Most Counties See Opioid Prescription Rates Falling

Posted on February 12, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC

Dr. Gery Guy

Gery Guy, PhD, MPH
Injury Center
CDC

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

Response: This study examined opioid prescribing at the national and county-level in 2015 and 2017.

During 2015 to 2017, the amount of opioids prescribed decreased 20.1% in the United States. The amount of opioids prescribed per person varies substantially at the county-level. The average amount of opioids prescribed in the highest quartile of counties was nearly 6 times the amount in the lowest quartile. Reductions in opioid prescribing could be related to policies and strategies aimed at reducing inappropriate prescribing, increased awareness of the risks associated with opioids, and release of the CDC Guideline for Prescribing Opioids for Chronic Pain.

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Policies Reducing Prescription Opioids Have Limited Effect on Overdose Deaths

Posted on February 2, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Dr. Qiushi Chen (first author) and
Jagpreet Chhatwal PhD
Assistant Professor, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Massachusetts General Hospital

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

Response: Opioid overdose epidemic is a national public health emergency — in 2017, more than 49,000 people died from overdose. Our study shows that under current conditions, the number of deaths is projected to increase to 81,700 by 2025. Efforts to curb the epidemic by reducing the incidence of prescription opioid misuse — the primary focus of current interventions — will have a modest effect of 3-5% reduction in overdose deaths.

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Changing Attitudes Toward Liver Transplant for Alcohol-Associated Liver Disease

Posted on January 22, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Prof. Terrault

Norah Terrault, MD MPH
Professor, Gastroenterology
Department of Medicine
University of California San Francisco

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

Response: Rates of liver transplantation (LT) for alcohol-associated liver disease (ALD) are rising such that ALD recently became the most common reason for LT in the United States. Although some assume that the increase in LT for ALD is because LT for hepatitis C has declined since the advent of antiviral therapy, little research has been done to formally investigate this hypothesis, or other reasons for the increase.

This national registry study used the United Network for Organ Sharing database and included over 32,000 liver transplant recipients, including 9,438 patients with ALD. The main findings are that

1) liver transplantation for ALD has doubled in the past 15 years, but only 48% of the increase in LT for ALD can be explained by declining LT for hepatitis C;

2) Many liver transplantation centers require patients to be abstinent at least 6 months to be eligible for LT for alcohol-associated liver disease, but this is changing – our trends analysis strongly suggest that shifting attitudes of transplant providers to allow earlier LT for ALD are an important part of the increase in LT for ALD, and are variable across different geographic regions;

3) Late post- liver transplantation survival after 5-years is 11% lower for alcohol-associated liver disease (vs. non-ALD).

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

Response: Changing attitudes regarding liver transplantation for acute alcoholic hepatitis may be having broad effects on LT for alcohol-associated liver disease, as more LT providers believe that it is justified to pursue earlier LT for ALD. As attitudes continue to change with more data to suggest that early LT for ALD can be undertaken with acceptable outcomes, we may see further increases in liver transplantation for ALD in future years. Since attitudes are provider-specific, and there is no national transplant policy for LT eligibility in terms of pre-LT abstinence requirements, this study suggests that variable policies and provider attitudes may be leading to inequity in healthcare access for alcohol-associated liver disease patients in need of liver transplantation.

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

Response: Given the significant increase in liver transplantation for alcohol-associated liver disease, which was different across regions, there would be value in a national policy to guide the management of LT for ALD. It is unclear why late survival for ALD is inferior for non-ALD, but other studies have shown recurrent alcohol use, malignancy, and infections to be important causes of late death after liver transplantation — these should be specifically investigated in future studies of liver transplantation for ALD.

No disclosures

Citation:

Lee BP, Vittinghoff E, Dodge JL, Cullaro G, Terrault NA. National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States. JAMA Intern Med. Published online January 22, 2019. doi:10.1001/jamainternmed.2018.6536

Jan 22, 2019 @ 10:34 pm

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Dramatic Rise in Benzodiazepine/ Z-Drugs and Opioid Co-Use

Posted on January 21, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Vozoris

Dr. Nicholas Vozoris, MHSc, MD, FRCPC
Division of Respirology, Department of Medicine
St. Michael’s Hospital, 30 Bond Street
Toronto, Ontario, Canada

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

Response: While there has been a lot of attention and research devoted to understanding trends in opioid use in North America, there has been relatively less attention paid to a more concerning drug use pattern, combination of benzodiazepines and opioids. Co-use of benzodiazepines and opioids is associated with a many more-fold risk of hospitalization and death than opioid use alone. Another concerning drug use pattern that has received little attention is combinations of benzodiazepines and Z-drugs. Z-drugs act similarly as benzodiazepine drugs, and when one is receiving both drug types, one is exposing oneself to excessive benzodiazepine receipt.

