Alcohol, Author Interviews, Memory / 19.07.2016 Interview with: Jeff Boissoneault, PhD Research Assistant Professor Center for Pain Research and Behavioral Health Department of Clinical and Health Psychology University of FloridaJeff Boissoneault, PhD Research Assistant Professor Center for Pain Research and Behavioral Health Department of Clinical and Health Psychology University of Florida What is the background for this study? What are the main findings? Response: Many older adults are regular moderate drinkers. Although moderate drinking is considered to be a low risk behavior, growing evidence suggests older adults may be more susceptible to the cognitive and behavioral effects of moderate alcohol intake than younger people. We have previously shown that blood alcohol concentrations (BACs) below the legal limit for driving in the United States, 0.08 g/dL, affect working, or short-term, memory performance in older but not younger adults. For this study, we examined frontal theta power (FTP) and posterior alpha power (PAP), which are electrophysiological measures of brain activity associated with cognitive effort and maintenance of visual information, during a working memory task in both older and younger social drinkers. We found that during a nine-second delay period during which participants held briefly-displayed images in memory, moderate alcohol intake increased PAP in younger adults but decreased PAP in older adults. Examining the relationship between PAP and behavioral performance (accuracy and reaction time) suggested older adults may attempt to compensate for moderate alcohol-induced working memory impairment by prioritizing quick responding over the protection of their mental representation of the task images from environmental distractions. Younger adults did not show this effect. (more…)
Author Interviews, Genetic Research, Opiods, Pain Research, Thromboembolism / 14.07.2016 Interview with: Brian Meshkin Founder and CEO of Proove Biosciences Editor’s note: Proove Biosciences, Inc introduced three new evidence-based tests to support better clinical decision-making for difficult-to-treat conditions that are influenced by genetics. These conditions include substance abuse, fibromyalgia and venous thromboembolism. The tests are especially relevant in light of the House of Representatives passing the Comprehensive Addiction Recovery Act (CARA) bill on July 8, 2016 to combat the opioid epidemic. Would you update our readers on the significance and implications of the CARA Act? What is the role of genetics in addiction? What is the background for the Proove Addiction™ Profile? How does it aid in addiction management? Response: CARA is a national piece of legislation to expand access to treatment for drug overdoses and addiction. It also includes some other provisions meant to help address the opioid epidemic. However, there are some serious implications. First, it does not contain any funding, so it is a bit of a “Potemkin Village”. It is also a bit of a façade because it does not address 50% of the equation. According to the definition of addiction from the American Society of Addiction Medicine (ASAM) and the National Institutes of Drug Abuse (NIDA), about half of substance abuse is due to genetic factors. If you are studying for a test and ignoring half of the material, chances are you are not going to do well on the test. As doctors are confronted with the challenges of objectively assessing pain and knowing which patients are at risk for abuse, they must consider genetics. The Proove Opioid Risk test combines genetic markers and phenotypic variables into an algorithm to effectively identify patients at low, moderate and high risk for opioid abuse. By knowing this information, a physician can make better decisions about opioids. For low risk patients, a physician can safely prescribe and a patient does not need to fear the opioid prescription they are given – as this is about 50% of the population. For those at moderate risk, a physician can use a greater level of vigilance to monitor those patients with abuse-deterrent formulations, regular urine drug screens, opioid contracts, and other tools to monitor their use. For the small number of patients – less than 10% - that are at high risk, a physician can use alternative forms of pain relief such as interventional procedures or non-opioid analgesics to provide the needed relief to patients. The Proove Addiction Profile builds on this commitment, by providing genetic data points related to other disorders, such as addictions to alcohol, heroin, cocaine and others. Unfortunately, many patients who screen positive for aberrant behavior, such as having an illicit drug in their urine, are often discharged from care by their doctor. This just gets them lost in the system. By running the Proove Addiction Profile in addition to a urine drug screen, a doctor can better understand the genetic factors associated with the aberrant behavior and refer the troubled patient to an addiction specialist for treatment. (more…)
