Understanding How Energy Drinks Plus Alcohol May Increase Risky Behavior

Posted on August 21, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Barbara D. Fontana
Laboratory of Experimental Neuropsychobiology,
Department of Biochemistry and Molecular Biology
Natural and Exact Sciences Center
Graduate Program in Biological Sciences
Toxicological Biochemistry, Federal University of Santa Maria,
Santa Maria, Brazil

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

Response: Our research group has been working with taurine and alcohol association for a long time. The background for this study is around increased consumption of molecules present in energy drinks frequently used as mixers for alcoholic beverages. Taurine is one of the most abundant molecules found in energetic drinks and has a neuromodulatory role in brain. In this context, we explore the effects of taurine associated to alcohol. Thus, as result we observed that this association exacerbate risky choices and reduces social cohesion in zebrafish, having a negative impact in social and fear-related behavior.

Continue reading →

Pregabalin Linked To Increased Risk for Opioid-Related Deaths

Posted on August 21, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Tara Gomes

Tara Gomes, MHSc
Li Ka Shing Knowledge Institute, St Michael’s Hospital,
The Institute for Clinical Evaluative Sciences
Leslie Dan Faculty of Pharmacy
Department of Health Policy, Management, and Evaluation
University of Toronto, Toronto, Ontario, Canada

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

Response: Pregabalin is a medication increasingly being prescribed to manage pain, however there is emerging evidence that this drug may increase one’s risk of opioid overdose when prescribed with opioids.

Continue reading →

Brain Imaging Reveals How Prolonged Intermittent Cannabis Can Induce Memory Deficits

Posted on August 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Ana Maria Sebastião, PhD
Professor of Pharmacology and Neurosciences
Director Institute of Pharmacology and Neurosciences, Faculty of Medicine and
Francisco Mouro, PhD
Unit of Neurosciences, Institute of Molecular Medicine
University of Lisbon, Portugal

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

Response: There is pressing need to comprehend how cannabinoid exposure impacts brain functioning. While cannabinoid-related research has increased exponentially in the last decade, the mechanisms through which cannabinoids affect brain functioning are still elusive. Specifically, we need to know how prolonged cannabinoid exposure affects important cognitive processes, such as memory, and also find the roots of those effects. This is particularly relevant considering that several countries have already approved cannabis-based medicines.

In this sense, our work sheds new light into the mechanisms underlaying the memory-deficits provoked by a continuous exposure to a cannabinoid drug. More precisely, using brain imaging techniques, we found that long-term exposure to a synthetic cannabinoid drug impairs the ability of key brain regions involved in learning and memory to communicate with each other. Our data points to the necessity of considering cannabinoid actions in a broader perspective, including brain circuitry and communication. Continue reading →

Study Identifies How Medical Marijuana May Ease IBD Symptoms

Posted on August 14, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. McCormick

Beth A. McCormick, Ph.D.
Professor and Vice Chair | Department of Microbiology & Physiological Systems
Founding Executive Director | University of Massachusetts Center for Microbiome Research
Board of Editors | Gastroenterology
University of Massachusetts Medical School
Worcester, MA 01655

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

Response: There has been extensive, but to date mostly anecdotal, support for a beneficial role for cannabinoids and cannabis-derived agents to provide benefit for symptoms in individuals suffering from intestinal inflammatory disease (IBD).

Our studies have provided one possible rationale for these previous findings: that there is a constitutively active efflux system at the luminal surface of cells that line the intestine that pumps out one class of lipids of the family known as endocannabinoids. In doing so, the intestine floods this surface with these endocannabinoids in a manner that counteracts the actions of a particular potent stimulators of intestinal inflammation that appears to be over-active in certain forms of IBD. This is most significant because a number of cannabinoids and cannabis-derived agents can mimic the actions of this class of endocannabinoids. Moreover, while cannabinoids and endocannabinoids have been shown to provide anti-inflammatory actions, these studies have identified one mechanism used by the body to localize and focus this protective function at a critical site where pro-inflammatory and anti-inflammatory events intersect, providing new insights into how to treat that imbalance in these process that occurs in certain forms of IBD.

Therefore, there is the immediate opportunity to use this research to identify new therapeutic strategies to treat individuals suffering from IBD that could include either agents extracted from marijuana plants or novel molecules selected based upon superior properties made obvious by this newly defined mechanism.

Continue reading →

Wisdom Tooth Extraction Can Lead To Persistent Opioid Use

Posted on August 9, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

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: Wisdom tooth extraction is one of the most common procedures among teens and young adults, with more than 3.5 million young people having wisdom teeth pulled every year.

