupivacaine, regularly scheduled acetaminophen, and NSAIDs.

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Prenatal Exposure to Nicotine May Increase Risk of Nicotine Susceptibility Later in Life

MedicalResearch.com Interview with:

Davide Dulcis, PhDAssociate ProfessorDepartment of Psychiatry, UCSD School of MedicineUniversity of California, San DiegoLa Jolla, CA 92093-0603

Dr. Dulcis

Davide Dulcis, PhD
Associate Professor
Department of Psychiatry, UCSD School of Medicine
University of California, San Diego
La Jolla, CA 92093-0603

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Previous studies in humans have shown that pre-natal and early life exposure to nicotine can lead to altered children behavior and propensity for drug abuse, but the precise mechanisms involved are still unclear.

In this pre-clinical study we showed how nicotine “primes” neurons of the mouse brain’s reward center for a fate they normally would not have taken, making them more susceptible to the effects of nicotine when the animals are again exposed to nicotine later in life, said Dr. Benedetto Romoli, first author of the research article.   Continue reading

US Dentists Prescribe Opioids Many Times More Often Than British

MedicalResearch.com Interview with:
Dr. Katie Suda, PharmD, M.S.
Associate Professor
College of Pharmacy
University of Illinois at Chicago

Dr. Susan Rowan, DDS
Clinical Associate Professor, Executive Associate Dean of Clinical Affairs
College of Dentistry
University of Illinois at Chicago, 

MedicalResearch.com: What is the background for this study? 

Dr. Katie Suda: Dentists treat a lot of pain – we have all probably had the experience of a terrible tooth ache. All dentists treat pain worldwide so we would not expect a large difference in which pain medication is prescribed. However, our results show that US dentists prescribe opioids more frequently than is likely needed. This is especially true because studies have shown that non-opioid pain medications are similar or more effective for the treatment of oral pain. 

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Some Emergency Departments See Drop in Heroin Overdoses

MedicalResearch.com Interview with:
<p style="font-size: 0.9rem;font-style: italic;"><a href="https://www.flickr.com/photos/35294562@N00/3049812708">"High School Photography"</a><span>by <a href="https://www.flickr.com/photos/35294562@N00">nadja.robot</a></span> is licensed under <a href="https://creativecommons.org/licenses/by-nc/2.0/?ref=ccsearch&atype=html" style="margin-right: 5px;">CC BY-NC 2.0</a><a href="https://creativecommons.org/licenses/by-nc/2.0/?ref=ccsearch&atype=html" target="_blank" rel="noopener noreferrer" style="display: inline-block;white-space: none;opacity: .7;margin-top: 2px;margin-left: 3px;height: 22px !important;"><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc_icon.svg" /><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc-by_icon.svg" /><img style="height: inherit;margin-right: 3px;display: inline-block;" src="https://ccsearch.creativecommons.org/static/img/cc-nc_icon.svg" /></a></p>Alana Vivolo-Kantor, PhD, MPH

Behavioral Scientist, Injury Center
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study analyzed emergency department (ED) data from 23 states funded by CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program to understand changes in suspected heroin overdose from 2017 to 2018. Overall there was a significant yearly decrease of 21.5% in heroin overdose ED visits in the 23 ESOOS states.

  • Overall, the 23 ESOOS states saw a significant yearly decrease of 21.5% in heroin overdose emergency department visits.
  • Ten states witnessed significant yearly decreases ranging from 12.6% (Massachusetts) to 67.5% (District of Columbia).
  • Decreases occurred mostly in eastern states (District of Columbia, Kentucky, Maryland, Massachusetts, New Hampshire, Ohio, Pennsylvania, Rhode Island, West Virginia, and Wisconsin).
  • Three states witnessed significant yearly increases (Indiana, Illinois, and Utah).

MedicalResearch.com: What should readers take away from your report? 

  • Monitoring overdose fatalities is difficult as a result of time lags in reporting; however, emergency department (ED) data can be used to rapidly detect changes in overdose trends.
  • This study showcases the importance of using emergency department data as an early warning system for communities so that they can better monitor and respond to overdoses. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

  • Public health agencies need support to develop rapid surveillance of local trends with a standardized national definition of suspected drug overdose, including heroin, that meets their needs
  • Real-time data on overdoses could be used to guide prevention initiatives, such as distributing naloxone, linking patients to peer navigators, and initiating medication-assisted treatment for opioid use disorder. 

MedicalResearch.com: Is there anything else you would like to add?