The purpose of my study was to characterize the trends in benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States over the past two decades, and to identify risk factors for receipt of these suboptimal drug use patterns.

The main findings were that there has been a dramatic rise in both benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, in the United States between 1999 and 2014. Benzodiazepine and opioid co-use increased by about 250% and benzodiazepine and Z-drug use increased by about 850%. Individuals with mental health disorders was one group at increased risk for getting a combination of benzodiazepines and opioids and morbidly obese individuals were at risk for being prescribed both a benzodiazepine and a Z-drug.

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

Response: I hope readers of my study come away with a greater awareness of the potential concerns and problems that can arise with combining benzodiazepines and opioids, and benzodiazepines and Z-drugs. I hope prescribers become more reflective of their prescribing practices relating to such drugs as benzodiazepines, Z-drugs and opioids, and prescribe these agents with more judiciousness. In particular, I think there is a lot on confusion and lack of knowledge around the Z-drugs, that is, what drug group do they belong to and how do they act. Even though they go by the name Z-drugs, they act in the same way as benzodiazepines do, and so in effect, they can be considered as benzodiazepine-equivalents.

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

Response: Although this can be challenging to get at, understanding the ‘why’ behind these rising concerning drug use patterns is important. Why are doctors prescribing, and why are patients receiving, in increasing numbers these concerning drug combinations? Having this knowledge would help us potentially reverse the trends of rising benzodiazepine and opioid co-use, and benzodiazepine and Z-drug co-use, and also potentially help prevent future ‘drug crises’. In September 2017, the US Food & Drug Administration issued that a safety warning be printed on all opioid and benzodiazepine drug labels, warning about the dangerous of combination use. In would be interesting to know if the frequency of combined benzodiazepines and opioids decreased as a result. Unfortunately, my study included only data up to 2014, so it was unable to ascertain an answer to this question.

No disclosures

Citation:

Nicholas T Vozoris; Benzodiazepineand Opioid Co-Usage in the United States Population, 1999–2014: An Exploratory Analysis, Sleep, , zsy264, https://doi.org/10.1093/sleep/zsy264

Jan 21, 2019 @ 3:42 am

Take Control of Your Life and Treat Your Gambling Addiction

Posted on January 21, 2019 by Marie Benz MD FAAD

An addiction to gambling can be an isolating ordeal that causes havoc among someone’s personal relationships, destroys personal finances, and exacerbates any mental health issues that a person may have.

Addiction is rarely an isolated incident. Typically there are many factors at play that can manifest themselves in the form of gambling. By tackling these underlying causes one can treat their addiction and eliminate the toxic habits that created it. In addition to confronting this by oneself, it is important for those who suffer from this to confide in those close to them as well as seeking advice from their doctor.

One major issue brought on by any kind of addiction is the sense of alienation that someone can experience. This is where it is important for them to open up to those who are close to them, like a loved one or a close friend. It will help alleviate the burden of struggling alone and will help others to understand what they are going through. Getting in touch with self-help groups can be another means of alleviating the feelings of alienation that addicts can experience while they are treating their compulsive gambling. This provides an outlet for an addict to express what they are going through while simultaneously getting the perspective of others who have struggled in a similar fashion.

One of the most important steps to take is the very first one. That is to be able to admit that there is a problem with gambling. Once this has been done, the problem becomes tangible and the addiction can be confronted directly.

Continue reading →

Medical Marijuana Users Preferred Cannabis to Pharmaceuticals

Posted on January 17, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Kruger

Daniel J. Kruger, PhD
Research Assistant Professor
University of Michigan

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

Response: We study health-related behaviors, such as diet and the consumption of caffeine and alcohol.

