Author Interviews, Cannabis, JAMA / 23.06.2015

MedicalResearch.com Interview with: Penny F. Whiting, PhD School of Social and Community Medicine, University of Bristol The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals, Bristol NHS Foundation Trust, Bristol UK Kleijnen Systematic Reviews Ltd, Escrick, York, United Kingdom MedicalResearch: What is the background for this study? What are the main findings? Dr. Whiting: Cannabis is one of the most popular recreational drugs - only tobacco, alcohol and caffeine are more popular. It can result in an alteration to mood and a feeling of “high”. An estimated 141 million people use cannabis worldwide – this is equivalent to 2.5% of the world’s population. Cannabis has a long history of use for the relief of a wide variety of medical symptoms. There is evidence of its use for medical purposes going back to early Egyptian times. The pen-ts’ao ching the world’s oldest herbal book includes reference to cannabis as medicine for rheumatic pain, constipation, disorders of the female reproductive system, and malaria amongst others, this herbal book also contains the first reference to cannabis as a psychoactive drug. However, its use is controversial as it has been included as a controlled drug in the United Nations Single Convention on Narcotic Drugs since 1961, and the use of cannabis is illegal in most countries. Medical cannabis (or medical marijuana) refers to the use of cannabis or cannabinoids (any compound, natural or synthetic, that can mimic the actions of plant-derived cannabinoids) as medical therapy to treat disease or alleviate symptoms, this is different from CBD oil that also has been found to help with certain medical conditions, click to see details about CBD oil. Some countries have legalised medicinal-grade cannabis to chronically ill patients but in others its use remains illegal even for medicinal purposes. Canada and the Netherlands have government-run programmes where specialised companies supply quality controlled herbal cannabis. There are different strains of cannabis can help with aliments, those who are interested in finding out more about a list of low odor strains by GreenBudGuru.com might be interested in visiting or doing some research to find out more. These programmes have been running since 2001 and 2003 respectively. In the US around half of the states have introduced laws to permit the medical use of cannabis; other countries have similar laws. Kleijnen Systematic Reviews Ltd (see below) were commissioned by the Swiss Federal Office of Public Health to conduct a systematic review for the effects and adverse events of medical cannabis to inform policy decision making. Systematic reviews are studies of studies that offer a systematic approach to reviewing and summarising evidence. They follow a defined structure to identify, evaluate and summarise all available evidence addressing a particular research question. We were asked to focus on the following ten indications which were of particular interest to our commissioners: nausea and vomiting due to chemotherapy, patients with HIV/AIDS, chronic pain, spasticity in patients with multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, and Tourette’s syndrome. We only included randomised trials, the most robust design for evaluating the effects of an intervention. We included almost 80 trials (nearly 6500 participants). We had most evidence for chronic pain (28 trials), nausea and vomiting due to chemotherapy (28 trials) and spasticity due to MS or paraplegia (14 trials) with less than five studies included for each of the other indications and none for depression. With the exception of the nausea and vomiting due to chemotherapy population, studies general compared cannabinoids to placebo with only single studies for each indication comparing cannabinoid with an active comparator. In the nausea and vomiting population the majority of studies compared cannabinoids to an active comparator, most commonly prochlorperazine. Most trials reported greater improvement in symptoms with cannabinoids compared to control groups, however, these did not always reach statistical significance. Cannabinoids were also associated with a greater risk of short term adverse events, including serious adverse events. Common adverse events included dizziness, dry mouth, nausea, fatigue, sleepiness, and euphoria. Overall we found that there was moderate quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity and low-quality evidence to suggest that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep quality, and Tourette syndrome. When determining the quality of the evidence we considered the risk of bias in trials, the consistency of the evidence across the trials, the directness of the evidence (was the trials research question directly applicable to our review question), and the precision of the evidence. (more…)
Author Interviews, Cannabis, Columbia, Lancet / 18.06.2015

Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032MedicalResearch.com Interview with: Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032 MedicalResearch: What is the background for this study? What are the main findings? Dr. Hasin: The background for the study was the need to identify the causes of the marked increase in marijuana use among U.S. adolescents over the last several years, given that early adolescent marijuana use leads to a number of adverse health and psychosocial consequences, including cognitive decline, into adulthood. We had two main findings from the study:
  1. A comparison of the rates of adolescent marijuana use between states that ever passed a medical marijuana law and those that did not revealed that states with such laws had higher rates of teen marijuana use, regardless of when they passed the law; and
  2. When we compared the rates of teen marijuana use in these states before and after passage of the laws, we did not find a post-passage increase in the rates of teen marijuana use. This suggests that some common factor may be causing both the laws to be passed and the teens to be more likely to smoke marijuana in the states that passed these laws.
(more…)
Author Interviews, Cannabis, Pediatrics / 15.06.2015

Dr. Gary Smith MD, DrPH Center for Injury Research and Policy Nationwide Children's Hospital Columbus, OhioMedicalResearch.com Interview with: Dr. Gary Smith MD, DrPH Center for Injury Research and Policy Nationwide Children's Hospital Columbus, Ohio Medical Research: What is the background for this study? What are the main findings? Dr. Smith: As of January 2015, 23 states and Washington D.C. have legalized marijuana for medical use. Four of those same states and Washington D.C. have also voted to legalize marijuana for recreational use. The debate about legalization often focuses on health effects among adults, economic benefits, and crime rates. Lost in the discussion is the potential harm to young children from unintentional exposure to marijuana. The study found that the rate of marijuana exposure among children 5 years of age and younger rose 147.5 percent from 2006 through 2013 across the United States. The rate increased almost 610 percent during the same period in states that legalized marijuana for medical use before 2000. In states that legalized marijuana from 2000 through 2013, the rate increased almost 16 percent per year after legalization, with a particular jump in the year that marijuana was legalized. Even states that had not legalized marijuana by 2013 saw a rise of 63 percent in the rate of marijuana exposures among young children from 2000 through 2013. Most children were exposed when they swallowed marijuana – that may be related to the popularity of marijuana brownies, cookies and other foods. (more…)
Author Interviews, Opiods, Orthopedics, Pain Research, Surgical Research / 02.06.2015

MedicalResearch.com Interview with: Winfried Meissner, M.D. Dep. of Anesthesiology and Intensive Care Jena University Hospital University Hospital Jena, Germany Medical Research: What is the background for this study? Dr. Meissner: Post-operative pain is managed inadequately worldwide. There are probably many reasons for this, one of which may be lack of evidence about outcomes of treatment in the clinical routine. PAIN OUT was established  as a  multi-national research network and quality improvement project offering healthcare providers  validated tools to collect data about pain-related patient reported outcomes and management after surgery. Patients fill in a questionnaire asking for pain intensity, pain interference and side effects of pain management. The questionnaire has now been translated into 20 languages. Data are collected electronically and clinicians are provided with feedback about management of their own patients, compared to similar patients in other hospitals.  Furthermore, the findings are used for outcomes and comparative effectiveness research. PAIN OUT is unique in that  outcomes of postoperative pain management can be examined internationally. PAIN OUT was created in 2009 with funds from the European Commission, within the FP7 framework and  has now been implemented in hospitals in Europe, USA, Africa and SE Asia. The findings allow us to gain insights as to how pain in managed in different settings and countries. For this particular study, we compared management of pain in the US to other countries. We assessed a large group of patients who underwent different types of orthopedic surgery and compared their patient reported outcomes and management regimens. We included 1011 patients from 4 hospitals in the USA  and 28,510 patients from  45  hospitals in 14 countries (“INTERNATIONAL”). Medical Research: What are the main findings? Dr. Meissner: Postoperative pain intensity of US patients was higher than in INTERNATIONAL patients; they felt more often negatively affected by pain-associated anxiety and helplessness, and more US patients stated they wished to have received more pain treatment. However, other patient-reported outcomes like time in severe pain or the level of pain relief did not differ. We found that treatment regiments of American patients differed compared to INTERNATIONAL patients. More US patients received opioids, and their opioid doses were higher compared to INTERNATIONAL patients. In contrast, INTERNATIONAL countries use more nonopioid medications intraoperatively and postoperatively. Thus, under-supply with opioids cannot explain our findings. Mean BMI of US patients was 30.3 while for INTERNATIONAL it was 27.4. However, insufficient evidence exists that this finding might account for differences in pain intensity. Routine pain assessment was performed in almost all US patients, in contrast to about 75% in the INTERNATIONAL group. Obviously, routine pain assessment, as practiced in the United States, fails to result in lower postoperative pain. Perhaps it has the opposite effect by directing patients’ attention to the pain. (more…)
Alcohol, Author Interviews, BMJ, Heart Disease, Women's Heart Health / 27.05.2015

