Addiction, Author Interviews, Cocaine, Opiods, Primary Care / 03.01.2019
Urine Tests Useful in Primary Care Monitoring of Opioid and Cocaine Use
MedicalResearch.com Interview with:
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Dr. Bagley[/caption]
Sarah M. Bagley MD, MSc
Assistant Professor of Medicine and Pediatrics
Director, CATALYST Clinic
Boston University School of Medicine/Boston Medical Center
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use.
The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients.
Dr. Bagley[/caption]
Sarah M. Bagley MD, MSc
Assistant Professor of Medicine and Pediatrics
Director, CATALYST Clinic
Boston University School of Medicine/Boston Medical Center
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use.
The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients.
Dr. Dermody[/caption]
Dr. Sarah Dermody, PhD
Assistant Professor
School of Psychological Science
Oregon State University
Corvallis Oregon
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Drinking alcohol is a risk factor for sustained smoking. In a sample of daily cigarette smokers receiving treatment for alcohol use disorder, we examined if reductions in drinking corresponded with reductions in nicotine metabolism as indexed by the nicotine metabolite ratio. The nicotine metabolite ratio is important because it is associated with smoking level and lapses. We found that for men, alcohol use and the nicotine metabolite ratio reduced significantly; however, for women, neither drinking nor nicotine metabolite ratio changed.
Dr. Daniel Romer[/caption]
Daniel Romer PhD
Annenberg Public Policy Center
The University of Pennsylvania
Philadelphia, PA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous research has found some troubling relations between adolescent cannabis use and subsequent increases in conduct problems and other unhealthy consequences. These studies were done in New Zealand in the late 90’s and we wanted to re-examine those relationships using more contemporary data in the US.
We had data on 364 adolescents who were followed from age 13 to 19 in Philadelphia that could provide a more up to date picture of the effects of using cannabis on one important outcome, conduct disorder. We also wanted to use more sensitive methods than had been used in prior research that would enable us to examine reciprocal relations between cannabis use and c (CP). That is, it might be the case that youth with CP are prone to using cannabis and that this helps to explain why there appears to be a relation over time between cannabis use and CP rather than cannabis use leading to CP.
Our findings supported that hypothesis. There was no prospective relation between changes in cannabis use and subsequent changes in conduct problems. Instead, changes in conduct problems were found to predict changes in use of cannabis. Youth with conduct problems also affiliated more with peers who used cannabis, adding further to their own use. There was also no evidence that youth who used cannabis sought out peers who used it apart from the effects of CP.
Finally, both use of cannabis and conduct problems predicted subsequent development of a mild cannabis use disorder (CUD). 
Dr. Mangione[/caption]
Dr. Carol Mangione M.D., M.S.P.H., F.A.C.P
Ronald Reagan UCLA Medical Center
Division Chief of General Internal Medicine and Health Services Research
Professor of Medicine.
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine David Geffen School of Medicine
University of California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Unhealthy alcohol use is relatively common and is increasing among U.S. adults. Alcohol use is the third leading cause of preventable death in the U.S. and contributes to more than 88,000 deaths per year. In pregnancy, it also leads to birth defects and developmental problems in children. The Task Force found that screening tests and brief counseling interventions can help detect and reduce unhealthy alcohol use among adults, and in turn help prevent negative consequences related to alcohol use. For adolescents ages 12 to 17, clinicians should use their best judgment when deciding whether or not to screen and refer their patients to counseling, until we have better studies available.
Yingxi (Cimo) Chen, MD, MPH, PhD
Postdoctoral Fellow
Radiation Epidemiology Branch, DCEG, NCI, NIH
Rockville MD 20850
MedicalResearch.com: What is the background for this study?
Response: Death rates from drug overdose have more than doubled in the US in the 21st century. Similar increases in drug overdose deaths have been reported in other high-income countries but few studies have compared rates across countries. 