This procedure is commonly paired with a prescription for opioid pain medication. As the opioid epidemic sweeps the nation, we must pay attention to the long term effects of opioid prescribing for even routine procedures. This is particularly important for wisdom tooth extraction where there is evidence that opioid pain medications may be no more effective than anti-inflammatories alone.

Using commercial insurance claims, we evaluated the association between receiving an opioid prescription with wisdom tooth extraction and developing new persistent opioid use in the year after the procedure. We found nearly a 3-fold increase in odds of persistent opioid use, attributable to whether or not an opioid was prescribed. This translates to nearly 50,000 young people developing new persistent opioid use each year from routine opioid prescribing for wisdom tooth extraction.

Continue reading →

Experimental Injection Reduces Cocaine Craving

Posted on August 8, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ana-Clara Bobadilla (Sarah Pack, photographer)

Ana-Clara Bobadilla, Ph.D.
Postdoctoral scholar
in the laboratory of Peter Kalivas, Ph.D
MUSC

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

Response: The Brain-derived neurotrophic factor (BDNF) is a growth factor that has well-described effects in the survival, growth and differentiation of neurons during development of the central nervous system, but it also maintains a role during adulthood in learning, memory and various disorders such as addiction. Several clinical studies show increased BDNF levels in the serum of cocaine- or alcohol-dependent patients compared to controls (D’Sa et al., 2011; D’Sa et al., 2012). In preclinical research, a wealth of studies shows that chronic exposure to drugs of abuse impacts BDNF expression in different parts of the brain, including the main regions comprised in the reward circuitry, the cortex and the nucleus accumbens (for a comprehensive review, see Li & Wolf, 2015). Conversely, altering BDNF expression or transmission has profound effects on the response of the brain to drugs (see McGinty et al., 2010). Importantly, BDNF effects are often region-specific, meaning that an increase in BDNF expression in one region can decrease the effects of drug exposure in the brain while the same increase in another region can have opposite effects (Li et al., 2013). Because BDNF transmission can modify the expression of a wide range of genes leading to long-term modifications, numerous studies administer BDNF early in the drug exposure protocol and focus on the long-term changes induced by the growth factor.

In this study, we microinjected BDNF directly in the nucleus accumbens minutes before measuring cocaine craving in a well-known rodent model of relapse. We found that BDNF induces a robust decrease in craving that lasts for at least 3 days post-treatment. The inhibitory effect of BDNF is not seen when animals are tested for sucrose, a very strong reward for rats, suggesting that this effect is specific to cocaine.

Moreover, cocaine craving is only decreased when BDNF is microinjected before the craving test, but has no effect when injected a day before the craving test or in the home cage, indicating a time-specificity in addition to the region-specificity previously described. Continue reading →

LUCEMYRA (Lofexidine) Now Available to Reduce Opioid Withdrawal Symptoms

Posted on August 6, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Mark Pirner

Mark Pirner, MD, PhD
Senior Medical Director
Clinical Research and Medical Affairs
US WorldMeds

MedicalResearch.com: What is the background for this announcement? How does lofexidine differ from other opioid withdrawal medications?

Response: LUCEMYRA™ (lofexidine) was FDA-approved on May 16 as the first and only non-opioid, non-addictive medication for the management of opioid withdrawal in adults.
LUCEMYRA mitigates the acute and painful symptoms of opioid withdrawal by suppressing the neurochemical surge in the brain that occurs when opioids are abruptly discontinued.

In clinical studies, patients receiving treatment with LUCEMYRA experienced greater symptom relief and were significantly more likely to complete their withdrawal. LUCEMYRA is not an opioid drug and is not a treatment for opioid use disorder; it should be used as part of a longer-term treatment plan.

Continue reading →

Pancreatic Cancer: Cannabidiol + Chemotherapy Improved Survival (in mice)

Posted on August 1, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Prof. Falasca

Prof Marco Falasca
Head Metabolic Signalling Group
School of Pharmacy & Biomedical Sciences
Faculty of Health Sciences
Curtin University
Western University

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

Response: Each year around 9,800 people in the UK are diagnosed with pancreatic cancer. The disease is particularly aggressive and has one of the lowest survival rates of all cancers.

Indeed, the life expectancy for pancreatic cancer patients has barely changed in the last 40 years because there are very few, and mostly only palliative care, treatments available. Given the five-year survival rate for people with pancreatic cancer is less than seven per cent, the discovery of new treatments and therapeutic strategies is urgently needed.

In this study, we decided to concentrate on a protein, named GPR55, found in high levels in pancreatic cancer. Our results show that GPR55 promotes pancreatic cancer progression. Consequently, we decided to use its inhibitor cannabidiol, a naturally occurring constituent of medicinal cannabis, as a pharmacological strategy to block GPR55 activity.

