How Does Alcohol Affect Risk of Cancer or Premature Death?

MedicalResearch.com Interview with:
“Alcohol” by zeevveez is licensed under CC BY 2.0Andrew Kunzmann
Research Fellow
Queen’s Universit
Belfast

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

Response: We decided to conduct this research because the messages about the health effects linked to light-moderate drinking are less consistent. Previous studies suggest that light-moderate drinking is linked to an increased risk of cancer but a lower risk of mortality than never drinking. The international guidelines around what constitutes drinking in moderation also differ, with UK guidelines now recommending intakes below 6 pints of beer or 175ml glasses of wine per week (equivalent to less than 1 per day) but other guidelines recommending intakes of 2 drinks or less per day. We wanted to see what the risk of getting either of these conditions (cancer or mortality) were to give a more comprehensive and less confusing message about the health effects of light-moderate drinking.

This was part of a well-established collaboration between Queen’s University Belfast and the National Cancer Institute in the US. We used data from a cancer screening trial in the US that contained data on over 100,000 people from the US, who were free from cancer at the start of the study and who completed a questionnaire asking how much alcohol they consumed at different periods of their adult life. This was then linked to data over an average of 9 years after they completed the questionnaire to see which individuals developed cancer or died from any cause. We then assessed whether risk of cancer and mortality differed based on lifetime alcohol intakes after accounting for a number of other factors such as age, educational attainment, smoking and dietary intakes.

Continue reading

Most Patients Who Survive Overdose Do Not Receive FDA Approved Medications for Opioid Use Disorder

MedicalResearch.com Interview with:

Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston University School of Medicine Boston MA

Dr. Larochelle


Marc R. Larochelle, MD, MPH

Assistant Professor of Medicine
Boston University School of Medicine
Boston MD 

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

Response: In this study we examined more than 17,000 individuals who survived an opioid overdose in Massachusetts between 2012 and 2014.

We were interested in identifying how many went on to receive one of the three FDA-approved medications for opioid use disorder (MOUD), and whether or not they were associated with mortality.

We found that only 3 in 10 received MOUD and that receipt of buprenorphine and methadone were associated with 40-60% reduction in all-cause and opioid-related mortality.

We found no association between naltrexone and mortality though the confidence of this conclusion is limited by the small number who received naltrexone in this cohort.

Continue reading

Treatment Initiation for Opioid Use Disorder in Emergency Departments

MedicalResearch.com Interview with:

Herbie Duber, MD, MPH, FACEP Associate Professor, Emergency Medicine Adjunct Associate Professor Department of Global Health Adjunct Associate Professor, Institute for Health Metrics and Evaluation University of Washington

Dr. Duber

Herbie Duber, MD, MPH, FACEP
Associate Professor, Emergency Medicine
Adjunct Associate Professor Department of Global Health
Adjunct Associate Professor
Institute for Health Metrics and Evaluation
University of Washington

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

Response: Opioid use disorder (OUD) and opioid overdose deaths are a rapidly increasing public health crisis.  In this paper, we review and synthesize current evidence on the identification, management and transition of patients from the emergency department (ED) to the outpatient setting and present several key recommendations.

For patients identified to haveOpioid use disorder, we recommend ED-initiated mediation-assisted therapy (MAT) with buprenorphine, an opioid agonist.  Current evidence suggests that it safe and effective, leading to improved patient outcomes.  At the same time, a coordinated care plan should be put into motion which combines MAT with a rapid transition to outpatient care, preferably within 72 hours of ED evaluation.  Where possible, a warm handoff is preferred, as it has been shown in other settings to improve follow-up.  Outpatient care should combine MAT, psychological interventions and social support/case management in order to maximize impact Continue reading

Study finds Cannabis Use Not Associated With Increased Suicide Risk in Patients with Psychiatric Disorders

MedicalResearch.com Interview with:

“Cannabis sativa” by Manuel is licensed under CC BY 2.0

Leen Naji, BHSc, MD
Family Medicine Resident
McMaster University

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

Response: Cannabis use has consistently been linked to suicide attempt in the general population, but little data exists linking the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. This is important data as we know that patients with psychiatric disorders are both more likely to use cannabis and to attempt suicide. Therefore, our goal was to study the association between cannabis use and suicide attempt amongst patients with psychiatric disorders. Additionally, since we know that women are more likely to suffer from mental health disorders, are more likely to attempt suicide and are more likely to incur the deleterious consequences of drug use at lower doses, we sought to compare the association between cannabis use and suicide attempt in men and women amongst our study population.

We conducted our analysis on a large sample of over 900 adults with psychiatric disorders (465 men, 444 women), of whom 112 men and 158 women had attempted suicide. The average age of our study sample was 40 years.

We found that cannabis use is not associated with an increased risk of suicide in patients with psychiatric disorders, though this association may vary when looking at specific subpopulations and/or amount of cannabis use. For instance, we found that heavier cannabis use is associated with an increased risk of suicide attempt amongst men with psychiatric disorders. Specifically, there was a 3% increased risk of suicide attempt for every day of cannabis use per month in men with psychiatric disorders. We also found that amongst those with psychiatric conditions, women, unemployed individuals and those with a mood disorder were at increased risk of suicide attempt.   Continue reading

Could Restricting Nicotine in E-Cigarettes Do More Harm Than Good?

