Addiction, Author Interviews, Gender Differences, Mental Health Research, Opiods / 28.07.2017

MedicalResearch.com Interview with: Andrea M. Tilstra Doctoral Student, Department of Sociology Population Program, Institute of Behavioral Science University of Colorado Boulder and Ryan K. Masters Assistant Professor, Department of Sociology Faculty Associate, Population Program and Health & Society Program Institute of Behavioral Science University of Colorado Boulder MedicalResearch.com: What is the background for this study? What are the main findings? Response:  “Despair” deaths – deaths from suicides, alcohol poisonings, and drug overdoses – have been a topic of interest in recent mortality research. For instance, existing findings suggest that mortality among white Americans has increased as a result of middle-aged whites experiencing elevated levels of despair and distress. These factors supposedly are driving white Americans to cope in unhealthy ways – excessive drinking, drug use, and suicides. However, there were two major problems with the existing research that supported this narrative. First, men and women were analyzed together, despite the knowledge that overall mortality levels and trends differ significantly by gender. Second, all three of the aforementioned causes of death were pooled together and analyzed as one group. This is highly problematic if deaths from suicides, alcohol use, and drug use are not, in fact, moving in conjunction with one another. We addressed these issues and expanded previous analyses by analyzing cause-specific death rates for men and women separately, for years 1980-2014, and decomposing the trends into period- and cohort- based analyses. We find that there are huge gender differences in U.S. white mortality rates and that trends in mortality from the three causes of death are quite distinct from one another. Recent increases in U.S. white mortality are largely driven by period-based increases in drug poisoning deaths and cohort-based increases in metabolic disease deaths. (more…)
Accidents & Violence, Author Interviews, Opiods / 28.07.2017

MedicalResearch.com Interview with: Stanford Chihuri, MPH Staff Associate/Data Analyst Department of Anesthesiology, College of Physicians and Surgeons Columbia University Medical Center NY, NY 10032  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the past 2 decades, consumption of prescription opioids has substantially increased in the U.S. Prescription drugs may cause drowsiness and impaired cognition which may interfere with psychomotor functioning necessary during the operation of a motor vehicle. The current study assessed time trends in prescription opioids detected in drivers killed in motor vehicle crashes from 1995 to 2015 in 6 states in the U.S. Results of the study showed that the prevalence of prescription opioids detected in fatally injured drivers has increased 700% in the past 2 decades. (more…)
Author Interviews, JAMA, Opiods, Pain Research, Primary Care / 17.07.2017

MedicalResearch.com Interview with: Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement. We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing (www.mytopcare.org). We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices. (more…)
Addiction, Alcohol, Author Interviews, NIH / 17.07.2017

MedicalResearch.com Interview with: Lorenzo Leggio, M.D., Ph.D. Chief of the Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, a NIAAA intramural laboratory MedicalResearch.com: What is the background for this study? MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aldosterone is an important hormone involved in the control of blood pressure and electrolytes via its mineralcorticoid receptor (MR). In addition to its roles in the periphery in our body, aldosterone also acts on the brain where the MR is particularly present in regions like the amygdala. The amygdala plays an important role in stress, anxiety and excessive alcohol drinking. Back in 2008, we conducted a small pilot study where we found that alcohol-dependent patients with higher blood aldosterone concentrations have higher alcohol craving. (more…)
Addiction, Author Interviews, CDC, Opiods / 11.07.2017

MedicalResearch.com Interview with: Deborah Dowell, MD, MPH Chief Medical Officer, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: CDC analyzed retail prescription data from QuintilesIMS which provides estimates of the number of opioid prescriptions dispensed in the United States from approximately 59,000 pharmacies, representing 88% of prescriptions in the United States. CDC assessed opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015. (more…)
Author Interviews, Opiods, Pharmacology / 10.07.2017