Addiction, Alcohol, Author Interviews, Neurological Disorders / 11.07.2016 Interview with:, Jun Wang, M.D., Ph.D. Assistant Professor Department of Neuroscience and Experimental Therapeutics Interdisciplinary Program in Neuroscience (TAMU/TAMHSC) TAMHSC COLLEGE OF MEDICINE Bryan, TX 77807 What is the background for this study? What are the main findings? Response: Alcohol use disorder is a big problem for our society and only a limited number of medicine is available. We hope to find more treatment in animal models of alcoholism. A group of neurons containing dopamine D2 receptors in the brain prevent us from drinking alcohol heavily. (more…)
Author Interviews, Cannabis, JAMA, Mental Health Research / 06.07.2016 Interview with: Mary P. Heitzeg, PhD Assistant Professor Department of Psychiatry University of Michigan What is the background for this study? What are the main findings? Response: We wanted to find out if marijuana use changed the way the brain’s reward system responded to natural rewards. To probe response to natural reward, we used the chance to win some money and we observed brain response using functional magnetic resonance imaging (fMRI). We looked at brain activity when participants were 20 years old on average, and then again 2 years later and 4 years later. We found that over time marijuana use was associated with a decrease in the brain’s reward response to the chance to win money. This finding is consistent with current theories of addiction that suggest that repeated use of a substance may dampen the brain’s reward response to things normally perceived as pleasurable and this alteration may drive the individual to continue substance use. (more…)
Addiction, Author Interviews, Cancer Research, Pharmacology / 04.07.2016 Interview with: Dr Wai Liu Senior Research Fellow St George's University of London London What is the background for this study? What are the main findings? Response: Naltrexone is a drug commonly used to wean addicts off alcohol and heroin, but clinical evidence has shown that when the drug is used at lower doses, patients would exhibit alter immunity. The symptoms that patients with a number of autoimmune diseases and those associated with chronic pain would ease significantly. Additionally, a number of reports showed patients with some forms of cancer would experience therapeutic benefit. Interestingly, the doses of the drug was crucial, and the non-conventional effects of naltrexone was only achieved at doses that were lower that what was conventionally used. We set about to understand why a drug could have such different effects when used at differing doses. Our results show that the genetic profile of the drug is subtly different at the two different doses, which helped us identify novel ways in which the drug could be used to induce an anticancer effect. (more…)
Addiction, Annals Internal Medicine, Author Interviews, Opiods, UCSF / 28.06.2016 Interview with: Phillip O. Coffin, MD, MIA Director of Substance Use Research San Francisco Department of Public Health Assistant Professor, Division of HIV, ID & Global Health University of California, San Francisco What is the background for this study? What are the main findings? Response: San Francisco has a longstanding naloxone distribution program that primarily works out of syringe exchange programs and is temporally associated with a substantial decline in opioid overdose death due to heroin or involving injection drug use. Over 90% of opioid overdose deaths from 2010-2012 were due to prescription opioids in the absence of heroin, and most of those decedents were prescribed opioids in primary care settings. Based on these data, as well as anecdotal reports from sites such as U.S. Army Fort Bragg in North Carolina - where providing naloxone to pain patients appeared to be associated with a radical decline in opioid overdose admissions to the emergency department - we implemented a naloxone prescribing program in the safety net primary care clinics. We recommended that providers offer naloxone to all patients who used opioids on a regular basis, or were otherwise at risk for experiencing or witnessing an opioid overdose, although we only measured outcomes related to patients who were prescribed opioids for chronic pain. We also recommended that providers avoid the term "overdose" as that term does not properly reflect the epidemiology of opioid poisoning and is interpreted by many to mean intentionally consuming a large amount of opioids; instead we recommended saying things like: "Opioids can cause bad reactions where you stop breathing or can't be woken up." Providers prescribed mostly the jerry-rigged nasal device, with the atomizer and a brochure dispensed at clinic and the naloxone picked up at the patients' usual pharmacies, to approximate real-world medical practice. (more…)
Alcohol, Author Interviews, BMJ, Heart Disease / 26.06.2016 Interview with: Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco What is the background for this study? Response: Multiple epidemiologic studies have demonstrated that alcohol consumption likely increases the risk for atrial fibrillation and reduces the risk for myocardial infarction. However, the results have been conflicting, they generally all rely on self-report of alcohol consumption (which is known to be unreliable, particularly in those that drink more heavily), and there is almost certainly confounding related to an individual’s choice to consume alcohol (which in most settings is ubiquitously available). In addition, the relationship between alcohol and heart failure remains poorly understood, with evidence suggesting there may be both harmful and beneficial effects. Finally, the relationship between alcohol consumption and these various cardiovascular diseases (atrial fibrillation, myocardial infarction, and heart failure) have not been examined within the same cohort of individuals in a simultaneous fashion. (more…)