MedicalResearch.com Interview with:
e-cigarette CDC imageDr Lynne Dawkins, PhD

Associate Professor
London South Bank University

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

Response: Many people think that it’s the nicotine that’s harmful so they opt for using a low strength in their e-liquid. We know from tobacco smoking that when people switch to using a lower nicotine yield cigarette, they compensate in order to maintain a steady blood nicotine level by taking longer, harder drags and this can increase exposure to toxins in the smoke. We also know from some of our other work with vapers (e-cigarette users) that they tend to reduce the nicotine strength of their e-liquid over time. We therefore wanted to explore whether vapers also engage in this compensatory puffing and whether this has any effect on exposure to potentially harmful chemicals.

Continue reading

Neurobiology Links Aggressive Behavior and Addiction

MedicalResearch.com Interview with:

Scott J. Russo PhD Fishberg Dept. of Neuroscience Friedman Brain Institute, and Center for Affective Neuroscience Icahn School of Medicine at Mount Sinai New York, NY

Dr. Russo

Scott J. Russo PhD
Fishberg Dept. of Neuroscience
Friedman Brain Institute, and Center for Affective Neuroscience
Icahn School of Medicine at Mount Sinai
New York, NY 

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

Response: There is increasing evidence that aggressive behavior might share key features with addiction.  For example, aggressive mice develop positive associations with environmental cues associated with previous aggressive encounters (ie. they find aggression rewarding) and aggressive animals will work very hard to obtain access to a subordinate animal in order to attack them.

Some of the same brain regions that are activated in response to addictive drugs, like cocaine and morphine, are also activated by aggressive experience.  Thus we hypothesized that there may be shared neurobiological mechanisms between addiction and aggression.

Our study showed that there is accumulation of the addiction-related transcription factor, ΔFosB, in the nucleus accumbens, a brain region well know to regulate the rewarding and addictive properties of drugs of abuse.

Continue reading

Major Brain Networks With Altered Brain Function In Individuals with Addiction Identified

MedicalResearch.com Interview with:
Professor, Rita Z. Goldstein, PhD
Department of Psychiatry (primary)
and Department of Neuroscience, Friedman Brain Institute (secondary)
Chief, Neuropsychoimaging of Addiction and Related Conditions (NARC) Research Program

Anna Zilverstand PhD
Assistant Professor, Psychiatry

Icahn School of Medicine at Mount Sinai
The Leon and Norma Hess Center for Science and Medicine
New York, NY 10029 

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

Response: In comparison to previous reviews that often focused on investigating select brain circuits, such as the reward network, our review is the first to systematically discuss all brain networks implicated in human drug addiction. Based on more than 100 neuroimaging studies published since 2010, we found that six major brain networks showed altered brain function in individuals with addiction. These brain circuits are involved in a person’s ability to select their actions (executive network), in directing someone’s attention (salience network), in adaptive learning of new behaviors (memory network), in the automatization of behaviors (habit network), in self-reflection (self-directed network) and the valuation of different options (reward network).

When individuals with addiction are confronted with pictures of drug taking, all of these networks become very highly engaged; however, when the same individuals are confronted with scenes depicting other people, their brains show a reduced reaction as compared to healthy individuals, indicating less involvement. Similarly, the brain of an addicted individual is less engaged when making decisions (that are not relevant to their drug taking) or when trying to inhibit impulsive actions. We further found that some impairments of brain functions, such as alterations underlying the difficulty to inhibit impulsive actions, seem to precede drug addiction, as we observe similar impairments in adolescents that later go on to abuse drugs. However, particularly the impairments in the executive network (involved in the ability to inhibit impulsive actions), the valuation network (which computes the value of an option) and the salience network (that directs attention towards events) seem to be getting worse with more severe drug use and also predict if someone is likely to relapse or not.

The good news is that we also found that it is possible to (partially) recover and normalize brain function in these networks through treatment. Importantly, the widespread alterations of brain function were independent of what drug an individual was addicted to (marijuana, alcohol, cigarettes, cocaine, methamphetamine, heroin, amongst others). Continue reading

Opioid Use Increases Alcohol Relapse Risk

MedicalResearch.com Interview with:

Dr. Katie Witkiewitz PhD Professor, Department of Psychology  University of New Mexico

Dr. Witkiewitz

Dr. Katie Witkiewitz PhD
Professor, Department of Psychology
University of New Mexico

MedicalResearch.com: What are the main findings?

Response: The main findings from our study indicate that individuals with alcohol dependence who misused opioids (e.g., used without a prescription or not as prescribed) had a significantly higher likelihood of relapse to heavy drinking during alcohol treatment and were drinking more alcohol during and following alcohol treatment. Continue reading

American Indian 8th Grade Students Have High Rates of Substance Abuse

MedicalResearch.com Interview with:
Randall C. Swaim, Ph.D.
Senior Research Scientist and Director
Linda R. Stanley, Ph.D.
Senior Research Scientist

Tri-Ethnic Center for Prevention Research
Department of Psychology
Colorado State University                          

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

Response: American Indian adolescents consistently report the highest levels of substance use compared with other US racial/ethnic groups. The harm associated with these high rates of use include higher risk of developing a substance use disorder, more alcohol-related problems, including alcohol-attributable death, and other negative outcomes such as school failure. These findings point to the importance of continuing to monitor this group, particularly given changing trends in perceived harmfulness of illicit substances as new statutes alter access to medical and recreational use of cannabis.

Continue reading

Cigna Creates Online Initiative To Drive Patient-Provider Conversations Regarding Pain and Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna

Dr. Lustig

Dr. Stuart Lustig, M.D., M.P.H
National Medical Executive for Behavioral Health
Cigna

Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic.

MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study?

Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention.

The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.

Continue reading