Medical Research.com Interview with: Dr. Christian Heidbreder, PhD Chief Scientific Officer Indivior Inc. Richmond, VA 23235, USA MedicalResearch.com: What is the background for this study? What are the main findings? Response: This pivotal Phase 3 clinical trial (RB-US-13-0001) evaluated the efficacy and safety of RBP-6000, an investigational once-monthly injectable buprenorphine in the ATRIGEL® delivery system for the treatment of adults with moderate-to-severe opioid use disorder (OUD) as part of a complete treatment plan to include counseling and psychosocial support1. The 24-week Phase 3 study met its primary and key secondary endpoints, demonstrating statistically significant differences in percentage abstinence and treatment success across both dosage regimens of RBP-6000 versus placebo1. The findings also showed that outcomes with RBP-6000 are consistent across other secondary clinical endpoints, including control of craving and withdrawal symptoms, as compared to placebo. These outcomes were associated with buprenorphine plasma concentrations ≥ 2 ng/mL and predicted whole brain mu-opioid receptor occupancy of ≥ 70%, and were also maintained for the one-month dosing intervals and for the entire treatment duration1. The results were confirmed by exposure-response analyses demonstrating a relationship between buprenorphine plasma concentrations, abstinence, withdrawal symptoms and opioid craving1. RBP-6000 was generally well tolerated and had a safety profile consistent with that of transmucosal buprenorphine. Injection site reactions were not treatment-limiting. The most common (reported in ≥ 5% of subjects) treatment-emergent adverse events (TEAEs) reported in the active total group were constipation, headache, nausea, injection site pruritus, vomiting, increased hepatic enzyme, fatigue and injection site pain1. (more…)
Addiction, Author Interviews, Technology / 24.06.2017

MedicalResearch.com Interview with: Dr. Phil Reed,  D.Phil. Professor Psychology Swansea University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Problematic internet use has been a growing concern for many people and bodies over the last decade, and more study has been requested into various aspects of this possible disorder.  One of the key questions is whether people overuse the internet, due to an addiction.  If it is an addiction, then there should be signs of withdrawal when people, who report having this problem, stop using the internet.  In this study, 144 participants, aged 18 to 33, had their heart rate and blood pressure measured before and after a brief internet session.  Their anxiety and self-reported internet addiction were also assessed. The results showed increases in heart rate and systolic blood pressure on terminating the internet session for those with problematically-high internet usage.  These increases in physiological arousal were mirrored by increased feelings of anxiety.  However, there were no such changes for those participants who reported no internet-usage problems. (more…)
Addiction, Author Interviews, JAMA, Opiods, Pediatrics / 19.06.2017

MedicalResearch.com Interview with: Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine Director, Urban Health and Advocacy Track, Boston Children’s Hospital and Boston Medical Center Associate Program Director, Boston Combined Residency Program in Pediatrics, Boston Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost no data have been available on this topic to date.  A recent study showed that teens in subspecialty treatment for opioid addiction were significantly less likely than adults to receive a medication.  Our study was the first to comprehensively look across the health care system, including looking at adolescents and young adults diagnosed with opioid use disorder in outpatient clinics, emergency departments, and inpatient hospitals. We had three important findings.  First, looking at a large sample of 9.7 million adolescents and young adults between the age of 13 and 25 years, we found that the number of youth diagnosed with opioid use disorder increased six-fold from 2001 to 2014.  This is perhaps not surprising given the national opioid crisis we know to be occurring. Second, we found that only a minority of youth (1 in 4) received buprenorphine or naltrexone, the two medications available for opioid addiction that can be prescribed in usual medical settings.  These two medications are evidence-based and their use is recommended by the American Academy of Pediatrics.  Utilizing them is critical to ensure that we offer effective treatment early in the life course of addiction, which can help prevent the long-term harms of addiction. Third, we found significant differences in who received medications.  Whereas approximately 1 in 3 young adults in our study received a medication, only 1 in 10 of the 16- and 17-year-olds we studied received one, and among adolescents under 15 years of age, 1 in 67 received a medication.  Females were less likely than males to receive medications, as were black youth and Hispanic youth relative to white youth. (more…)
Author Interviews, Opiods / 19.06.2017

MedicalResearch.com Interview with: Robin Gelburd, JD President FAIR Health MedicalResearch.com: What is the background for this study? Response: The opioid crisis is affecting the entire nation, but not in the same way in every location. Although a number of studies have been conducted on geographic variations in the opioid epidemic, there remains a need for more information on the regional level. To help meet that need, FAIR Health consulted its database of more than 23 billion privately billed healthcare claims, the largest such repository in the country. Focusing on the most recent complete ten-year period (2007-2016), FAIR Health examined claims data from rural and urban settings, the country’s five most populous cities (Chicago, Houston, Los Angeles, New York and Philadelphia) and the states where those cities are located. When the term “opioid-related diagnoses” is used in this study, it refers to opioid abuse, opioid dependence, heroin overdose and opioid overdose (i.e., overdose of opioids excluding heroin). (more…)
Abuse and Neglect, Addiction, Alcohol, Pediatrics / 19.06.2017