Given the recent trends in legalization of cannabis for medical and even recreational purposes, we were concerned with the narrow focus of current public health efforts regarding cannabis. Although some in the field take a harm-reduction approach to substance use, too many efforts focus solely on abstinence. These programs are a legacy from the era of prohibition, and we know that there are disadvantages to such a restricted scope in public health.

For example, municipalities that eliminated or blocked accurate and effective sex education had increases in teenage pregnancy rates. There are so many public health-related aspects of cannabis, beyond risks and adverse effects, which need to be addressed by systematic scientific research. Because of the legal history of cannabis, there is little integration with the mainstream health care system.

The focus of the current study was investigating how medical cannabis users perceived medical cannabis in comparison to pharmaceutical drugs and other aspects of the mainstream health care system and how they navigated they relationships between these currently separate systems

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Reporters Covering Drugs Should Include 1-800-662-HELP In Their Stories

Posted on January 15, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ayers

John W. Ayers, PhD MA
Division of Infectious Diseases and Global Public Health
Department of Medicine, University of California
San Diego, La Jolla

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

Response: The Substance Abuse and Mental Health Services Administration national helpline (1-800-662-HELP) is the only free, federally managed and endorsed US drug treatment referral service, helping callers find the best local services that match their needs. Are millions suffering simply because they are not aware that lifesaving help is a phone call away?

In our new study, published in JAMA Internal Medicine, Mark Dredze, Alicia Nobles and I delved into Americans’ engagement with 1-800-662-HELP following singer Demi Lovato’s July 24, 2018 hospitalization for a reported overdose that on-the-scene investigators originally linked to heroin. Lovato has since recovered.

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Parental Drinking Linked to Anxiety and Depression in Children

Posted on January 9, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ingunn Olea Lund

Dr. Ingunn Olea Lund, PhD
The Norwegian Institute of Public Health
Oslo, Norway

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

Response: There are significant amounts of research on children of parents with alcohol use disorders – where the children are shown to be at risk of several adverse outcomes, including mental disorders, substance use disorders, suicide, impaired school performance, and employment problems. There is very little previous research on how other, more normal levels of parental drinking may influence child outcomes, such as mental health. This is a grave oversight, as there are vastly more parents with normal drinking patterns than there are parents who suffer from an alcohol use disorder. This means that there are potentially a lot more cases of adverse effect for children, and the number of children at risk may be higher than previously assumed.

In addition to parents’ alcohol use, several other risk factors in the family that may affect child mental health outcomes, such as parents’ mental health and socio-economic status. Researchers have tended to look at these risk factors separately, but as these risks tend to co-occur, it may be more informative to consider them together.

To our knowledge, this is the first study that examines possible harm from normal levels of parental drinking, alone or in combination with other parental risk factors, on children’s anxiety and depression.

The sample consists of more than 8700 triads: children and both their parents. We combined information from three health registries with survey data where both adolescents and their parents provided information about health and social conditions. The health registers include information about the children ‘s actual contact with the health care system; we used information about whether children received diagnoses and/or treatment for anxiety and/or depression.

Continue reading →

Prescription Stimulant Use Varies Widely Across US

Posted on January 6, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509

Dr. Piper

Brian J. Piper, PhD, MS
Assistant Professor of Neuroscience
Department of Basic Sciences,
Geisinger Commonwealth School of Medicine,
Scranton PA 18509

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

Response: The U.S. accounts for five percent of the world population but more than 92 percent of the world’s spending on pharmacotherapies for Attention Deficit Hyperactivity Disorder (ADHD). According to the 2011 National Survey of Children’s Health, ADHD increased to 11.0 percent of U.S. children, seven percent of girls and 15 percent of boys. Interestingly, ADHD rates were much lower among Hispanic children.

The 2013 revision to the Diagnostic and Statistical Manual of Mental Disorders broadened the criteria such that it became easier to diagnose adult ADHD. Together, we hypothesized that use of amphetamine (Adderall), methylphenidate (Ritalin), and lisdexamfetamine (Vyvanse) would be increasing. We also predicted that there would be some regional differences in stimulant use.

Continue reading →

Urine Tests Useful in Primary Care Monitoring of Opioid and Cocaine Use

Posted on January 3, 2019 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Bagley

Sarah M. Bagley MD, MSc
Assistant Professor of Medicine and Pediatrics
Director, CATALYST Clinic
Boston University School of Medicine/Boston Medical Center
Boston, MA

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

Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use.