Author Interviews, NEJM, Occupational Health, Opiods / 24.06.2016 Interview with: Professor Ellen Meara, PhD Professor The Dartmouth Institute for Health Policy and Clinical Practice What is the background for this study? Response: Responding to a fourfold rise in death rates, between 2006 and 2012, states collectively enacted 81 laws restricting prescribing and dispensing of prescription opioids. Jill Horwitz, PhD, JD, said “states hoped passing a range of laws might help. So they are enacting small fixes — forbidding patients from “doctor-shopping,” and requiring doctors to use tamper-resistant prescription forms. They are also implementing major efforts such as prescription drug monitoring programs (PDMPs) — online databases that allow law enforcement and clinicians to monitor prescriptions.” (more…)
Author Interviews, Cannabis, OBGYNE, Pediatrics / 21.06.2016 Interview with: Dr. Hanan El Marroun, PhD Assistant Professor Department of Child and Adolescent Psychiatry, Department of Epidemiology The Generation R Study Erasmus, The Netherlands What is the background for this study? What are the main findings? Response: The background for the study is that little is known about the potential long-term effects of cannabis exposure during pregnancy on child development. The main findings are the prenatal cannabis exposure was associated with differences in cortical thickness in childhood. What should readers take away from your report? Response: That our findings suggest an association between prenatal cannabis exposure and cortical thickness in children. However, the results must be carefully interpreted, as there may be other factors involved that we did not take into account. Therefore, further research is needed to explore the causal nature of this association. (more…)
Addiction, Author Interviews, Cocaine, Science / 20.06.2016 Interview with: Dr Karen Ersche PhD University of Cambridge Department of Psychiatry Brain Mapping Unit Herchel Smith Building Cambridge UK What is the background for this study? Dr. Ersche: Cocaine addiction is a major public health problem that is associated with significant harm - not just for the individual, but also for their families and for society as a whole. Without medically proven pharmacological treatments, therapeutic interventions mainly rely on psychosocial approaches, but behaviour in people with cocaine addiction remains extremely difficult to change. The impetus for this study was to find out why people with cocaine addiction are so resistant to change. One possibility would be that they have a strong tendency to develop habits, which means that they show patterns of behaviour that are not under direct voluntary control. (more…)
Author Interviews, Cannabis, CHEST, Pulmonary Disease / 12.06.2016 Interview with: Stefania I. Papatheodorou, MD, PhD Cyprus International Institute for Environmental and Public Health Limassol, Cyprus What is the background for this study? What are the main findings? Response: Marijuana is the most commonly used illicit drug in the United States. Despite increasing use and acceptance of marijuana, both medically and recreationally, gaps remain in our knowledge regarding potential health effects. In this study, we aimed to evaluate associations between recent marijuana use, exhaled Nitric Oxide (eNO) and pulmonary function. We performed a cross-sectional study of 10,327 US adults participating in the National Health and Nutrition Examination Survey (NHANES) in the years 2007 to 2012. Exhaled Nitric Oxide was lower among participants who used marijuana in the past 0 to 4 days and those who last used marijuana 5 to 30 days before the examination compared with the never users. FEV1 was higher among participants who used marijuana within 0 to 4 days before the examination compared with those who never used marijuana, while FVC was higher in both past and current marijuana users compared with never users. The FEV1/FVC ratio was significantly lower among those who used marijuana in the 0 to 4 days before the examination compared with never users. (more…)
Addiction, Author Interviews, Columbia, Pediatrics / 11.06.2016 Interview with: Hannah Carliner, ScD MPH Post Doctoral Fellow in Substance Abuse Epidemiology Mailman School of Public Health Columbia University What is the background for this study? What are the main findings? Dr. Carliner: We know from previous research that traumatic experiences in childhood can have far-reaching effects on the mental and physical health of adults, including increasing the risk for substance use disorders. There is a particularly strong body of evidence about this concerning exposure to child abuse and various other forms of family dysfunction and violence. However, no previous studies have examined a wider range of traumatic childhood experiences and their link to experimentation with different kinds of drugs in adolescence. While some studies have interviewed adults about initiation of drug use at this age, those results are not as reliable as interviewing teens directly. Using a nationally-representative sample of almost 10,000 non-institutionalized U.S. adolescents, we therefore determined that childhood trauma was associated with lifetime drug use in teens-- not only with clinically-significant disordered drug use, but even with just trying drugs one time. (more…)