MedicalResearch.com Interview with: Tammy E. Corr, D.O. Assistant Professor of Pediatrics Division of Newborn Medicine Penn State Hershey College of Medicine MedicalResearch.com: What is the background for this study? Response: Recent literature has revealed hospital charges related to neonatal abstinence syndrome (NAS) have increased. However, there are no data available regarding costs of an NAS admission. Because charges are variable and influenced by a number of factors, provider costs to care for a patient offer more meaningful information. Therefore, we endeavored to determine the incidence of NAS in the United States and estimate the total annual costs and hospital length of stay for an neonatal abstinence syndrome admission as well as the incremental costs and hospital days of admission for an NAS patient compared to a non-NAS admission. (more…)
Author Interviews, Cannabis, Pediatrics / 14.06.2017

MedicalResearch.com Interview with: David Kerr PhD Associate professor in the School of Psychological Science College of Liberal Arts Ohio State University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Oregon legalized sale and use of marijuana for recreational purposes and the part of the law (regarding use) took effect in July 2015. However, there have been no controlled studies of which we’re aware of the possible effects of the Oregon law that take into account the trends toward increased marijuana use across the country and differences in use rates between states that predated the law. We used survey data on college students in Oregon and in 6 states without recreational legalization to examine the issue. (more…)
Accidents & Violence, Alcohol, Author Interviews, Cannabis, Columbia / 13.06.2017

MedicalResearch.com Interview with: Guohua Li DrPH, MD Professor and Director Center for Injury Epidemiology and Prevention Department of Epidemiology Mailman School of Public Health Columbia University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drugged driving has become a serious problem in the United States in the recent years due to increased consumption of marijuana and opioids. About 20% of fatally injured drivers used two or more substances, with alcohol-marijuana being the most commonly detected polydrug combination. Our study of over 14000 fatal 2-car crashes indicates that drivers testing positive for alcohol, marijuana, or both are significantly more likely to be responsible for initiating these crashes than those using neither of the substances. Specifically, compared to drivers not using alcohol and marijuana, the risk of being responsible for initiating fatal crashes increases 62% for those testing positive for marijuana and negative for alcohol, 437% for those testing positive for alcohol and negative for marijuana, and 539% for those testing positive for both alcohol and marijuana. These results suggest that when used in combination, alcohol and marijuana have a positive interaction on the risk of fatal crash initiation. The most common driver error leading to fatal 2-car crashes is failure to keep in proper lane, followed by failure to yield right of way and speeding. (more…)
Author Interviews, BMJ, Cannabis, Pediatrics / 12.06.2017

MedicalResearch.com Interview with: Dr Michelle Taylor PhD Senior Research Associate in Epidemiology MRC Integrative Epidemiology Unit (IEU) School of Social and Community Medicine University of Bristol Bristol UK MedicalResearch.com: What is the background for this study? Response: Many previous studies have looked at adolescent cannabis use, however most of these look at use at a single time point, for example whether an individual has ever used cannabis at age 16 years, or how regularly a person uses cannabis at age 18. However, as young people do not initiate use at the same time or follow the same pattern of use, using measures at a single time point does not always tell the whole story. We used a form of statistical modelling using data taken over the course of adolescence to try and characterise underlying patterns of cannabis use across adolescence. We used data from the Avon Longitudinal Study of Parents and Children which had information on cannabis use at six time points between the ages of 13 and 18 years. (more…)
Addiction, Author Interviews, Cost of Health Care, Opiods, PLoS / 10.06.2017

MedicalResearch.com Interview with: A. Simon Pickard, PhD Professor, Dept of Pharmacy Systems, Outcomes and Policy University of Ilinois at Chicago College of Pharmacy MedicalResearch.com: What is the background for this study? What are the main findings? Response: The heroin epidemic, which has left virtually no part of American society unscathed, can be viewed as an illness.  Unlike some illnesses, however, it was largely manufactured by stakeholders in the healthcare system, wittingly or unwittingly. The main finding, that heroin addiction costs us just over $50 billion per year, is likely a conservative estimate. (more…)
Accidents & Violence, Author Interviews, Cannabis / 06.06.2017

