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.

Continue reading

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.

Continue reading

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.

Continue reading

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. 

Continue reading

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%.
Continue reading

Upper Arm Fractures: Comordid Conditions Linked to More Opioids and Longer Hospital Stays

MedicalResearch.com Interview with:

Paul Cagle, Jr. MDAssistant Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Cagle

Paul Cagle, Jr. MD
Assistant Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings ie What are some of the significant comorbidities? 

Response: In this study our goal was to better understand what medical issues (medical comorbidities) can cause trouble or issue for patients with a proximal humerus fracture (shoulder fracture).  To tackle this issue we used a large national sample of patients and sorted our the different medical issues the patients had.

We found that patients with increased medical issues had longer hospital stays and higher use of opioid medications (pain medications).

Continue reading

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

MedicalResearch.com Interview with:

Dr. Alexis Colvin, MDAssociate Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai 

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

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids.  Set guidelines for post surgery opioid prescriptions have not been established.  Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures.  The purpose of this study was to determine how many opioids were being prescribed  among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

Continue reading

Number of Opioid Prescriptions for New Users Has Dropped More Than 50%

MedicalResearch.com Interview with:

Wenjia Zhu, PhD. Marshall J. Seidman FellowDepartment of Health Care PolicyHarvard Medical School

Dr. Zhu

Wenjia Zhu, PhD.
Marshall J. Seidman Fellow
Department of Health Care Policy
Harvard Medical School 

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

Response: The current opioid epidemic continues to cause deaths and tremendous suffering in the United States, driven in large part by overuse of prescription opioids. Of special concern are new opioid prescriptions, i.e. opioids given to patients who have not used opioids before, which research tells us are an important gateway to long-term opioid use, misuse, overdoes and death. Recently, in their efforts to curb over prescribing of opioids, the CDC issued guidelines (December 2015 in draft form; March 2016 in final version) to encourage opioid prescribers to limit the use, duration and dose of opioids, particularly opioids to first-time users. Despite these, little is known about the prescribing of opioids to first-time users on a national scale, particularly among commercially insured patients.

In this study, we examined national monthly trends in the rate at which opioid therapy was started among commercially insured patients. Using administrative claims from Blue Cross Blue Shield Association commercial insurers from 2012 to 2017, we analyzed more than 86 million commercially insured patients across the United States.

Continue reading

Opioid-Induced Constipation: Can Your Hospital Afford the Financial Burden?

MedicalResearch.com Interview with:

Howard Franklin, MD, MBAVice President of Medical Affairs and StrategySalix Pharmaceuticals

Dr. Franklin

Howard Franklin, MD, MBA
Vice President of Medical Affairs and Strategy
Salix Pharmaceuticals

MedicalResearch.com: What is opioid-induced constipation?

Response: Opioid-induced constipation (OIC) is a side effect in as many as 80 percent of chronic pain patients on opioids. OIC is unlikely to improve over time without treatment and can lead to suffering and discomfort. More importantly, the insufficient treatment of OIC can have negative implications for patients, both those on opioid therapy for chronic non-cancer pain as well as advanced illness, and for hospitals. 

Continue reading

Combination of Alcohol and High BMI Linked to Liver Injury Biomarkers

MedicalResearch.com Interview with:
Alice R Carter MSc
Doctor of Philosophy Student
MRC Integrative Epidemiology Unit
Population Health Science, Bristol Medical School
University of Bristol

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

Response: Higher body mass index and alcohol intake have been shown to increase the risk of liver disease. Some studies have looked at their combined effect by comparing the risk of liver disease between individuals with both high BMI and high alcohol intake and individuals with low BMI and low alcohol intake. However, these studies have produced mixed results. Some possible reasons for that are errors in self-reported BMI and alcohol intake, other factors confounding the association of BMI & alcohol intake with liver disease risk and changes in lifestyle that individuals with ill health may have been advised to adopt.

One way to overcome these limitations is to use a technique called Mendelian randomisation. This method uses genetic differences between individuals that influence their characteristics (e.g. their body mass and how much alcohol they drink) to help understand whether these characteristics are causally related to diseases.

Our study used this method to explore the joint effects of BMI and alcohol consumption on liver disease and biomarkers of liver injury.  Continue reading

More Hospitals Dropped Addiction Services Than Added Them

MedicalResearch.com Interview with:

Cory E. Cronin PhDDepartment of Social and Public HealthOhio University College of Health Sciences and ProfessionsAthens, Ohio

Dr. Cronin

Cory E. Cronin PhD
Department of Social and Public Health
Ohio University College of Health Sciences and Professions
Athens, Ohio

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

Response: One of my primary areas of research is exploring how hospitals interact with their local communities. My own background is in health administration and sociology, and I have been working with colleagues in the Heritage College of Osteopathic Medicine here at Ohio University (Berkeley Franz, Dan Skinner and Zelalem Haile) to conduct a series of studies looking at questions related to these hospital-community interactions.

This particular question occurred to us because of the timeliness of the opioid epidemic. In analyzing data collected from the American Hospital Association and other sources, we identified that the number of hospitals offering in-patient and out-patient substance use disorder services actually dropped in recent years, in spite of the rising number of overdoses due to opioid use. Other factors seemed to matter more in regard to whether a hospital offered these services or not.