  • The findings in this report demonstrate the local and dynamic nature of this epidemic, and highlights the need for timely regional, state, and local information.
  • No disclosures.

Citation:

American Journal of Public Health (AJPH)
Suspected Heroin Overdoses in US Emergency Departments, 2017–2018

May 22, 2019 @ 12:08 am

 

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Addiction Risk: No One Opioid Safer Than Other After Surgery

MedicalResearch.com Interview with:

Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School

Dr. Heng

Marilyn M. Heng, MD, MPH, FRCSC
Orthopaedic Trauma Surgeon
Assistant Professor of Orthopaedic Surgery
Harvard Medical School 

MedicalResearch.com: What is the background for this study?  

Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids.

The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that.  Continue reading

Caffeine Cravers Really Do Wake Up and Smell the Coffee

MedicalResearch.com Interview with:

Dr Lorenzo Stafford, PhD, CPsycholSenior Lecturer, Department of PsychologyUniversity of PortsmouthPortsmouth

Stafford

Dr Lorenzo Stafford, PhD, CPsychol
Senior Lecturer, Department of Psychology
University of Portsmouth
Portsmouth 

MedicalResearch.com: What is the background for this study?  

Response: The background to this work was that I had been thinking for sometime on the role of our sense of smell in drug consumption and addiction.  Most of the research in this area is dominated by visual processes, in particular showing how cues associated to drugs (e.g. packet of cigarettes, bottle of beer) become conditioned in such drug users. That work has been useful in explaining how in recovering addicts, long after the withdrawal symptoms have subsided, when exposed to such cues, they can nevertheless relapse to craving and consuming the drug; hence though a powerful driver, addiction is not just about reversing withdrawal symptoms.

However, most of our richer experiences are multisensory, so it seems likely that other senses must also play a role in the addictive process. Years ago, I completed a PhD on the topic of caffeine and with the general importance placed on the sensory (especially smell) aspects of coffee, all planted the seed for a possible study. We completed two experiments that examined the lowest concentration at which participants (high, moderate and non-coffee consumers) could detect (Threshold test) a coffee associated chemical (exp 1) and in a separate task, how fast they were at identifying (Recognition test) the odour of real coffee. In experiment 2, participants (coffee consumers and non-consumers) completed the same Threshold test for the coffee odour but also completed a Threshold test for a control odour.

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Over a Million Opioid Prescriptions at Risk of Diversion by Family Members

MedicalResearch.com Interview with:

Kao-Ping Chua, M.D., Ph.D.Department of PediatricsSusan B. Meister Child Health Evaluation and Research CenterUniversity of Michigan, Ann Arbor

Dr. Kao-Ping Chua

Kao-Ping Chua, M.D., Ph.D.
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan, Ann Arbor

MedicalResearch.com: What is the background for this study?  

Response: Doctor and pharmacy shopping is a high-risk behavior in which patients obtain opioid prescriptions from multiple prescribers and fill them at multiple pharmacies. Because this behavior is associated with a high risk of overdose death, there have been many efforts to help clinicians detect doctor and pharmacy shopping among patients prescribed opioids. For example, 49 states have a prescription drug monitoring program that provides information on patients’ prior controlled substance prescriptions.

In contrast, there has been little attention to the possibility that patients prescribed opioids may have family members who are engaged in opioid doctor and pharmacy shopping. Such family members may divert opioids prescribed to patients because of their access to these opioids.

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Health Professionals Concerned About Side Effects and Diversion of Medicinal Cannabis

MedicalResearch.com Interview with:
Kyle Gardiner B.Pharm(Hons)PhD candidateDiscipline of PharmacyQueensland University of Technology | QUT · Brisbane, Australia
Kyle Gardiner B.Pharm(Hons)

PhD candidate
Discipline of Pharmacy
Queensland University of Technology | QUT ·
Brisbane, Australia

MedicalResearch.com: What is the background for this study?  

Response: The background to this study was a personal interest in behavioural science. I am often intrigued as to why health professional behave the way they do. Studies exploring health professional behaviour are seldom complete or comprehensive, however.

Medicinal cannabis presents an interesting case point to explore health professional behaviours due to its topical nature. The socio-political discussion surrounding medicinal cannabis is often quite different from the medical discussion, yet for legal and regulated access to be achieved across most jurisdictions, a health professional is required to be involved in that process. Simply, if health professionals are not willing to behave, the delivery of medicinal cannabis does not occur. For purposes of transparency, I neither support or reject the use of medicinal cannabis and this paper has nothing to do improving or reducing access. This paper is about beginning to understand health professional behaviours within the context of medicinal cannabis. Yet, if we hope to change practice in the future, by definition, we need to change behaviour. We cannot change behaviour without first understanding the behaviour in context.