Alexandra Gonçalves, MD, PhD Postdoctoral Research Fellow Cardiovascular Department Brigham and Women's Hospital Boston, MA 02115MedicalResearch.com Interview with: Alexandra Gonçalves, MD, PhD Postdoctoral Research Fellow Cardiovascular Department Brigham and Women's Hospital Boston, MA 02115 MedicalResearch.com: What is the background for this study? Dr. Gonçalves: Excessive alcohol consumption is associated with alcoholic cardiomyopathy, while light to moderate drinking might have benefits in the risk of heart failure (HF). However, the cardiovascular mechanisms and the alcohol dosage associated with risks or potential benefits are uncertain. Furthermore, the variation in the toxic and protective effects of alcohol by sex remains controversial, as women may be more sensitive than men to the toxic effects of alcohol on cardiac function, developing alcoholic cardiomyopathy at a lower total lifetime dose of alcohol compared to men. In this study we assessed the associations between alcohol intake and cardiac structure and function by echocardiography, in elderly men and women in the large, community-based Atherosclerosis Risk in Communities (ARIC) Study. MedicalResearch.com: What are the main findings? Dr. Gonçalves: We studied 4466 participants (76±5 years and 60% women) with alcohol consumption ascertained, who underwent transthoracic echocardiography. Participants were classified into 4 categories based on self-reported alcohol intake: non-drinkers, drinkers of up to 7 drinks per week, ?7 to 14 and ? 14 drinks per week. In both genders, increasing alcohol intake was associated with larger left ventricular (LV) diastolic and systolic diameters and larger left atrial diameter. In men, increasing alcohol intake was associated with greater LV mass and higher E/E’ ratio. In women, increasing alcohol intake was associated with lower LV ejection fraction. (more…)
Alcohol, Author Interviews, PNAS, Scripps / 19.05.2015