The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients.

Continue reading →

Can New Heart Failure Patients Drink Alcohol?

Posted on December 29, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Brown

David L. Brown, MD, FACC
Professor of Medicine
Cardiovascular Division
Washington University School of Medicine
St. Louis, MO 63110

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

Response: The genesis of this study was a patient asking me if he could continue to have a nightly cocktail or two after he was hospitalized with the new diagnosis of heart failure.

The main findings are that moderate drinking after the diagnosis of heart failure in older adults is probably safe and is associated with longer survival. These types of studies can not prove a causal relationship between alcohol consumption and survival.

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Cutting Back on Alcohol May Help You Quit Smoking

Posted on December 28, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Dermody

Dr. Sarah Dermody, PhD
Assistant Professor
School of Psychological Science
Oregon State University
Corvallis Oregon

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

Response: Drinking alcohol is a risk factor for sustained smoking. In a sample of daily cigarette smokers receiving treatment for alcohol use disorder, we examined if reductions in drinking corresponded with reductions in nicotine metabolism as indexed by the nicotine metabolite ratio. The nicotine metabolite ratio is important because it is associated with smoking level and lapses. We found that for men, alcohol use and the nicotine metabolite ratio reduced significantly; however, for women, neither drinking nor nicotine metabolite ratio changed.

Continue reading →

Glaucoma: CBD (cannabidiol) May Raise Pressure in Eye

Posted on December 21, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Straiker

Alex Straiker PhD
Senior Scientist
Psychological & Brain Sciences
Indiana University

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

Response: We’ve known for almost 50 years that cannabis can lower ocular pressure but the mechanism of action was still unknown. Most of the work on this stopped well before the cannabinoid receptors were discovered in the early 1990s.

Over the last several years we have determined that three different cannabinoid receptors (CB1, GPR18, and GPR119) each can lower pressure in mice when activated. Once this was established, it made sense to go back to THC (and CBD) to see how they act.

MedicalResearch.com: What are the main findings?

Response: There are four main findings.

Probably the most interesting is that CBD raises ocular pressure in mice. Ours isn’t the first study to show this but we do show how it works.
Our second major finding is that THC lowers pressure through a combination of CB1 and GPR18 receptors.
The third major finding is that the effect of THC is sex-dependent, with longer effects in male mice.
Lastly, CBD cancels out the pressure-lowering effects of THC, probably by blocking CB1 receptors.

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

Response: There are two main take-homes.

There is a real possibility that CBD elevates ocular pressure and therefore the risk of glaucoma as a side-effect. This is significant given the widespread (and growing) availability of CBD and its recent FDA approval as a treatment for Dravet’s Syndrome. Second, the sex-dependence is significant in and of itself but also because the current AAO position that topical THC is ineffective as a glaucoma therapy is based on four studies, three of which were small mixed-sex subject pools. If the sex-dependence holds for humans, then it is possible that those studies yielded a false-negative result.

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

Response: The question of whether CBD raises ocular pressure in humans should be revisited and should be monitored in patients being treated for Dravet’s Syndrome.

No disclosures.

Citation:

Sally Miller, Laura Daily, Emma Leishman, Heather Bradshaw, Alex Straiker. Δ9-Tetrahydrocannabinol and Cannabidiol Differentially Regulate Intraocular Pressure. Investigative Opthalmology & Visual Science, 2018; 59 (15): 5904 DOI: 10.1167/iovs.18-24838

Dec 21, 2018 @ 12:47 am

When Asked, Teens Frequently Report Hallucinations, Paranoia or Anxiety with Marijuana Use

Posted on December 19, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Levy

Sharon Levy, MD, MPH
Director, Adolescent Substance Use and Addiction Program
Boston Children’s Hospital
Associate Professor of Pediatrics
Harvard Medical School

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

Response: For this study we analyzed data that were collected as part of a larger survey study that recruited a sample of adolescents who were coming to the doctor’s office for routine medical care. We asked them a lot of questions about their health, school, extracurricular activities, plans for the future, substance use patterns and problems associated with use among other things.

The main finding was that among the participants who reported marijuana use in the past year, many of them, more than 40%, said that they had experienced either an hallucination, or paranoia/anxiety related to their use.