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Over 11 Million US Adults Have Alcoholic Liver Disease

MedicalResearch.com Interview with:

Robert Wong, MD, MS, FACGAssistant Clinical Professor of MedicineDirector, GI Education & ResearchHighland Hospital   I A member of Alameda Health SystemOakland, CA 94602

Dr. Wong

Robert Wong, MD, MS, FACG
Assistant Clinical Professor of Medicine
Director, GI Education & Research
Highland Hospital   I A member of Alameda Health System
Oakland, CA 94602 

MedicalResearch.com: What is the background for this study?  

Response: Alcoholic liver disease is a major cause of chronic liver disease in the United States and has become the leading indication for liver transplantation in the U.S.  However, accurate estimates of the true burden among U.S. adults is not well studies due to challenges in accurately identifying alcoholic liver disease or lack of awareness is screening individuals for alcohol use disorder.  Given the gaps in knowledge regarding the epidemiology of alcoholic liver disease in the U.S., our current study attempts to further contribute to the understanding of alcoholic liver disease epidemiology in the U.S

We utilized a U.S. national cross sectional database and focused on the specific subset of alcoholic fatty liver disease, which is the earlier stage of disease along the spectrum of alcoholic liver disease.  Focusing on alcoholic fatty liver disease allowed us to more accurately define and capture the prevalence of this disease.  Furthermore, given that alcoholic fatty liver disease is early on the overall spectrum of alcoholic liver disease, it is a disease state that early identification provides opportunities to implement therapy and counseling for alcohol abstinence that can prevent further liver damage and disease progression.

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Few Valid Tools to Identify Pain Patients Who Can Be Safely Prescribed Opioids

MedicalResearch.com Interview with:

Jan Klimas, PhD, MScSenior Postdoctoral FellowBC Centre on Substance Use (BCCSU) Vancouver, BC

Dr. Klimas

Jan Klimas, PhD, MSc
Senior Postdoctoral Fellow
BC Centre on Substance Use (BCCSU)
Vancouver, BC

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Some individuals prescribed opioid analgesic medications for pain develop opioid use disorder. So, much research has been conducted to develop strategies to identify patients who can be safely prescribed opioid analgesics. However, this research has not been critically reviewed through rigorous quality assessment.

This study therefore sought to identify signs, symptoms & screening tools to identify patients with pain who can be safely prescribed opioids  Continue reading

Emergency Personnel: Unintentional Occupational Exposure to Opioids

MedicalResearch.com Interview with:
Sophia K. Chiu, MD

Epidemic Intelligence Service, CDC
Division of Surveillance, Hazard Evaluations, and Field Studies
National Institute for Occupational Safety and Health
CDC 

MedicalResearch.com: What is the background for this study?

Response:  Responders across the United States are reporting work-related health effects during incidents in which suspected opioids (including fentanyl) and other illicit drugs such as cocaine, methamphetamine, cathinones, and synthetic cannabinoids are present, often as a mixture. These health effects have interfered with responders’ ability to perform their job duties.

Since 2018, a number of responder organizations have requested that NIOSH investigate the health effects experienced by emergency responders during these response incidents. These organizations are looking for ways to protect their responders and prevent the symptoms responders have reported experiencing, so that they can in turn better serve the public. NIOSH’s goal is to increase awareness among responders of how they can remain safe while providing the care the public needs.

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Cannabis and Tobacco/Nicotine Co-Use Common Among Young Adults

MedicalResearch.com Interview with:

Joan S. Tucker, Ph.D.Senior Behavioral ScientistRAND CorporationSanta Monica, CA

Dr. Tucker

Joan S. Tucker, Ph.D.
Senior Behavioral Scientist
RAND Corporation
Santa Monica, CA

MedicalResearch.com: What is the background for this study?  

Response: In light of young adults’ expanding access to cannabis through legalization for recreational use, there has been growing interest in the co-use of cannabis with tobacco/nicotine products.  Although existing data show that young adults who use cannabis products also tend to use tobacco/nicotine products, little is known about how these products are typically used together.