Strikingly, mice with pancreatic cancer that were treated with cannabidiol alongside chemotherapy, survived almost three times longer than those treated with chemotherapy alone, our study reports. Continue reading →

COPD: Vaporized Cannabis Did Not Reduce Breathlessness or Improve Exercise Capacity

Posted on July 30, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

cannabis

Sara Abdallah, PhD Student, first author and
Dennis Jensen, PhD Associate Professor,
Department of Kinesiology and Physical Education
Associate Dean – Infrastructure, Faculty of Education
Director, McGill Research Center for Physical Activity and Health
Canada Research Chair in Clinical Exercise & Respiratory Physiology
Associate Member, Translational Research in Respiratory Diseases Program
Research Institute of the McGill University Health Center

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

Response: Many patients with chronic obstructive pulmonary disease (COPD) suffer from severe breathlessness at rest and on minimal exertion despite receiving optimal drug therapy for their underlying disease (e.g., bronchodilators). In these patients, breathlessness significantly diminishes exercise capacity and quality of life. Thus, research focused on identifying adjunct therapies for management of breathlessness in patients with advanced COPD is clinically relevant.

A series of studies conducted in the 1970’s found that smoked cannabis caused bronchodilation (i.e., improved airway function) in healthy individuals and in patients with asthma. More recently, it has been demonstrated that delta-9 (∆⁹)-tetrahydrocannabinol (THC, the major cannabinoid constituent of cannabis) inhibits cholinergic contractions in isolated human bronchi and that a positive association exists between measure of lung function (e.g., forced expiratory volume in 1-sec) and cannabis use in patients with COPD. These studies lead us to hypothesize that inhalation of vaporized cannabis may alleviate exertional breathlessness and improve exercise tolerance in patients with advanced COPD by improving airway function at rest and during exercise. Continue reading →

Bariatric Surgical Approach To Increase Bile Acids May Reduce Cocaine Reward

Posted on July 27, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Galli

Aurelio Galli, Ph.D.
Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science
Associate Director for Research Strategy
Vanderbilt Brain Institute

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

Response: The study builds on evidence that bile acids influence the brain’s reward system. Bile acids are normally released from the gall bladder into the upper part of the small intestine, where they emulsify fats for absorption, before being recycled further down the small intestine. In bile diversion surgery, an experimental treatment for weight loss, bile is released at the end of the small intestine, increasing the amount of bile acids that enter the general circulation.

Mice treated with this surgery have less appetite for high-fat foods, which suggests that bile acids affect brain reward pathways.

We demonstrated that mice receiving the surgery also showed less preference for the cocaine-associated chamber, indicating that cocaine was probably less rewarding. Continue reading →

Ketamine vs Opioids for Acute Pain in the Emergency Department

Posted on July 23, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Schwarz

Evan Schwarz, MD FACEP, FACMT
Associate Professor of Emergency Medicine
Medical Toxicology Fellowship Director
Section Chief Medical Toxicology
Advisory Dean in the Office of Student Affairs
Division of Emergency Medicine
Washington University School of Medicine

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

Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department.

Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED.

In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.

Continue reading →

Opioid Prescription Rates Higher in South, Appalachia and Rural West

Posted on July 22, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Lyndsey Rolheiser MD Postdoctoral Research Fellow at Harvard Center for Population Studies Cambridge, Massachusetts

Dr. Rolheiser

Dr. Lyndsey Rolheiser PhD
Postdoctoral Research Fellow at Harvard Center for Population Studies
Cambridge, Massachusetts

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

Response: The opioid crisis was declared a “public health emergency” in 2017. Opioid related overdoses and prescribing rates have increased dramatically over the past decade and previous literature has identified a relationship between high-dose prescriptions and overdose deaths. Thus, understanding the variation and trends in the opioid prescribing rate is crucial in understanding the nature of the opioid epidemic. Opioid prescribing data is publicly available at the county and state level.

County level data represents an administrative boundary that lacks political representation and accountability. In contrast, the congressional district represents a geography that has both of these characteristics. Further, knowing the congressional district level rates allows for policy makers and researchers to observe the variation that exists within states.

The main findings are high prescribing rate districts are concentrated in the South, Appalachia and the rural West. Low-rate districts are concentrated in urban centers.

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

Response: There is a great deal of variation across congressional districts, but there are also very clear geographical patterns. In terms of policy, this paper highlights the importance of constructing and disseminating crucial public health data at a politically relevant boundary.

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

Response: Our hope is that the estimates we have created can be used within health related public policy research.