Interview of Candice Contet, Ph.D. Assistant Professor The Scripps Research Institute, La Jolla, CAMedicalResearch.com Interview with: Interview of Candice Contet, Ph.D. Assistant Professor The Scripps Research Institute, La Jolla, CA MedicalResearch: What is the background for this study? Dr. Contet: Alcohol changes the activity of numerous proteins in the brain. One of them is an ion channel found in neurons, the G-protein activated inwardly rectifying potassium (GIRK) channel. It is however unknown whether the ability of alcohol to open GIRK channels matters for its effects in vivo, i.e. how tipsy we feel or how motivated we are to drink alcohol. To address this question, we studied mice that are lacking one of the components of GIRK channels, the GIRK3 subunit. These mice behave normally in the absence of alcohol, and we sought to determine whether they respond differently to alcohol. MedicalResearch: What are the main findings? Dr. Contet: We found that the absence of GIRK3 did not impact how fast the mice clear alcohol from their body nor how sensitive they are to alcohol intoxication. Alcohol reduced their motor coordination, made them sleepy and lowered their body temperature to the same extent as in normal mice. GIRK3-deficient mice also drank as much alcohol as normal mice when they were given continuous access to alcohol, a situation in which mice sporadically drink throughout the day but rarely get intoxicated. By contrast, when mice are given access to alcohol only for a couple hours per day at a specific time of the day, they drink to the point of intoxication. Under these conditions, which emulate “binge drinking”, the GIRK3-deficient mice drank more than normal mice. The next step was to locate the region of the brain responsible for the effect of GIRK3 on binge drinking. We turned our attention to the mesocorticolimbic dopaminergic pathway, a neural circuit that facilitates reward seeking. This pathway originates in an area of the midbrain called the ventral tegmental area (VTA) and releases the neurotransmitter dopamine in two forebrain areas: the ventral striatum and the prefrontal cortex. Alcohol, like other drugs of abuse, activates this pathway. When we reintroduced GIRK3 in the VTA of GIRK3-deficient mice, their alcohol intake dropped down to normal levels. Increasing the levels of GIRK3 in the VTA of normal mice reduced their alcohol consumption even further. We concluded that GIRK3 in the VTA keeps binge drinking in check: the more GIRK3, the less binge drinking. We then wanted to understand how GIRK3 controls binge drinking: do the GIRK3-deficient mice drink more because alcohol is more rewarding to them, or because more alcohol is needed for them to experience the same level of reward? To answer this question, we measured the activity of VTA neurons in brain slices. Alcohol usually make VTA neurons fire more – but in the absence of GIRK3, these neurons were completely insensitive to alcohol, even at a very high concentration. We also measured the levels of dopamine in the ventral striatum. Injecting mice with a moderate dose of alcohol usually causes a rise in dopamine levels – but again, GIRK3-deficient mice were completely unresponsive. These results may seem paradoxical. If the canonical “reward pathway” of the brain cannot be activated by alcohol, these mice should not have any motivation to drink alcohol. But the mesocorticolimbic dopaminergic pathway is not the only brain circuit responsible for the rewarding properties of alcohol, and we think that GIRK3-deficient mice end up drinking more alcohol to activate alternative circuits more strongly than normal mice would. (more…)
Alcohol, Author Interviews, OBGYNE, PLoS / 18.05.2015

Dr. Nina Kaminen-Ahola Ph.D. Department of Medical Genetics Faculty of Medicine University of Helsinki Helsinki, FinlandMedicalResearch.com Interview with: Dr. Nina Kaminen-Ahola Ph.D. Department of Medical Genetics Faculty of Medicine University of Helsinki Helsinki, Finland Medical Research: What is the background for this study? Dr. Kaminen-Ahola: The beginning of embryonic development is vulnerable to the effects of  external influences and disruption of these processes can have long-term effects on development. Our previous study demonstrated, for the first time, that alcohol exposure in early pregnancy can cause permanent changes to the epigenetic regulation, gene function and the appearance of mouse offspring. We discovered increased DNA-methylation, transcriptional silencing of an epigenetically sensitive allele Agouti viable yellow (Avy) and darker coat colour in the offspring. In this study we wanted to see whether alcohol consumed in early pregnancy causes long-term changes to the epigenome and gene expression in hippocampus. According to previous studies the phenotype of offspring in this mouse model is highly variable, but reminiscent of human FAS with growth restriction, similar structural changes to corresponding areas of the face and skull, and hyperactivity. In this study we wanted to determine the impact of alcohol on the structures of the central nervous system. Medical Research: What are the main findings? Dr. Kaminen-Ahola: We observed that early exposure to alcohol caused subtle changes in  the epigenome and altered the function of several genes in the hippocampi of adolescent mice. We also detected alcohol-induced alterations in the brain structure of adult offspring. Interestingly, we also found out that in addition to hippocampus, alcohol caused similar changes to gene function in two different tissues of the infant mouse, bone marrow and the olfactory epithelium of the snout. These results support our hypothesis that early gestational ethanol exposure alters the epigenetic reprogramming of the embryo, which leads to alterations in gene regulation and embryonic development, and causes life-long changes in brain structure, function, and behaviour. (more…)
Addiction, Author Interviews, Columbia, Emergency Care, Pharmacology / 13.05.2015