Anesthesiology, Author Interviews, Breast Cancer, Opiods, Pain Research / 04.06.2016 Interview with: Dr. Sarah Saxena Université Libre de Bruxelles What is the background for this study? What are the main findings? Dr. Saxena: Opioids are well known analgesics, but like every drug, they do not come without side-effects. Recently, certain studies have been published about an opioid-free approach in bariatric patients. An opioid free approach is possible combining ketamine, lidocaine and clonidine. We studied this type of approach in breast cancer patients and looked at several factors such as patient comfort pain quality after an opioid free approach vs after an opioid approach. The study showed patients requiring less analgesics after an opioid free approach. (more…)
Author Interviews, Opiods / 03.06.2016 Interview with: Hsien-Yen Chang PhD Assistant Scientist Johns Hopkins Bloomberg School of Public Health Department of Health Policy & Management Center for Drug Safety & Effectiveness What is the background for this study? Dr. Chang: Prescription opioid addiction and non-medical use are significant public health problems, responsible for about 44 daily overdose deaths in the United States. Although there are no magic bullets to address these issues, policy makers play an important role in shaping regulatory, payment and public health policies to reduce opioid-related injuries and deaths. For example, state policy-makers in the United States have used prescription drug monitoring programs (PDMPs) and “pill mill” laws to address the prescription opioid epidemic. While there is growing evidence regarding the effect of these approaches on opioid sales, little is known about how they affect specific groups of prescribers. This is important, as approximately 20% of U.S. physicians are responsible for prescribing 80% of all opioid analgesics. Therefore, in this study we evaluated the impact of PDMPs and pill mill laws on the clinical practices of high-risk prescribers in Florida, such as their total number of prescription-filling patients with an opioid prescription. Furthermore, we also characterized the concentration of opioid volume and prescriptions among this group of prescribers as well as how the policies of interest impacted these measures. (more…)
Author Interviews, Cannabis, OBGYNE, Pediatrics, Toxin Research / 18.05.2016 Interview with: Professor Claire Roberts PhD Robinson Research Institute Adelaide University What is the background for this study? What are the main findings? Dr. Roberts: Our research aimed to identify novel risk factors for the four main complications of pregnancy;
  • preeclampsia where the mother gets high blood pressure and her kidneys don’t work properly,
  • preterm birth which is delivery before 37 weeks of gestation,
  • small for gestational age and
  • gestational diabetes. We have studied over 5500 pregnant women in 6 centres in 4 countries, Australia, New Zealand, the UK and Ireland. We have identified a number of factors that contribute to these major pregnancy complications. However, in this paper we have focused on well known risk factors for pregnancy complications including maternal cigarette smoking, BMI and socioeconomic status. To these we added maternal use of marijuana before pregnancy, in first trimester, at 15 weeks and at 20 weeks gestation. After adjusting the data for the other factors, we found that continued maternal marijuana use at 20 weeks gestation is strongly associated with spontaneous pre-term birth independent of maternal cigarette smoking. Women who continued to use marijuana at 20 weeks’ gestation were over 5 times more likely to deliver preterm than women who did not use marijuana. Previous studies have shown conflicting evidence but none have accounted for maternal cigarette smoking.
Importantly, not only did continued use of marijuana increase risk for preterm birth but it also made these births 5 weeks earlier on average with a greater number of women delivering very preterm. That is much more dangerous for the baby who inevitably would require admission to a neonatal intensive care unit (NICU). Earlier delivery would be expected to increase the baby’s risk for dying and having long term disabilities. (more…)
Accidents & Violence, Author Interviews, Cannabis / 11.05.2016 Interview with: Mr. Brian C. Tefft Senior Research Associate AAA Foundation for Traffic Safety What is the background for this study? What are the main findings? Response: In December 2012, a new law took effect in Washington state that effectively legalized the possession and use of small amounts of marijuana by adults aged 21 years and older for recreational purposes, and also created a legal limit for driving under the influence of marijuana such that having a concentration of 5.00 nanograms or greater of delta-9-tetrahydrocannabinol (THC, the main psychoactive chemical in marijuana) per milliliter of whole blood while driving in the state of Washington is per se driving under the influence. Data from population-based surveys indicate that the