Kids who used more frequently and those who met criteria for a substance use disorder were more likely to experience these symptoms, as were those who had symptoms of depression Continue reading →

Preventing Opioid Relapse: Cost-Effectiveness of Buprenorphine–Naloxone vs Extended-Release Naltrexone

Posted on December 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Murphy

Sean M. Murphy, PhD
Associate Professor of Research
Director, CHERISH Consultation Service
Weill Cornell Medicine
Department of Healthcare Policy & Research
New York, NY 10065-8722

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

Response: A recent eight-site US randomized effectiveness trial compared buprenorphine-naloxone to extended-release naltrexone to prevent opioid-use relapse. Participants were recruited from inpatient detoxification or short-term residential treatment programs.

Current treatment protocols require persons initiating extended-release naltrexone, but not buprenorphine-naloxone, be fully detoxified from opioids. Both medications were effective at treating opioid use disorder with regard to time abstinent from opioid use and health-related quality-of-life; however, the higher cost of extended-release naltrexone and additional costs associated with detoxification prior to administering this medication, resulted in buprenorphine-naloxone being the better value to the healthcare sector, among patients who require detoxification before initiating extended-release naltrexone.

The economic value of extended-release naltrexone, compared to buprenorphine-naloxone, became more attractive after accounting for additional costs to society (participant time and travel, criminal activity, workforce productivity), and among persons who were successfully initiated on treatment.

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

Response: Because the economic value of extended-release naltrexone compared to buprenorphine-naloxone increased among persons who were successfully initiated on treatment, identifying persons who are most likely to achieve superior outcomes on extended-release naltrexone in advance would be a preferred to offering this medication to everyone.

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

Response: Narrowing the cost gap by identifying the best possible patients for each medication, lowering the cost of extended-release naltrexone, and shortening or eliminating the induction period could improve its relative economic value, thereby increasing its attractiveness to payers and allowing more people to access either alternative according to their clinical needs and preferences.

Thus, I would really like to see additional research on treatment models that could achieve these objectives. I am also eager to see comparative effectiveness and economic evaluations of extended-release naltrexone compared to extended-release buprenorphine products.

Citation:

Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-Effectiveness of Buprenorphine–Naloxone Versus Extended-Release Naltrexone to Prevent Opioid Relapse. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-0227

Dec 18, 2018 @ 12:50 am

Health Effects of Alcohol May Depend on How Much You Drink

Posted on December 16, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Simona Costanzo MS, PhD
Laboratory of Molecular and Nutritional Epidemiology,
Department of Epidemiology and Prevention.
IRCCS Istituto Neurologico Mediterraneo Neuromed,
Italy

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

Response: We investigated how the different intake of alcohol relates to all-cause and cause-specific hospitalizations. In particular, we mainly investigated the association of alcohol consumption with total number of hospitalizations that occurred during 6 years of follow-up.

We also examined cause-specific hospitalizations (e.g., alcohol-related diseases, vascular diseases, cancer, traumatic injury, and neurodegenerative diseases).

Continue reading →

Marked Increase in Infected Heart Valves Due to Injected Opioids

Posted on December 4, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Schranz

Asher Schranz, MD
Division of Infectious Disease
Department of Medicine
UNC School of Medicine

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

Response: The opioid crisis has led to several major infectious diseases concerns, including HIV and Hepatitis C.

Drug use-associated infective endocarditis (DUA-IE) is a less commonly discussed consequence of the opioid epidemic. DUA-IE is an infection of one or more heart valves that occurs from injecting drugs. It can be a severe, life-threatening infection and requires a long course of intravenous antibiotics as well as, in some cases, open heart surgery to replace an infected heart valve. Several studies over the past few years have shown that DUA-IE has been increasing.

Our study examined hospital discharges in North Carolina statewide from 2007 to 2017. We sought to update trends in DUA-IE and describe how much heart valve surgery was being performed for DUA-IE. We also aimed to report the demographics of persons who are undergoing heart valve surgery for DUA-IE and the charges, lengths of stay and outcomes of these hospitalizations. Continue reading →

Wisdom Teeth Extractions Can Lead to Opioid Addiction in Adolescents and Young Adults

Posted on December 3, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Schroeder

Alan Schroeder MD
Associate Chief for Research
Division of pediatric hospital medicine
Lucile Packard Children’s Hospital Stanford

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

Response: Third molar “wisdom teeth” extractions are one of the most common surgeries performed in adolescents and young adults, but an adequate appraisal of risks and benefits is lacking. Most patients who undergo this procedure are exposed to opioids post-operatively.

