Does Alcohol Really Protect Against Heart Disease? Evidence Not Clear Cut

MedicalResearch.com Interview with:

Dr. Jinhui Zhao PhD Scientist, Centre for Addictions Research of BC University of Victoria

Dr. Jinhui Zhao

Dr. Jinhui Zhao PhD
Scientist, Centre for Addictions Research of BC
University of Victoria

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

Response:  There are now many studies questioning the validity of the theory that moderate alcohol consumption protects against heart disease. We provided an up to date and comprehensive review of the evidence from ‘cohort’ studies i.e. those that assess health risk behaviours of people then follow them up for a number of years to see what characteristics predict death from a particular condition. We wished to test the theory that the appearance of health benefits in relation to heart disease is due to biases that accumulate and become more severe when cohorts are recruited at older ages (e.g. over 55 years). We found evidence to support this hypothesis. Moderate drinkers recruited before 55 years of age did not show any evidence of reduced risk of heart disease even when followed up into old age. Moderate drinkers from the older cohorts, however, did appear to have significant benefits – a finding we attribute to selection biases that accumulate across the life-course.

Several published meta-analyses showed inconsistent findings about how alcohol consumption affects the risk of coronary heart disease (CHD). Most systematic reviews find associations between low-volume alcohol consumption and reduced CHD risk, while some also find increased CHD risk for higher levels of consumption (Maclure 1993, Corrao, Rubbiati et al. 2000, Corrao, Bagnardi et al. 2004, Ronksley, Brien et al. 2011, Roerecke and Rehm 2012). More recent evidence has accumulated to suggest that the case for cardio-protection may be less straightforward. The association of alcohol consumption with CHD may be confounded or modified by other factors such as age and sex and / or biased by those factors which have not been investigated or controlled for in these previously published studies.

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Frequent Marijuana Use Linked To Increased Risk of Severe Periodontal Disease

MedicalResearch.com Interview with:

Jaffer A Shariff DDS MPH cert.DPH Periodontal Resident | Research Scientist Division of Periodontics, Columbia University College of Dental Medicine New York

Dr. Shariff

Jaffer A Shariff DDS MPH cert.DPH
Periodontal Resident | Research Scientist
Division of Periodontics,
Columbia University College of Dental Medicine
New York

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

Response: Marijuana use for both medical and recreational purposes has become increasingly common in recent years; it is the most commonly used recreational drug in the United States. Subsequent increase in its legalization among countries including the United States for recreational purposes, poses an emergent oral and periodontal health concerns.

Our study revealed that frequent recreational marijuana users exhibited deeper periodontal probing depths, clinical attachment loss and higher odds of having severe periodontal disease than the non-frequent users, even after controlling for other risk factors linked to gum disease, such as cigarette smoking.

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Recreational Cocaine Use Activates Addiction Related Brain Mechanisms Sooner Than Previously Realized

MedicalResearch.com Interview with:

Marco Leyton, Ph.D. Professor, Department of Psychiatry McGill University

Dr. Marco Leyton

Marco Leyton, Ph.D.
Professor, Department of Psychiatry
McGill University

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

Response: Drug-related cues are potent triggers for eliciting conscious and unconscious desire for the drug. In people with severe substance use disorders, these cues also activate dopamine release in the dorsal striatum, a brain region thought to be involved in hard-to-break habits and compulsions.

In the present study we found evidence that drug cues also activate this same dopamine response in non-dependent ‘recreational’ cocaine users.

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Post-Surgical Medications Are Major Cause Of New Chronic Opioid Use

MedicalResearch.com Interview with:

Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology Division of Pain Medicine University of Michigan Medical School Ann Arbor, MI  48109

Dr. Brummett

Chad M. Brummett, M.D.
Associate Professor
Director, Clinical Anesthesia Research
Director, Pain Research
Department of Anesthesiology
Division of Pain Medicine
University of Michigan Medical School
Ann Arbor, MI  48109 

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

Response: The opioid epidemic has received tremendous attention in recent years, but most of the focus has been on chronic pain, opioid abuse and overdose. Far less attention has been paid to the importance of acute care prescribing (e.g. surgical pain) in patients that are not chronic opioid users.

We found that 5-6% of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery. Moreover, the rates of new chronic use did not differ between patients having major and minor surgeries, suggesting that patients continue to use these pain medications for something other than simply pain from surgery. Building on other work by our group, and the few additional studies done on the topic to date, these data suggest that pain medications written for surgery are a major cause of new chronic opioid use for millions of Americans each year.