proportion of Washington state residents who report using marijuana increased after this law took effect; however, not much was known about the impact of this new law on traffic safety in the state. To investigate the traffic safety impact of the new law, we examined drug test results from drivers involved in motor vehicle crashes that occurred in years 2010 – 2014 in Washington and resulted in the death of at least one person within 30 days of the crash. Specifically, we looked at the proportion of all drivers involved in fatal crashes who had detectable THC in their blood at or shortly after the time of the crash, which generally suggests that the driver had used marijuana within the past few hours. Results showed that from 2010 through 2013, approximately 8-9% of drivers in fatal crashes each year were positive for THC, and that proportion was basically flat from 2010 through 2013. In 2014, the proportion basically doubled, to 17%. Our modelling suggests that an increasing trend in the proportion of drivers who were positive for THC began in late 2013, about 9-10 months after the new law took effect. (more…)
Author Interviews, Opiods, Pain Research / 11.05.2016 Interview with: Richard M. Mangano, PhD Chief Scientific Officer at Relmada Therapeutics Dr. Mangano has extensive experience leading global R&D programs in both large and small pharmaceutical companies including positions in discovery and clinical research at Hoffmann-La Roche, Lederle Laboratories, Wyeth Research and Adolor Corporation. He served as acting Therapeutic Area Director for Neuroscience at Wyeth before joining Adolor as Vice President of Clinical Research and Development. Dr. Mangano’s expertise includes multiple IND/CTC submissions and NDA/MAA approvals in psychiatry, neurology and gastrointestinal therapeutic areas. Dr. Mangano is also an adjunct professor in the Department of Pharmacology and Physiology at the Drexel University School of Medicine. He lectures in the Drug Discovery and Development Program and in the Psychiatry Department’s Resident Training Program.  He has authored 30 peer reviewed publications and over 120 abstracts and presentations. Dr. Mangano holds a B.S degree in Chemistry from Iona College and a PhD degree in Biochemistry from Fordham University. Prior to joining the pharmaceutical industry, he was a research faculty member of the Maryland Psychiatric Research Institute at the University of Maryland School of Medicine. Dr. Mangano discusses the opioid addiction and the development of abuse-resistant medications. What is the background for the development of abuse-resistant medications? How extensive is the problem of opioid addiction? Dr. Mangano: Recognizing the growing incidence of opioid abuse, misuse, and overdose in the United States, pharmaceutical companies, with the guidance of the FDA, are developing products that can mitigate abuse, while recognizing the importance of maintaining the availability of opioid analgesics for the millions of patients in this country who suffer from pain. Approximately two million people in the U.S. are addicted to opioids. The market for products that treat opioid dependence has grown significantly due to the rapidly escalating problem of prescription opioid misuse and abuse, a recent resurgence of heroin use, and the growing number of physicians treating opioid dependence. One of our product candidates, REL-1028 (BuTab), is a proprietary formulation of buprenorphine designed to treat both opioid addiction and moderate to severe chronic pain. Although there is the potential for addiction to buprenorphine, the risk is lower because it is a “partial agonist” of the mu opioid receptor compared with “full agonist” opioids like heroin, morphine, oxycodone, and hydrocodone. As a result, products containing buprenorphine, such as BuTab, should have reduced risk of abuse and physical dependence and would be controlled in Schedule III of the Controlled Substances Act (as opposed to the more restrictive Schedule II). We are also considering a formulation that would include an opioid antagonist that would not interfere with analgesia when taken orally as prescribed but would block the action of buprenorphine if it were to be inhaled or injected. (more…)
Author Interviews, Emergency Care, Heart Disease, Opiods / 05.05.2016 Interview with: William Eggleston, PharmD Fellow in Clinical Toxicology/Emergency Medicine Upstate Medical University Upstate New York Poison Center What is the background for this study? What are the main findings? Dr. Eggleston: The case series describes two deaths associated with loperamide abuse with supportive post-mortem findings. It adds to the growing body of literature reporting cardiac toxicity after loperamide abuse and demonstrates the deadly consequences. It also highlights the growing trend of loperamide abuse amongst opioid addicted patients looking to get high or stave off withdrawal symptoms. What should readers take away from your report? Dr. Eggleston: Readers should recognize that loperamide is an OTC opioid medication that acts similarly to morphine or heroin in the body after high doses. The drug is easily abused due to its low cost, ease of accessibility, legal status, and lack of social stigma associated with its possession. Most importantly, loperamide is a cardiac toxin that causes conduction disturbances in high doses and can produce deadly dysrhythmias. (more…)