Existing research on co-use has mostly focused on combustible products, not accounting for the recent proliferation in cannabis and tobacco/nicotine product types and methods of use (e.g., vaping). Further, not much is known about whether there are important differences between types of co-use (e.g., using both products on the same occasion, one right after another, but not mixing them vs. using both products by mixing them in the same delivery device) in terms of heaviness of use, consequences from use, or associations with young adult functioning.

This study was designed as an important first step toward understanding cannabis and tobacco/nicotine co-use behavior among young adults and addressing these gaps in the research literature.

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Fentanyl Increasingly Found in Cocaine and Meth Drug Tests

MedicalResearch.com Interview with:

Leah LaRue, PharmD, PMPAssociate Director, Clinical AffairsMillennium Health

Dr. LaRue

Leah LaRue, PharmD, PMP
Associate Director, Clinical Affairs
Millennium Health

MedicalResearch.com: What is the background for this study?

Response: Drug overdose deaths continue to increase, despite the leveling off of prescription opioid use and policy changes limiting opioid prescribing. While fentanyl has garnered most of the attention, overdose deaths involving cocaine and methamphetamine also have increased markedly over the past few years. It is possible that those increases are due not just to those drugs, but to concomitant use with fentanyl.

To better understand what is causing this rapid increase in overdose deaths, it is important to characterize the emerging combination of other illicit drugs with fentanyl, which increases the risk of overdose. The purpose of this study was to determine whether rates of the combination of nonprescribed fentanyl with cocaine or methamphetamine have changed in urine drug test (UDT) results through time.

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14% Drivers with Kids in the Car Tested Positive for Cannabis

MedicalResearch.com Interview with:
Angela Eichelberger, Ph.D.
Senior Research Scientist
Insurance Institute for Highway Safety

MedicalResearch.com: What is the background for this study?

Response: Dr. Romano and Dr. Kelley-Baker have previously studied the problem of child endangerment in alcohol-related crashes. In the United States, each year, about 200 children die and another 4,000 are injured while being driven by a drinking adult.

For this study, we wanted to take the opportunity to look at the prevalence of alcohol and cannabis use among drivers who participated in a roadside survey in Washington State. To our knowledge, this is the first study to examine cannabis use among drivers transporting a child.

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Replacing Alcohol with Soda Not Good for the Liver

MedicalResearch.com Interview with:
E. van Eekelen, MSc | PhD Candidate
Leiden University Medical Center
Dept. Clinical Epidemiology
Leiden, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Fatty liver, defined as excess accumulation of fat within the liver, covers a broad clinical spectrum and is the leading cause of chronic liver diseases. It has also been linked to type 2 diabetes and cardiovascular disease.

The consumption of alcohol is a well-established risk factor for fatty liver. However, we hypothesized that consumption of non-alcoholic energy-containing beverages also leads to liver fat accumulation. We analysed data from the Netherlands Epidemiology of Obesity (NEO) study, which is a prospective population-based cohort study including non-invasive measurements of liver fat content by magnetic resonance spectroscopy. Besides consumption of alcoholic beverages, sugar sweetened beverages were associated with more liver fat. We specifically showed that replacement of alcoholic beverages with milk was associated with less liver fat, whereas replacement with sugar sweetened beverages was associated with a similar amount of liver fat, even when taking calories into account.  Continue reading

Does Marijuana Really Cause the Munchies?

MedicalResearch.com Interview with:
"Chocolate Brownies" by Kurtis Garbutt is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Jessica S. Kruger PhD
Clinical Assistant Professor
Department of Community Health and Health Behavior
School of Public Health and Health Professions
University of Buffalo
Daniel J. Kruger PhD
Adjunct Faculty Associate, Population Studies Center.
Michigan’s Population Studies Center 

MedicalResearch.com: What is the background for this study?

Response: The legal environment for cannabis is changing rapidly and an increasing proportion of people are using cannabis for medical and recreational purposes. All policy and practice should be informed by science, yet there is a large gap between evidence and existing practices, and the current scope of research on cannabis users is limited.

Public Health has the responsibility of protecting the public, maximizing benefits and minimizing harm in any area. However, the Public Health approach to cannabis has largely been limited to a focus on abstinence, and Federal regulations have restricted the scope of cannabis-related research.