Citation: Lyndsey A. Rolheiser, Jack Cordes, BSPH, S.V. Subramanian. Opioid Prescribing Rates by Congressional Districts, United States, 2016. American Journal of Public Health, 2018; e1 DOI: 10.2105/AJPH.2018.304532

Jul 22, 2018 @ 11:46 am

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Moderate Drinkers Had Higher Sperm Count

Posted on July 19, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Elena Ricci, ScD, PhD
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico,
Milano

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

Response: The role of alcohol drinking on male fertility is still controversial. A negative association between alcohol intake and semen quality has been suggested by some authors, although other studies did not confirm this finding. We performed a cross-sectional analysis of baseline data from a cohort study on subfertile couples, and found that men with a moderate alcohol intake (4 to 7 units of ethanol per week – 1unit=12.5 grams ) had higher semen volume and sperm total count than men with both lower and higher intake.

Abstainers had a better sperm concentration, but the small size of this group prevented us from drawing any significant conclusions. Alcohol was not associated to sperm motility. Continue reading →

Age 21 Can Define Lifelong Drinking Patterns

Posted on July 18, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Richard Saitz, MD, MPH, FACP, DFASAM
Chair and Professor,Department of Community Health Sciences
Boston University School of Medicine

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

Response: Most of what we know about the time course of drinking too much (at-risk use) is from people in treatment or special groups and not adults in the US population at large. That’s why we did this study. We need to know how often at-risk drinking persists, how often it resolves, and how often it appears de novo.

Risky drinking means exceeding limits that are associated with health consequences. It includes people with an alcohol use disorder but the vast majority of people drinking risky amounts do not have a disorder, they are simply drinking amounts that can harm their health. Even low amounts can harm health (e.g. breast cancer risk increases at <1 drink a day) but substantial increases in risk occur over 7 in a week on average (for women, and 14 for men) or >5 for men (>4 for women) on an occasion. The latter are associated with acute consequences (e.g. injury, unwanted sex), and the former with chronic conditions (e.g. cirrhosis). People should be aware of their risks and then they can make choices about what risks they want to take (and for those with a disorder, they may need help with those choices and help changing behavior like treatment).

The main findings were….that 3 years later, 3/4ths of adults drinking risky amounts were still doing so. But importantly, a quarter had stopped drinking risky amounts. It is important to know that things change. One factor associated with that positive change was having kids—presumably a positive social change even if stressful. Of those adults not drinking risky amounts when first interviewed, 15% started doing so 3 years later. Again having children was protective but the main factor associated with starting was young age, particularly those who became of legal drinking age. Despite the fact that youth may be able to access alcohol illegally, this finding confirms that the drinking age of 21 in the US does in fact restrict access, and that turning 21 increases use and risky use by making alcohol more accessible. Continue reading →

Gene Deficit May Give Immunity to Effects of Cocaine

Posted on July 17, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

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

Response: Drug addiction is a chronically relapsing neuropsychiatric disease that affects 15.5 million people in Europe at a cost of 65.7 billion euros per year. All addictive drugs have in common to cause an artificial increase in the release of a neurotransmitter called dopamine, a very basic effect that can be found in all studied animal species from the fly to the man. The release of dopamine takes place in a region of the brain called the ventral striatum, or Nucleus Accumbens (NAc), which is directly involved in reward and reinforcement processes. An excess of dopamine release by the dopaminergic neurons projecting to the NAc from the Ventral Tegmental Area (VTA) triggers long-term changes in the brain, which can lead to addiction.

Cocaine is a prototypical addictive drug, since it is heavely abused in Western societies and extensively studied in animal models as well as humans.

We discovered that mice lacking the Maged1 gene showed a marked decrease in cocaine-elicited release of dopamine in the NAc and were entirely unresponsive to cocaine at behavioral level. In fact, they did not show any behavioral reaction normally observed after cocaine treatment, such as cocaine-elicited hyperlocomotion, sensitization (an increased effect of the drug following repeated administrations) or addictive behaviors, such as increased preference for places where the animal expects to obtain a cocaine reward or cocaine self-administration.

In a subsequent set of experiments, the researchers tried to identify what brain regions are responsible for Maged1 influence on cocaine effects and found that Maged1 expression is specifically required in the prefrontal cortex, and not in the neurons producing dopamine in the VTA, for the development of cocaine sensitization and dopamine release. Continue reading →

Criminal Justice System Involvement High Among Those With Opioid Use Disorder

Posted on July 9, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Winkelman

Tyler Winkelman MD, MSc
Clinician-Investigator
Division of General Internal Medicine, Hennepin Healthcare
Center for Patient and Provider Experience, Hennepin Healthcare Research Institute
Assistant Professor
Departments of Medicine & Pediatrics
University of Minnesota

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

Response: Opioid overdose deaths continue to escalate, and there have been reports that jails and prisons are bearing the brunt of the opioid epidemic. However, it wasn’t known, nationally, how many people who use opioids were involved in the criminal justice system. We also didn’t have recent estimates of common physical and mental health conditions among people with different levels of opioid use.