Addiction, Author Interviews, Genetic Research, PNAS / 29.04.2016 Interview with: Shelly B. Flagel, PhD Molecular and Behavioral Neuroscience Institute Department of Psychiatry University of Michigan, Ann Arbor, MI 48109 What is the background for this study? What are the main findings? Dr. Flagel: We used a unique genetic animal model to examine individual differences in addiction liability. This model of selectively bred rat lines allowed us to examine the brains of “addiction-prone” and “addiction-resilient” rats before and after they were exposed to cocaine. I mportantly, even though all rats were exposed to the same amount of drug, only a certain subset exhibited addiction-like behavior. We focused our neurobiological analyses on two molecules that have been previously implicated in response to drugs of abuse – the dopamine D2 receptor and fibroblast growth factor (FGF2). We examined gene expression and the epigenetic regulation of these molecules and found that low levels of FGF2 in the core of the nucleus accumbens, a brain region known for regulating motivated behavior, may protect individuals from becoming addicted; whereas low levels of D2 in this brain region may predispose individuals to addiction. Further, this is the first study to show that epigenetic modulation of these molecules may be a predisposing factor and that, the epigenetic regulation of D2 may be especially important in susceptibility to relapse. (more…)
Addiction, Author Interviews, Cocaine, Methamphetamine, Opiods, University of Pittsburgh / 25.04.2016 Interview with: Jeanine Buchanich, Ph.D. Deputy director of the Graduate School of Public Health’s Center for Occupational Biostatistics and Epidemiology Research assistant professor in Pitt Public Health’s Department of Biostatistics University of Pittsburgh What is the background for this study? What are the main findings? Dr. Buchanich: Using the Mortality and Population Data System, a unique repository and retrieval system for detailed death data from the National Center for Health Statistics, housed at the University of Pittsburgh Graduate School of Public Health, my team examined overdose deaths in the U.S. from 1979 to 2014. We started with 1979 because changes in reporting cause of death make it impossible to make comparisons with previous years. 2014 is the most recent year for which data are available. The counties with the largest increases in overdose death rates were clustered in southern Michigan; eastern Ohio and western Pennsylvania; eastern Pennsylvania, New Jersey and much of southeastern New York; and coastal New England. Counties in the Midwest, California and Texas have seen little to no increase in overdose death rates. We cross-referenced the mortality data with counties in the High Intensity Drug Trafficking Areas program, which was created by Congress in 1988 to provide 31 high drug-trafficking areas of the U.S. with coordinated law enforcement resources dedicated to reducing trafficking and production. High Intensity Drug Trafficking Areas with high overdose death rates were mostly concentrated in Appalachia and the Southwest U.S., whereas such areas with lower death rates were near the borders in California, Texas and southern Florida. (more…)
Author Interviews, Cannabis, FASEB, Fertility / 20.04.2016 Interview with: Paola Grimaldi, PhD Associate Professor of Anatomy Department of Biomedicine and Prevention, School of Medicine, University of Rome Tor Vergata Rome, Italy What is the background for this study? What are the main findings? Dr. Grimaldi: Our previous studies reported that mouse mitotic germ cells, spermatogonia, express type 2 cannabinoid receptor (CB2) and its stimulation promoted differentiation and meiotic entry of these cells in vitro. In this study we demonstrate that CB2 plays a role of in regulating the correct progression of spermatogenesis in vivo and we found that the use of exogenous agonist or antagonist of this receptor disrupts the normal differentiation of germ cells. This suggests that a basal and finely regulated level of endocannabinoids in male germ cells activate CB2, thus maintaining the homeostasis of spermatogenesis. Another important novelty of our study is that CB2 activation in developing germ cells determines the appearance of modifications in DNA-bound proteins, which are known to impact on gene expression and inheritance of specific traits in developing germ cells. An exciting idea could be that these modifications might be maintained in the mature spermatozoa and transmitted to the offspring. (more…)
Author Interviews, CMAJ, Opiods / 17.04.2016 Interview with: Dr. Zainab Samaan, MBChB, MSc, DMMD, PhD, MRCPsych Associate Professor Dept of Psychiatry and Behavioural Neurosciences Member Population Genomics Program Member Peter Boris Centre for Addiction Research Associate Faculty Dept of Clinical Epidemiology and Biostatistics McMaster University Hamilton, ON, Canada Medical Research: What is the background for this study? Response: Opioid addiction has become a leading public health concern in North America with Canada leading the way in the amount of opioid use per capita. Opioid addiction has moved from heroin use by young men to prescription pain killers such as oxycodone and fentanyl with devastating impact on individuals and society including increasing number of deaths due to opioid overdose. In addition many people on treatment will also relapse (go back using drugs). We wanted to understand the problem of opioid addiction by investigating the factors that increase the risk of relapse in people with opioid addiction receiving methadone treatment. Medical Research: What are the main findings? Response: People who injected drugs and used benzodiazepines (BDZ) are more likely to relapse faster than people who did not use injection or benzodiazepines. (more…)