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New Marijuana Laws Associated With Increase in Cannabis-Related Health Problems

MedicalResearch.com Interview with:

Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032

Dr. Hasin

Deborah S. Hasin, Ph.D.
Professor of Epidemiology
Columbia University
New York, New York 10032

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

Response: Among adults, the prevalence of cannabis use and cannabis use disorders has increased in recent years. Concerns have been raised that for various reasons, medical marijuana laws would promote use of cannabis and consequently, cannabis-related consequences.

Many studies show that this didn’t happen among adolescents, but very little was known about the relationship between medical marijuana laws and adults. Using data from three surveys spanning the years 1991-2013, the study findings suggested that medical marijuana laws did play a role in increasing rates of cannabis use and cannabis use disorders.

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Cannabis Exacerbates Schizophrenia Symptoms and Prolongs Recovery

MedicalResearch.com Interview with:
Ian Hamilton

Department of Health Sciences
University of York
York, UK 

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

Response: This review looked back over 40 years of research on the links between cannabis and psychosis to examine how knowledge has developed on this issue.

The review found that there is sufficient evidence to suggest a dose response relationship exists in the risk for developing a psychosis that would not have happened if the individual had not been exposed to cannabis. Also for people with schizophrenia cannabis exacerbates their symptoms and prolongs recovery.

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Proove Opioid Risk Profile Predictive of Opioid Use Disorder

MedicalResearch.com Interview with:

Maneesh Sharma, M.D</strong> Director of Pain Medicine MedStar Good Samaritan Hospital Medical Director of the Interventional Pain Institute Baltimore, Maryland

Dr. Maneesh Sharma

Maneesh Sharma, M.D
Director of Pain Medicine
MedStar Good Samaritan Hospital
Medical Director of the Interventional Pain Institute
Baltimore, Maryland

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

Response: Opioid abuse in chronic pain patients is a major public health issue, with rapidly increasing addiction rates and deaths from unintentional overdose more than quadrupling since 1999. Just in the last year alone according to the CDC, synthetic opioid deaths have increased 72%. As a practicing interventional pain specialist, I am confronted with the challenge of assessing patient risk for opioids as I evaluate multi-modal approaches to effective pain management. Existing tools are inadequate, as they either rely on a urine toxicology test to evaluate a patient’s current potential substance abuse as a predictor of future abuse, or on a patient’s honesty to fill out a questionnaire. We know that many patients who are not currently abusing illicit drugs or misusing prescription medications can develop prescription opioid tolerance, dependence, or abuse—especially with prolonged opioid therapy. Furthermore, we know that patients who are looking to abuse medications or divert those prescriptions will obviously lie on questionnaires.
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Outbreak of Severe Fungal Eye Infections Linked To IV Opioid Epidemic

MedicalResearch.com Interview with:
Aubrey Tirpack, PGY3

New England Eye Center
Tufts Medical Center 

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

Response: Intravenous drug abuse is a known risk factor for the development of endogenous fungal endophthalmitis (EFE), a severe intraocular infection cause by the seeding of mycotic organisms to the eye.

Our institution noted a marked increase in cases of EFE beginning in May 2014, which correlates to increasing rates of opioid abuse throughout the New England region. Ten patients were found to have intravenous drug abuse related EFE over the two year time period studied. The most common presenting symptoms were floaters, decreased vision, and pain. All patients were treated with systemic antifungals and nine patients underwent intravitreal antifungal injection. All patients were ambulatory at presentation and the majority were without systemic signs of infection.

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Topical Cannabinoids May Fight Itch and Inflammatory Skin Diseases

MedicalResearch.com Interview with:
Jessica S. Mounessa, BS

University of Colorado School of Medicine
Aurora, Colorado and
Robert Dellavalle, MD, PhD, MSPH
Professor of Dermatology and Public Health
University of Colorado School of Medicine
Colorado School of Public Health
Chief, Dermatology Service
US Department of Veterans Affairs
Eastern Colorado Health Care System
Denver, CO 80220 

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

Response: One in 10 adult cannabis users in the U.S. use it for medicinal purposes. Medicinal cannabis is well studied for its uses in chronic pain, anorexia, and nausea. Numerous recent studies have highlighted other medicinal uses for cannabinoids and related compounds.

We conducted a comprehensive review of the literature on the potential role of cannabinoids in conditions affecting the skin.

Our study reveals the potential benefit of topically prepared cannabinoid compounds, especially for pruritus and eczema.  For example, creams containing Palmitoylethanolamide (PEA), which enhances cannabinoid-receptor binding, have been successful in relieving itch both in the literature, and anecdotally in our clinics.