We used two years of national survey data to understand these associations, which are critical in developing a public health response to the opioid epidemic.

Continue reading →

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

Posted on June 30, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

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

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

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

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).

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

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

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

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures.

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH¹, Zaid Aljuboori, MD¹, Miriam A.Nuño, PhD², Doniel Drazin, MD³, and Maxwell Boakye, MD, MPH, MBA¹

Risky Drinking By Either Sex Can Affect Future Offspring

Posted on June 28, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Pak

Toni Pak, Ph.D.
Professor and Department Chair
Department of Cell and Molecular Physiology
Loyola University Chicago
Maywood, Ill

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

Response: We have known for many years that drinking alcohol during pregnancy can lead to developmental delays and birth defects in offspring. However, our data demonstrate that drinking large quantities of alcohol in a “binge” fashion before pregnancy can also impact future offspring and importantly, this is true for drinking behaviors of both parents, not just the mother.

Our previous data support the idea that alcohol is affecting the parental sperm and eggs to induce these modifications in the offspring, but this most recent work shows the extent of those effects on social behavior, pubertal maturation, and stress hormones as the offspring grow to adulthood.

This means that the risky behaviors of young people, such as the extremely popular practice of binge drinking, have potentially far-reaching consequences for generations to come.

Continue reading →

Potentially 70,000 Opioid-Related Overdose Deaths Undercounted

Posted on June 27, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Buchanich

Jeanine M. Buchanich, Ph.D.
Research associate
Professor in the University of Pittsburgh Graduate
School of Public Health’s Department of Biostatistics

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

Response: In the U.S., cause of death codes are assigned by the National Center for Health Statistics (NCHS) using information reported by the coroner or medical examiner completing the death certificate. Drug-specific overdose deaths are identified by the contributory causes of death, which are categorized as “T codes” and are assigned based on the specific drugs recorded by the coroner or medical examiner completing the death certificate. A code of T50.9 means “other and unspecified drugs, medicaments and biological substances.”

My colleagues and I extracted death data by state for 1999 through 2015 from the NCHS’s Mortality Multiple Cause Micro-data Files. We grouped overdose deaths into opioid-related, non-opioid-related and unspecified codes. In five states – Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – more than 35 percent of the overdose deaths were coded as unspecified.

We then calculated the change in percentage of overdose deaths that fell into each category from 1999 to 2015 by state. In those 17 years, opioid-related overdose deaths rose 401 percent, non-opioid-related overdose deaths rose 150 percent and unspecified overdose deaths rose 220 percent.

This allowed us to extrapolate how many of the unspecified overdose deaths were likely opioid-related. By our calculations, potentially 70,000 opioid-related overdose deaths were not included in national opioid-related mortality estimates since 1999 because coroners and medical examiners did not specify the drug that contributed to the cause of death when completing the death certificates. Continue reading →

Buprenorphine Exposures Among Children and Adolescents

Posted on June 27, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

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

Response: Buprenorphine is a prescription opioid medication commonly used to treat opioid use disorder. From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000. Although buprenorphine is important for the treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes.

Continue reading →

More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

Posted on June 26, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

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

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

Continue reading →

Concurrent Opioids and Benzodiazepines Raise Risk of Overdose, esp. Early On

Posted on June 25, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

Dr. Hernandez

Inmaculada Hernandez, PharmD, PhD
Assistant Professor of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
Pittsburgh, PA 15261

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

Response: Prior research has found that taking opioids and benzodiazepines simultaneously increases the risk of overdose by 2 to 3 fold, when compared to opioid-use only.

However, prior to our study, it was unclear how the risk of overdose changes over time with the concurrent use of opioids and benzodiazepines.

Continue reading →

How Does Alcohol Affect Risk of Cancer or Premature Death?

Posted on June 20, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:
Andrew 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

Posted on June 19, 2018 by Marie Benz MD FAAD

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.

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Treatment Initiation for Opioid Use Disorder in Emergency Departments

Posted on June 16, 2018 by Marie Benz MD FAAD

MedicalResearch.com Interview with:

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 →

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Treatment Initiation for Opioid Use Disorder in Emergency Departments