Continue reading

When Evaluating Teens for Surgery, Check Family Opioid Use

MedicalResearch.com Interview with:

Calista Harbaugh, MD House Officer, General Surgery Clinician Scholar, National Clinician Scholars Program Research Fellow, Michigan Opioid Prescribing Engagement Network University of Michigan 

Dr. Harbaugh

Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Research Fellow
Michigan Opioid Prescribing Engagement Network
University of Michigan 

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

Response: Nonmedical prescription opioid use and prescription opioid-related overdose remain significant concerns among adolescents and young adults. Among adolescents and young adults prescribed an opioid after surgery, prior work found that 4.8% of opioid-naïve patients develop new persistent use, filling additional opioid prescriptions at 3-6 months after surgery. This work found associations of persistent use with diagnoses such as chronic pain disorders, depression, anxiety, and prior substance use disorder. It is likely that for young patients, family members may also play an important role in development of new persistent use, but this has not previously been explored. We performed this study to evaluate whether long-term opioid use among family members was associated with prescription opioid fills among adolescents and young adults perioperatively – and we found that opioid-naïve adolescents and young adults who have 1 or more family members with long-term opioid use are more likely to fill at the time of surgery, during recovery, and in the long-term with a near-doubling of rates of new persistent use.

Continue reading

Synthetic Opioids Are Primary Driver of Current Opioid Epidemic

MedicalResearch.com Interview with:

Dr-Mathew Vinhhoa Kiang

Dr. Kiang

Mathew Vinhhoa Kiang, PhD
Postdoctoral Research Fellow
Primary Care and Outcomes Research
Stanford University School of Medicine
Stanford, California

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

Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation’s capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate.

Continue reading

Prescription Fentanyl Reductions and Opioid Prescribing Laws

MedicalResearch.com Interview with:

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

Dr. Brian Piper

Brian J. Piper, PhD, MS
Assistant Professor of Neuroscience
Geisinger Commonwealth School of Medicine

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

Response: Fentanyl is an important opioid for pain management but also has exceptional potential for misuse. Illicitly manufactured fentanyl accounts for a large portion of opioid overdoses. Seven states including Maine, Connecticut, Massachusetts, New York, Rhode Island, and Vermont have recently implemented opioid prescribing laws. The objectives of this study were to:

  • 1) characterize how medical use of fentanyl, fentanyl analogues like sufentanil, alfentanil, and remifentanil, and other opioid use changed over the past decade, and
  • 2) determine whether opioid prescribing laws impacted fentanyl use in the US.

    The Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is the gold-standard for pharmacoepidemiology research of controlled substances in the US for its comprehensiveness. 

Continue reading

What Happens to Crime Rates When Marijuana Dispensaries Open in the Neighborhood?

MedicalResearch.com Interview with:

Lonnie M. Schaible PhD Associate Professor School of Public Affairs University of Colorado Denver, CO

Dr. Schaible

Lonnie M. Schaible PhD
Associate Professor
School of Public Affairs
University of Colorado
Denver, CO

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

Response: Following legalization of recreational marijuana use in Colorado, strong — but unsubstantiated — claims were being made about crime surrounding marijuana dispensaries.  We wanted to know what the data would show.  We were especially interested in determining whether the addition of recreational facilities had any effects above and beyond those which might exist for medical dispensaries.  To better capture the dynamic landscape of marijuana legalization, this is the first study to control for the prior existence of medical dispensaries and assess how effects of both of these types of establishments changed over time.

Continue reading

Most Counties See Opioid Prescription Rates Falling

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.

Continue reading

Prescription Opioids Lead to Decrease in Labor Participation and Increase in Unemployment

Dr. Kessler

MedicalResearch.com Interview with:
Lawrence M. Kessler, PhD 
Research Assistant Professor

Matthew C. Harris, PhD, Assistant Professor Boyd Center for Business and Economic Research and Department of Economics, The University of Tennessee

Dr. Harris

Matthew C. Harris, PhD Assistant Professor

Boyd Center for Business and Economic Research and Department of Economics
The University of Tennessee  

 

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

Response: Motivation for this study came from Co-Author, Matt Murray, who was at a speaking engagement and heard a community business leader say “we’ve got jobs, but no one is applying, could opioids be a contributing factor?” This led to a conversation back at the Boyd Center between us and Matt Murray, where we decided that if we could get data on prescription rates, we could answer this question empirically.

We started by contacting each state agency in charge of their respective prescription drug monitoring program to see if they’d be willing to share county-level data on prescription opioid rates. From this letter-writing campaign we received data from 10 states, which formed the basis for our analysis. As time went on, new data was made publicly available and we were able to expand the analysis to all 50 states.

Continue reading

Policies Reducing Prescription Opioids Have Limited Effect on Overdose Deaths

MedicalResearch.com Interview with:
"Opioids" by KSRE Photo is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Dr. 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.

Continue reading

Changing Attitudes Toward Liver Transplant for Alcohol-Associated Liver Disease

MedicalResearch.com Interview with:

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

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 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

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

MedicalResearch.com Interview with:

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

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 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.