Dr. Quast[/caption]
Troy Quast, PhD
Associate Professor in the University
South Florida College of Public Healt
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: One of the cited repercussions of the opioid epidemic is its effect on families. However, there is considerable variation in opioid misuse across the county. This is the first nation-wide study to investigate the relationship between opioid prescription rates and child removals at the state level.
I found that there are significant differences across states in the relationship between opioid prescription and child removal rates associated with parental substance abuse. In twenty-three states, increases in opioid prescription rates were associated with increases in the child removal rate. For instance, in California a 10% increase in the county average prescription rate was associated with a 28% increase in the child removal rate. By contrast, in fifteen states the association was flipped, where increases in the opioid prescription rate were associated with decreases in the child removal rate. There was no statistically significant relationship in the remaining states. 
Dr. McLaughlin[/caption]
Ryan J. McLaughlin, PhD
Assistant Professor
Department of Integrative Physiology & Neuroscience
College of Veterinary Medicine
Washington State University
Pullman, WA 99164-7620
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The use of cannabis during pregnancy is a growing health concern, yet the long-term cognitive ramifications for developing offspring remain largely unknown. Human studies exploring the long-term effects of maternal cannabis use have been sparse for several reasons, including the length and cost of such studies, as well as the fact that experimentally assigning mothers to smoke cannabis during pregnancy is obviously ethically impractical. Animal models of maternal cannabis use have been advantageous in this respect, but they have been limited by the drugs used (synthetic cannabinoids vs. THC vs. cannabis plant) and the way that they are administered. In our study, we used a more translationally relevant animal model of maternal cannabis use that exposes pregnant rat dams to whole plant cannabis extracts using the intra-pulmonary route of administration that is most common to human users. Our preliminary data indicate that twice-daily exposure to a high-dose cannabis extract during pregnancy may produce deficits in cognitive flexibility in adult rat offspring. Importantly, these rats did not experience general learning deficits, as they performed comparably to non-exposed offspring when required to follow a cue in their environment that dictate reinforcer delivery. Instead, deficits were observed only when rats were required to disregard this previous cue-based strategy and adopt a new egocentric spatial strategy in order to continue receiving the sugar reinforcers.
Prof. Kleiman[/caption]
Prof. Mark A. R. Kleiman PhD
Affiliated Faculty, NYU Wagner; Professor of Public Policy
NYU Marron Institute of Urban Management
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As state after state legalizes the sale of cannabis, the question of cannabis-impaired driving is getting more attention. There is evidence that the practice has become more common, both because cannabis use - and especially heavy, frequent use - has increased and because a distressingly large fraction of cannabis users believe, falsely, that stoned driving is safe.
The natural response to the problem is to treat cannabis on a par with alcohol: fairly severe criminal penalties for impaired driving, with impairment defined by a specific level of the drug in the body. The paper argues that this would be a mistake, for four independent reasons:
- While cannabis makes driving riskier, it does so by about a factor of two, with no strongly observed dependency on dosage. Alcohol, by contrast, has a steep dose-effect curve. At the legal limit of 0.08% blood alcohol content by weight, the relative risk of drunk driving is at least eight; at 0.15%, which is fairly common, the relative risk has been estimated at 30-50. So there is no justification for punishing stoned driving as severely as we punish drunk driving.
- The lack of evidence of a strong dose-effect relationship suggests that a legal standard based on the content of cannabinoids in blood may not be appropriate.
- Even if a blood standard were valid, the lack of a breath test would make enforcing that standard nearly impossible as a practical matter.
- The long and unpredictable course of cannabis metabolism means that frequent users will be at risk of failing a drug test even when they are neither subjectively intoxicated nor objectively impaired. Worse, they would have no way of judging in advance whether or not driving would be legal. The result would be a re-criminalization of cannabis use through the back door. 
Dr. Rothbard[/caption]
MedicalResearch.com Interview with:
Jonathan Rothbard, MA, PhD
Steinman Lab Stanford Medicine
Co-founder 