Addiction, Author Interviews, JAMA, Opiods / 06.04.2016 Interview with: Dr. Eugenia Oviedo-Joekes PhD Assistant Professor, School of Population and Public Health University British Columbia Centre for Health Evaluation and Outcome Sciences Providence Health Care, St Paul’s Hospital, Vancouver British Columbia, Canada What is the background for this study? What are the main findings? Dr. Oviedo-Joekes: Diacetylmorphine is the active ingredient in heroin. Medically prescribed diacetylmorphine has shown greater effectiveness than methadone alone for the treatment of patients with long term opioid dependence who are not benefitting from available treatments (i.e., they continue injecting in the street daily for many years).  Medically prescribed diacetylmorphine is being used in a small number of countries in Europe but is unlikely to be accepted in many countries around the world, including Canada and the US.  SALOME is the world’s first study to examine the effectiveness of hydromorphone, a licensed, legal pain medication, as an alternative treatment to diacetylmorphine for chronic heroin addiction. Participants were randomly assigned to receive injectable diacetylmorphine or hydromorphone, double-blinded (up to three times daily) for six months under supervision. Injectable hydromorphone was as effective as injectable diacetylmorphine for long-term street opioid users not currently benefitting from available treatments (about 10 per cent of the heroin-dependent population).Study participants on both medications reported far fewer days of street-heroin and other opioid use at six months compared to almost daily illicit opioid use before taking part in the study. They also reported a reduction in days of illegal activities, from an average of 14.1 days per month to fewer than four. (more…)
Author Interviews, BMJ, Cannabis, OBGYNE, Pediatrics / 06.04.2016 Interview with: Cara Christ, M.D., M.S. Director of the Arizona Department of Health Services What is the background for this study? What are the main findings? Dr. Christ: This study was a systematic review. The purpose of a systematic review is to critically assess and summarize the best available research evidence on a specific issue. This usually involves a critical synthesis of the results of several high quality studies on the issue under review. Overall, this review found that infants exposed to cannabis during pregnancy had a 77% higher likelihood of being underweight (<2500grams) at birth, compared to infants whose mothers did not use cannabis. Also, if the mother used cannabis during pregnancy, the likelihood of her infant needing to be placed in a neonatal intensive care unit was two times higher compared to those infants whose mothers did not use cannabis during pregnancy. (more…)
Author Interviews, CMAJ, Opiods, Pain Research / 04.04.2016 Interview with: Shawn Bugden B.Sc. (Pharm), M.Sc., Pharm.D. Associate Professor College of Pharmacy, Faculty of Health Sciences University of Manitoba Winnipeg, Manitoba, Canada What is the background for this study? What are the main findings? Dr. Bugden: Fentanyl is 100 times more potent than morphine.  While there has been a great deal of attention to fentanyl deaths associated with substance abuse, our study focused on the safety of fentanyl use in standard medical practice.   Fentanyl is most commonly prescribed as a transdermal (skin) patch that delivers the medication over 3 days. The product monograph and numerous safety warnings (FDA, Health Canada…) make it clear that fentanyl patches should not be used unless the patient has had considerable previous opioid exposure (more than 60mg morphine per day for more than 1 week).  Failure to heed these warnings may result in opioid overdose, respiratory depression and death. This study examined over 11 000 first prescriptions for fentanyl patches over a 12-year period to determine if patients had received adequate exposure to opioids.  Overall 74.1% of first prescriptions were filled by patients who had not received adequate prior opioid exposure. An improvement was seen over the study period but even at the end of the study, 50% of prescriptions would be classed as unsafe.  More than a quarter (26.3%) of fentanyl prescriptions were given to patients who were completely opioid naïve and had no exposure to opioids of any kind in the previous 60 days.  Older adults, who may be more sensitive to the effects of fentanyl overdose, were more likely to receive unsafe prescriptions than younger adults. (more…)