We demonstrate that, for privately-insured opioid-naïve patients 16-25 years of age, exposure to opioids from a dental provider is associated with persistent use at 90-365 days in 7% of patients and a subsequent diagnosis relating to abuse in 6% of patients. In contrast persistent use and abuse were significantly lower in control patients not exposed to dental opioids (0.1% and 0.4%, respectively). The median number of pills dispensed for the initial prescriptions was 20.

Continue reading →

Youth with Conduct Problems More Likely To Use Cannabis

Posted on December 2, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dan Romer PhD Research director, Annenberg Public Policy Center Director of its Adolescent Communication Institute University of Pennsylvania

Dr. Daniel Romer

Daniel Romer PhD
Annenberg Public Policy Center
The University of Pennsylvania
Philadelphia, PA

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

Response: Previous research has found some troubling relations between adolescent cannabis use and subsequent increases in conduct problems and other unhealthy consequences. These studies were done in New Zealand in the late 90’s and we wanted to re-examine those relationships using more contemporary data in the US.

We had data on 364 adolescents who were followed from age 13 to 19 in Philadelphia that could provide a more up to date picture of the effects of using cannabis on one important outcome, conduct disorder. We also wanted to use more sensitive methods than had been used in prior research that would enable us to examine reciprocal relations between cannabis use and c (CP). That is, it might be the case that youth with CP are prone to using cannabis and that this helps to explain why there appears to be a relation over time between cannabis use and CP rather than cannabis use leading to CP.

Our findings supported that hypothesis. There was no prospective relation between changes in cannabis use and subsequent changes in conduct problems. Instead, changes in conduct problems were found to predict changes in use of cannabis. Youth with conduct problems also affiliated more with peers who used cannabis, adding further to their own use. There was also no evidence that youth who used cannabis sought out peers who used it apart from the effects of CP.

Finally, both use of cannabis and conduct problems predicted subsequent development of a mild cannabis use disorder (CUD). Continue reading →

Amphetamine Use Even Higher than Opioids Among Rural Pregnant Women

Posted on December 2, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Admon

Lindsay Admon, MD MSc
Assistant Professor, Department of Obstetrics & Gynecology
Institute for Healthcare Policy and Innovation
University of Michigan

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

In our previous work (https://journals.lww.com/greenjournal/Fulltext/2017/12000/Disparities_in_Chronic_Conditions_Among_Women.19.aspx), we identified higher rates of deliveries complicated by substance use among rural women. We knew that some of this difference would be accounted for by opioids.What we didn’t expect was that when we took a closer look, amphetamine use disorder accounted for a significant portion of this disparity as well.

The main findings of this study are that, between 2008-09 and 2014-15, amphetamine and opioid use among delivering women increased disproportionately across rural compared to urban counties in three of four census regions. By 2014-15, amphetamine use disorder was identified among approximately 1% of all deliveries in the rural western United States, which was higher than the incidence of opioid use in most regions.

Compared to opioid-related deliveries, amphetamine-related deliveries were associated with higher incidence of the majority of adverse gestational outcomes that we examined including pre-eclampsia, preterm delivery, and severe maternal morbidity and mortality. Continue reading →

Primary Care Providers Should Ask All Adults About Alcohol Use

Posted on November 20, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Mangione

Dr. Carol Mangione M.D., M.S.P.H., F.A.C.P
Ronald Reagan UCLA Medical Center
Division Chief of General Internal Medicine and Health Services Research
Professor of Medicine.
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine David Geffen School of Medicine
University of California

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

Response: Unhealthy alcohol use is relatively common and is increasing among U.S. adults. Alcohol use is the third leading cause of preventable death in the U.S. and contributes to more than 88,000 deaths per year. In pregnancy, it also leads to birth defects and developmental problems in children. The Task Force found that screening tests and brief counseling interventions can help detect and reduce unhealthy alcohol use among adults, and in turn help prevent negative consequences related to alcohol use. For adolescents ages 12 to 17, clinicians should use their best judgment when deciding whether or not to screen and refer their patients to counseling, until we have better studies available.