Though not strictly considered an endocannabinoid, as it does not directly bind to CB1 and CB2 receptors, PEA works by enhancing endocannabinoid binding to these receptors.** Furthermore, the majority of the cannabinoid compounds we studied did not contain psychoactive effects.

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Millions of Americans Become Chronic Opioid Users After Surgery

MedicalResearch.com Interview with:

Chad M. Brummett, MD Division of Pain Medicine, Department of Anesthesiology University of Michigan Medical School Ann Arbor, MI 48109

Dr. Brummett

Chad M. Brummett, MD
Division of Pain Medicine, Department of Anesthesiology
University of Michigan Medical School
Ann Arbor, MI 48109 

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

Response: The opioid epidemic has received considerable attention, but most of the focus has been on chronic pain and primary care. However, surgeons prescribe ~40% of the opioids in the US, and little attention has been given to the importance of prescribing after surgery.

In this study, we found that among patients not using opioids in the year prior to surgery, ~6% of patients continued to use opioids long after what would be considered normal surgical recovery. Furthermore, there was no difference between patients undergoing minor and major surgeries, thereby suggesting that some patients continue to use opioids for reasons other than pain related to surgery.

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Inhaling Poppers Associated With Visual Toxicity

MedicalResearch.com Interview with:
Dr. Rebecca Rewbury
Sussex Eye Hospital
Brighton and Sussex University Hospitals Trust
Brighton, UK

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

Response: ‘Poppers’ are recreational drugs which are illegal to sell for human ingestion, but are sold under the guise of household cleaning products. Inhalation leads to a brief sense of euphoria, enhanced sexual arousal and smooth muscle relaxation. The Psychoactive Substances Act 2016 was due to outlaw poppers, but they were excluded on the basis that they do not act directly on the central nervous system.

The main constituent of poppers, isopropyl nitrite, replaced isobutyl nitrite when the latter was classified as a carcinogen in 2006. Since then, there have been several case reports of ‘poppers maculopathy.’

We noted an increase in patients presenting with central visual disturbances after using poppers and describe 12 such cases. They all demonstrated similar disruption of the photoreceptor layer on retinal imaging. Onset of symptoms was frequently linked to specific brands of poppers, with 3 people having used poppers for many years and only developing side effects on changing brand. Chemical analysis showed that these products contained isopropyl nitrite. One brand of poppers, used without side effects by one patient, contained amyl nitrite, 2-methyl butyl nitrite and isobutyl alcohol, but no isopropyl nitrite.

The outcome of poppers maculopathy varied, but following abstention, visual disturbances and retinal damage tended to improve over months, if not fully resolve. Although in some cases, symptoms and/or imaging findings were prolonged. Ongoing use of implicated brands led to persistent, but not worsening maculopathy, whereas one patient that switched back to another brand showed full recovery.

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Animal Study Suggests Lorcaserin (Belviq®) May be Useful to Reduce Opioid Intake

MedicalResearch.com Interview with:
Christina R. Merritt and Kathryn A. Cunningham
Center for Addiction Research
University of Texas Medical Branch
Galveston, TX 77555

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

Response: Opioid use disorder (OUD) is one of the top public health problems in the United States. Overdoses on prescription opioids, heroin and fentanyl accounted for 33,091 deaths in the U.S. in 2015 (https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm); each day, 91 Americans die from an opioid overdose (https://www.cdc.gov/drugoverdose/epidemic/). The first-ever Surgeon General’s Report on Alcohol, Drugs and Health (https://addiction.surgeongeneral.gov/ ) observed that more people used prescription opioids than tobacco in 2015. Furthermore, individuals with OUD, the most problematic pattern of opioid abuse, often relapse, particularly in environments associated with past drug use, and new means to help maintain abstinence are needed.

Serotonin (5-hydroxytryptamine; 5-HT) function in the brain, particularly through its cognate 5-HT2C receptor, is an important regulator of the abuse liability of cocaine and other psychostimulants. Previous studies suggested that the weight loss medication and selective 5-HT2C receptor agonist lorcaserin (Belviq®) can curb cocaine- and nicotine-seeking in preclinical models, even when tested in tempting environments. We administered lorcaserin to rats who were trained to take the powerful painkiller oxycodone (OxyContin®), a prescription opioid currently approved for treatment of acute and chronic pain with characteristically high abuse potential. Lorcaserin suppressed oxycodone intake as well as the drug-seeking behaviors observed when rats were exposed to cues such as the lights and sounds previously associated with drug intake. Taken together, these findings highlights the therapeutic potential for lorcaserin to extend abstinence and enhance recovery from OUD.

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