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Better Use of Nicotine Replacement Therapies Can Help Smokers Quit

MedicalResearch.com Interview with:

Dr Nicola Lindson PhD CPsycholCochrane Tobacco Addiction Group (TAG) Managing Editor & Senior Researcher Nuffield Department of Primary Care Health Sciences,University of Oxford 

Dr. Lindson

Dr Nicola Lindson PhD CPsychol
Cochrane Tobacco Addiction Group (TAG) Managing Editor & Senior Researcher
Nuffield Department of Primary Care Health Sciences,
University of Oxford
 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: People have been using nicotine replacement therapy, otherwise known as NRT, to quit smoking for more than 20 years. NRT is available in a range of forms: skin patches, chewing gum, nasal and oral sprays, inhalators, and lozenges. We have good evidence that it is safe and that it helps more people to quit than trying to stop smoking using no medication.

We carried out a systematic review to try and find out what the best ways are to use NRT to maximise a person’s chances of quitting successfully. We did this by looking at studies that compared at least two different types of NRT use, such as higher versus lower doses, or longer versus shorter use.

The takeaway message from the review is that using more nicotine (in the form of nicotine replacement therapy, ) to aid quitting can help more people to stop smoking in the long-term. There is high quality evidence that using two forms of nicotine replacement at the same time – a patch as well as a faster-acting form such as gum – increases chances of quitting, and evidence also suggests that starting to use nicotine replacement before the day you give up cigarettes can help more people quit than beginning use on the day you stop.

There is no evidence that using more nicotine replacement is harmful when used as directed. Continue reading

Unhealthy, Binge Behaviors in College Students Disrupts Brain Chemistry

MedicalResearch.com Interview with:

Lina Begdache, PhD, RDN, CDN, CNS-S, FANDAssistant ProfessorHealth and Wellness Studies Department GW 15Decker School of NursingBinghamton University

Dr. Begdache

Lina Begdache, PhD, RDN, CDN, CNS-S, FAND
Assistant Professor
Health and Wellness Studies Department GW 15
Decker School of Nursing
Binghamton University 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: College students engage in activities such as binge drinking, abuse of ADHD medications as “study drugs” or use of illicit drugs during a critical brain developmental window that supports maturation of the brain (the prefrontal cortex) necessary for emotional control, cognitive functions and regulation of impulsive behaviors. These activities not only affect brain function, thus mental health and cognitive functions, but may dampen brain development with potential long-lasting effects.

As for findings, we were able to identify neurobehavioral patterns that associate with mental wellbeing and mental distress in young adults. Based on evidence from the literature, we constructed conceptual models that describe how one behavior may lead to another until virtuous or vicious cycles set-in.  Continue reading

Billions in Tax Revenue Lost Due to Misuse of Opioids

MedicalResearch.com Interview with:

Joel Segel, Ph.D.Assistant ProfessorDepartment of Health Policy and AdministrationThe Pennsylvania State UniversityUniversity Park, PA 16802

Dr. Segel

Joel E. Segel, Ph.D.
Assistant Professor
Department of Health Policy and Administration
The Pennsylvania State University
University Park, PA 16802

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Earlier research has shown that the societal costs of opioid misuse are high, including the impact on employment. However, previous work to understand the costs of opioid misuse borne by state and federal governments has largely focused on medical costs such as care related to overdoses and the cost of treating opioid use disorder.

Our main findings are that when individuals who misuse opioids are unable to work, state and federal governments may bear significant costs in the form of lost income and sales tax revenue. We estimate that between 2000 and 2016, state governments lost $11.8 billion in tax revenue and the federal government lost $26.0 billion.  Continue reading

Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State

MedicalResearch.com Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Professor
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states.  Continue reading

Medicaid Work Requirements Disproportionately Affect Those with Mental Health or Substance Use Disorders

MedicalResearch.com Interview with:

Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health

Dr. Wen

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health

MedicalResearch.com: What is the background for this study?

Response: Work requirements condition Medicaid eligibility on completing a specified number of hours of employment, work search, job training, or community service. Little is known about how behavioral health and other chronic health conditions intersect with employment status among Medicaid enrollees who may be subject to work requirements.

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Genes Linked to Alcohol Use Disorder Identified

MedicalResearch.com Interview with:

Henry R. Kranzler, MDProfessor of PsychiatryPerelman School of MedicineUniversity of Pennsylvania

Dr. Kranzler

Henry R. Kranzler, MD
Professor of Psychiatry
Perelman School of Medicine
University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Alcohol consumption and alcohol use disorder (AUD) are moderately heritable traits.  To date, genome-wide association studies (GWAS) have not examined these traits in the same sample, which limits an assessment of the extent to which genetic variation is unique to one or the other or shared.