Continue reading →

Asthma in Children Can Worsen From Allergy to Secondhand Marijuana

Posted on November 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Bryce Hoffman, MD
Allergy & Immunology Fellow
National Jewish Health

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

Response: Secondhand marijuana exposure is expected to increase as personal cannabis use becomes legalized in more states and countries. Cannabis allergy from firsthand use has been reported in adults but allergy in young children exposed to secondhand smoke has not been previously reported. We present a case of a young child with difficult-to-control asthma who was found to have cannabis allergy after being exposed to secondhand marijuana smoke in his household. This child’s asthma improved after cannabis was removed from the environment.

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

Response: Children exposed to secondhand marijuana smoke can become allergic to cannabis, which in turn may significantly worsen their asthma or allergy symptoms. This is particularly concerning as the cannabis may not be suspected as a cause. Parents and physicians should consider the possibility of cannabis allergy in any child with uncontrolled asthma who is being exposed to secondhand marijuana smoke. This includes any use of marijuana in the household where the patient lives. These children should be referred to an allergist for further work-up.

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

Response: Further studies are needed to replicate these results with more patients in the future, and to optimize methods of testing for cannabis allergy. We need to better understand how secondhand allergy develops – is it from particles in the smoke, or plant particles left over in the environment? We also need to better characterize cannabis allergy and in particular its cross-reactivity with other plant foods and pollens.

I have no disclosures.

Citation:Abstract MEETING American College of Allergy, Asthma and Immunology 2018 Annual Scientific Meeting

Abstract Title: Cannabis allergy in a young child with severe asthma exposed to secondhand marijuana smoke

Author: Bryce Hoffman, MD

Nov 18, 2018 @ 12:20 pm

More Pharmacies Willing To Dispense Naloxone Without Prescription

Posted on November 15, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS
Clinical Assistant Professor
College of Pharmacy, The University of Texas at Austin
Adjoint Assistant Professor
School of Medicine, University of Texas Health Science Center at San Antonio
Ambulatory Care Pharmacist
Southeast Clinic, University Health System
UT Health Science Center at San Antonio
Pharmacotherapy Education and Research Center
San Antonio, TX 78229

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

Response: Previous studies in Indiana and New York City, and the similar study in California published alongside ours identified that, despite the fact that laws designed to increase naloxone access had been in place for 2-3 years, patients were still not able to obtain naloxone without first seeing a doctor in many pharmacies.

Our study showed contrasting results to the previous studies, with a much higher proportion of pharmacies stocking naloxone and stating their willingness to dispense without an outside prescription. Among the 2,317 Texas chain community pharmacies we contacted, 83.7% correctly informed our interviewers that they could obtain naloxone without having to get a prescription from their doctor before coming to the pharmacy. We also found that 76.4% of the pharmacies had at least one type of naloxone currently in stock. Continue reading →

Not All Pharmacies Have Naloxone for Opioid Overdose in Stock

Posted on November 14, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Puzantian

Talia Puzantian, PharmD, BCPP
Associate Professor of Clinical Sciences,
School of Pharmacy and Health Sciences
Keck Graduate Institute

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

Response: Naloxone has been used in hospitals and emergency rooms since the early 1970s. Distribution to laypersons began in the mid-1990s with harm reduction programs such as clean needle exchange programs providing it, along with education, to mostly heroin users. In the years between 1996-2014, 152,000 naloxone kits were distributed in this way with more than 26,000 overdoses reversed (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm).

We have data showing that counties in which there was greater naloxone distribution among laypeople, there were lower opioid death rates (Walley AY et al BMJ 2013). However, not all opioid users at risk for overdose will interface with harm reduction programs, particularly prescription opioid users, hence more recent efforts to increase access to laypersons through pharmacists. Naloxone access laws have been enacted in all 50 states but very little has been published about how they’ve been adopted by pharmacists thus far. One small study (264 pharmacies) from Indiana (Meyerson BE et al Drug Alcohol Depend 2018) showed that 58.1% of pharmacies stocked naloxone, only 23.6% provided it without prescription, and that large chain pharmacies were more likely to do so.

Continue reading →

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