Alcohol, Author Interviews, Diabetes, Endocrinology / 03.04.2016 Interview with: Ken C. Chiu, MD, FACE, FACP Professor Endocrinology Fellowship Training Program Department of Clinical Diabetes, Endocrinology, and Metabolism Diabetes and Metabolism Research Institute City of Hope National Medical Center Duarte, CA 91010-3000 What is the background for this study? What are the main findings? Dr. Chiu: The benefit of moderate alcohol consumption is well established in cardiovascular disease. However, the role of alcohol consumption in type 2 diabetes is less clear. We examined the role of alcohol consumption in type 2 diabetes using the data from the National Health and Nutrition Examination Survey 2005-1012, which is a representative US population. In the rare alcohol consumption group (< 12 drinks per year), 24.04% were diabetic while only 14.67% were diabetic in the moderate alcohol consumption (1-4 drinks per day) group (P><0.000001). In contrast, 21.05% were diabetic in the heavy alcohol consumption (≥ 5 drinks/day) group (P=0.003) when compared to the rare alcohol consumption group. Thus, in compared to the rare alcohol consumption, moderate alcohol consumption was associated with a lower risk of diabetes (OR: 0.72; 95%CI: 0.65-0.79) after adjustment for co-variates, while there was no benefit from heavy alcohol consumption (OR: 0.97; 95%CI: 0.90-1.05). Our study demonstrates that moderate alcohol consumption reduces the risk of diabetes by 28%. (more…)
Addiction, Author Interviews, NEJM, NYU / 31.03.2016 Interview with: Joshua D. Lee MD, MSc Associate Professor in Medicine and Psychiatry NYU Langone Medical Center What is the background for this study? Dr. Lee: Opioid use disorders, both from prescription pain medication and heroin use, and related death rates are increasing annually in the US.  Many states, counties, and cities that have previously not had great experience with heroin addiction are now overwhelmed.  This presents unprecedented challenges to affected families and communities, and also health providers and criminal justice systems that have historically not provided high rates of evidence-based treatment for opioid addictions.  Left untreated or inadequately treated, opioid use disorders are chronic, destructive, and often fatal. Extended-release naltrexone, an opioid receptor blocker, is a promising relapse prevention medication intervention, but had not been evaluated in a US criminal justice system (CJS) setting or under real-world conditions. This effectiveness study recruited 308 adults with US criminal justice system involvement (i.e., recent jail or prison incarceration, on parole or probation) and a history of opioid dependence (addiction), who were not currently accessing methadone or buprenorphine maintenance treatment, and were interested in treatment with extended-release naltrexone (XR-naltrexone).  All participants were off opioids (detoxed or recently abstinent) at the time of study start (randomization).  Participants randomized to an open-label, non-blinded evaluation of XR-naltrexone versus treatment-as-usual for six months of treatment.  Long-term follow-up occurred at 12 months and 18 months (6 and 12 months post-treatment).  We estimated rates of opioid relapse and opioid use between the two arms over the course of treatment.  We also tracked other drug and alcohol use, re-incarceration rates, and overdose rates throughout the study. (more…)
Addiction, Dental Research, Microbiome, NYU, Smoking / 30.03.2016 Interview with: Jiyoung Ahn, PhD, RD, MS Associate Professor of Population Health Associate Director of Population Sciences, NYU Perlmutter Cancer Center  and Brandilyn Peters (post-doctoral fellow, lead author) NYU Langone School of Medicine What is the background for this study? What are the main findings? Response: Oral bacteria play important roles in oral health, and can influence the health of other body systems as well. We were interested in studying how cigarette smoking affects oral bacteria. To do this, we examined the oral bacteria in mouthwash samples from 112 current smokers, 571 former smokers, and 521 people who never smoked. We found that the mouth bacterial composition of current smokers differed dramatically from those who never smoked. However, the mouth bacterial composition of former smokers was similar to that of never smokers, suggesting that quitting can restore the oral bacteria back to a healthy state. (more…)
Addiction, Author Interviews, Cocaine, Lancet / 30.03.2016 Interview with: Mascha Nuijten MSc Researcher/ PhD candidate Brijder Research (PARC) The Hague The Netherlands What is the background for this study? What are the main findings? Response: Crack-cocaine dependence is a complex disorder, for which no proven effective pharmacotherapy is yet available. Prior to our study, sustained-release dexamfetamine was found to be a promising treatment for cocaine dependence in several studies, but no studies so far had shown a convincing benefit in terms of substantial cocaine use reductions. Therefore, we investigated the efficacy of sustained-release (SR) dexamphetamine in a robust dose of 60 mg/day in chronic crack-cocaine dependent patients. We found that the number of days of cocaine use decreased with almost 40% in the dexamfetamine group, compared with 9% in the matched placebo group. In addition, the number of cocaine self-administrations on days that patients used crack-cocaine decreased with 43% in the dexamfetamine group and with 7% in the placebo group. Thus, SR dexamfetamine both contributed to cocaine abstinence and to cocaine use reductions. (more…)