MedicalResearch.com Interview with: Mitchell L. Doucette, MS PhD Candidate The William Haddon Jr Fellowship in Injury Prevention 2017 Co-Fellow Center for Injury Research and Policy Department of Health Management and Policy Johns Hopkins Bloomberg School of Public Health Baltimore, MD 21205 MedicalResearch.com: What is the background for this study? Response: Currently in the U.S., 8 states have legalized marijuana for recreational use and an additional 28 states permit marijuana for medical use. Some states have instituted a legal driving limit for marijuana intoxication, 5 ng/mL, and for Colorado specifically, research indicates the average time from law enforcement dispatch to blood sample collection was 2.32 hours—a period of time outside the window of legal sample collection under state law and peak THC detectability. Countries with similar marijuana driving limits perform roadside oral fluid testing for establishing intoxication at point of arrest. (more…)
Alcohol, Author Interviews, Cognitive Issues / 05.06.2017

MedicalResearch.com Interview with: Dr. Anya Topiwala, BA (Hons) BMBCh (Oxon) MRCPsych DPhil Clinical lecturer Department of Psychiatry University of Oxford MedicalResearch.com: What is the background for this study? Response: I thought the question of whether moderate alcohol consumption is harmful or protective to the brain was a really interesting and important one, particularly because so many people drink this amount. There were a few studies reporting that a little alcohol may protect against dementia or cognitive decline, but the few brain imaging studies were conflicting in their results and had methodological limitations. We examined whether alcohol consumption over a 30-year period was associated with brain imaging and memory decline in a group of 550 non-alcohol dependent individuals from the remarkable Whitehall II cohort. Subjects completed questionnaires and had clinical examinations approximately every 5 years over the 30 years of the study, and had detailed brain scans at the end. (more…)
Addiction, Alcohol, Author Interviews, Pediatrics / 05.06.2017

MedicalResearch.com Interview with: Suniya S. Luthar, Ph.D. Foundation Professor of Psychology Arizona State University Professor Emerita Columbia University's Teachers College President-elect, American Psychological Association's Div.7 (Developmental) MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the last 20 years, we have found that kids in high achieving schools report higher use of drugs and alcohol than do their counterparts in national normative samples. This particular study was the first in which we followed up samples of high school students through young adulthood, to track levels of substance abuse and addiction. Our findings showed consistently elevated use of various substances across the years. Of greatest concern were diagnoses of dependence (that is, not just abuse of substances but actual addiction to them); among 26 year olds, rates of these diagnoses were two to three times those in national norms. (more…)
Author Interviews, Cost of Health Care, HIV, Opiods, PLoS / 31.05.2017

MedicalResearch.com Interview with: Cora Bernard, MS, PhD candidate Pre-doctoral Student in Management Science and Enginnering Affiliate, Center for Health Policy and the Center for Primary Care and Outcomes Research Stanford Health Policy MedicalResearch.com: What is the background for this study? Response: The US opioid epidemic is leading to an increase in the US drug-injecting population, which also increases the risks of HIV transmission. It is critical to public health that the US invests in a coherent and cost-effective suite of HIV prevention programs. In our model-based analysis, we considered programs that have the potential both to prevent HIV and to improve long-term health outcomes for people who inject drugs. Specifically, we evaluated opioid agonist therapy, which reduces the frequency of injection; needle and syringe exchange programs, which reduce the frequency of injecting equipment sharing; enhanced HIV screening and antiretroviral therapy programs, which virally suppress individuals and decrease downstream transmission; and oral HIV pre-exposure prophylaxis (PrEP), which is taken by an uninfected individual and lowers the risk of infection. (more…)
Alcohol, Author Interviews, Heart Disease / 26.05.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Cannabis, Columbia, Dental Research / 26.05.2017

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 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. (more…)
Author Interviews, Cocaine, McGill / 24.05.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, JAMA, Opiods, Pain Research, Surgical Research / 03.05.2017

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  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. (more…)
Addiction, Author Interviews, Cannabis, JAMA / 27.04.2017

MedicalResearch.com Interview with: 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. (more…)
Addiction, Author Interviews, Cannabis / 24.04.2017

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. (more…)
Addiction, Genetic Research, Opiods / 24.04.2017

MedicalResearch.com Interview with: 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. (more…)
Addiction, Author Interviews, Infections, JAMA, Ophthalmology / 22.04.2017

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. (more…)
Author Interviews, Cannabis, Dermatology / 21.04.2017

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. (more…)
Author Interviews, JAMA, Opiods, Surgical Research, University of Michigan / 18.04.2017

MedicalResearch.com Interview with: 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. (more…)
Addiction, Author Interviews, BMJ, Ophthalmology / 17.04.2017

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. (more…)
Author Interviews, Opiods, Pharmacology, University Texas / 11.04.2017

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. (more…)