This GWAS examined a large sample (nearly 275,000 individuals) from the U.S. Veterans Affairs Million Veteran Program (MVP) for whom data on both alcohol consumption and alcohol use disorder diagnoses were available from an electronic health record.  We identified 18 genetic variants that were significantly associated with either alcohol consumption, AUD, or both. Five of the variants were associated with both traits, eight with consumption only, and five with alcohol use disorder only.  Continue reading

Cancer Patients Use THC and CBD Differently Than Other Medical Marijuana Patients

MedicalResearch.com Interview with:

Arum Kim, MDAssistant professor of Medicine and Rehabilitation MedicineNYU School of MedicineDirector of the Supportive Oncology ProgramPerlmutter Cancer Center

Dr. Kim

Arum Kim, MD
Assistant Professor
Medicine and Rehabilitation Medicine
NYU School of Medicine
Director of the Supportive Oncology Program
Perlmutter Cancer Center

MedicalResearch.com: What is the background for this study?  

Response: There is increasing interest in medical marijuana and its applications for patients with cancers. Despite increasing access, little is known regarding doses of cannabinoids – specifically tetrahydrocannabinol (THC)  and cannabidiol (CBD), methods of drug delivery, and differences in patterns of use between cancer and non-cancer patients.

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Marijuana Use During Pregnancy May Increase Risk of Psychosis in Offspring

MedicalResearch.com Interview with:

Jeremy FineB.A. in Philosophy, Neuroscience, and PsychologyWashington University in St. Louis, Class of 2019

Jeremy Fine

Jeremy Fine
B.A. in Philosophy, Neuroscience, and Psychology
Washington University in St. Louis, Class of 201

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Alongside increasingly permissive marijuana use attitudes and laws, the prevalence of marijuana use among pregnant mothers has increased substantially (by 75% between 2002 and 2016), with some evidence that pregnant women may be using cannabis to combat pregnancy-related nausea.

Our data came from the Adolescent Brain Cognitive Development (ABCD) Study, which included over 4,000 subjects with data on maternal marijuana use during pregnancy.

Our main finding was that the children of mothers who used marijuana after learning they were pregnant had a small but significant increase in risk for psychosis in their future.

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Nonmedical Use of Prescription Drugs a Common Cause of Emergency Room Visits

CDR Andrew Geller, MDMedical Officer, Medication Safety ProgramDivision of Healthcare Quality Promotion,CDCAtlanta GA 30329

Dr. Geller

MedicalResearch.com Interview with:
CDR Andrew Geller, MD
Medical Officer, Medication Safety Program
Division of Healthcare Quality Promotion,
CDC
Atlanta GA 30329

MedicalResearch.com: What is the background for this study?

Response: There has been a lot of recent attention on drug overdoses in the United States, particularly fatal overdoses which involve opioids. But the overall frequency with which patients end up in the emergency department (ED) due to nonmedical use of medications across the US is unknown.

  • Nonmedical use refers to a spectrum of circumstances, including intentionally using more medication than is recommended in an attempt to treat a health condition (therapeutic misuse) to using medication to attain euphoria or get “high” (abuse).

With this analysis, we wanted to focus on the acute harms to individual patients from nonmedical use of all medications, in order to help target prevention efforts.

  • Specifically, we used data from a nationally-representative sample of hospital EDs to identify the medications with the highest numbers of emergency visits for harms following nonmedical use of medications and to identify the patient groups with the highest risks. 

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Opioid Crisis Linked To Rapid Increase in Chronically Infected Heart Valves

MedicalResearch.com Interview with:

Serena Day, MDOhio State University.

Dr. Serena Day

Serena Day, MD
Ohio State University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The idea for this research came from my own observations of patients that I was caring for in the hospital first as an Internal Medicine Resident and now as a senior Cardiology Fellow. I did my residency here at Ohio State and noticed a marked increase in the number of patients with endocarditis that we were caring for just in my short time here as a trainee.

Over 5 years, we saw an increase of 436% in intravenous drug use related endocarditis. How this disease is treated as changed as well. It used to be that if a patient was a good surgical candidate, we would offer a replacement valve. Now, we see that these patient’s have such a high rate of recurrent intravenous drug use and reinfection of their heart valves that we now treat with antibiotics only rather than surgery. In many cases, the infection never goes away because we can’t offer definitive therapy with surgery due to their high relapse and reinfection rates of nearly 50%.
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