MedicalResearch.com Interview with: Joanne Brady, PhD candidate Department of Anesthesiology, College of Physicians and Surgeons Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY Medical Research: What is the background for this study? What are the main findings? Response: Prescription drug overdose is a major public health problem in the United States. Prescription drug overdose mortality has increased dramatically over the past twenty five years. Frequent emergency department utilization may be a marker for risk of prescription drug overdose death. The current study assessed how frequency of emergency department visits in the past year related to risk of subsequent prescription drug overdose death. In a cohort of patients visiting the emergency department, patients with four or more visits to the emergency department in the past year were at substantially higher risk for prescription drug overdose death than patients who visited the emergency department one or fewer times. As the number of visits to the emergency department increased from 0 - 1 to 4 or more for any reason the risk of dying from prescription drug overdose also increased. (more…)
Author Interviews, Opiods, Orthopedics, Pain Research, Pharmacology / 08.05.2015

Hassan R. Mir, MD, MBA Associate professor of Orthopaedics and Rehabilitation Vanderbilt Orthopaedic InstituteMedicalResearch.com Interview with: Hassan R. Mir, MD, MBA Associate professor of Orthopaedics and Rehabilitation Vanderbilt Orthopaedic Institute and and Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital in affiliation with the University of Texas Houston Health Science Center, Houston, TexasDr. Brent J. Morris, M.D. Shoulder and Elbow Surgery Fellowship Texas Orthopaedic Hospital University of Texas Houston Health Science Center, Houston, Texas Medical Research: What is the background for this study? What are the main findings? Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world's population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large. Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain. Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases. (more…)
Alcohol, Author Interviews, Pediatrics, Pediatrics / 04.05.2015

MedicalResearch.com Interview with: Jennifer A. Emond, M.Sc., PhD Research Instructor Department of Epidemiology Geisel School of Medicine at Dartmouth College Cancer Control Research Program Lebanon, NH  03756 Medical Research: What is the background for this study? What are the main findings? Dr. Emond: Several studies have documented a link between consuming alcohol mixed with energy drinks and an increased risk of negative outcomes while drinking, including binge drinking. It is known that mixing energy drinks with alcohol increases the risk for binge drinking--the high caffeine intake consumed when mixing energy drinks with alcohol may cause individuals to feel what is been called "wide-awake drunk," and they may underestimate their level of intoxication. However, most studies to date have been conducted among undergraduate college students, and we wanted to know if those same associations were also observed among adolescents. In our study of 3,342 adolescents and young adults between the ages of 15-23, we also found a positive link between a history of consuming alcohol mixed with energy drinks and abusive alcohol use. Specifically, 22.3% of participants had ever consumed an energy drink mixed with alcohol (including 9.7% of 15-17 year olds), and such a history of mixed use was associated with a more than 4-fold increased likelihood of engaging in binge drinking. Importantly, that association was just as strong among 15-17 year olds as it was among the older participants. One critical component of our study was that we also looked at a validated outcome for alcohol use disorder (i.e., the participants completed the Alcohol Use Disorders Identification Test [AUDIT]), and participants with a history of consuming alcohol mixed with energy drinks were also 4.2 times more likely to meet that clinically defined criteria for alcohol use disorder as defined for adolescents. Again, those associations were observed for all participants, regardless of age. Our study has limitations. It was cross-sectional, so we cannot prove that mixed use of alcohol and energy drinks causes abusive alcohol use behaviors. However, our study does support that mixed use of alcohol with energy drinks can identify adolescents at risk for alcohol abuse. (more…)
Author Interviews, Columbia, Opiods / 30.04.2015

Silvia S. Martins, MD, PHDAssociate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032MedicalResearch.com Interview with Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032 MedicalResearch: What is the background for this study? What are the main findings? Dr. Martins: The background for this study is former studies showing links between nonmedical use of prescription opioids and transition to heroin and other illegal substances, prescription opioid-related and heroin-related fatal overdoses . In addition, a particular public health concern is that the transition to heroin and further injecting heroin may increase the risk of bloodborne infections. We used data from the National Survey on Drug Use and Health, a large nationally representative household sample of 67,500 people, and self-reported heroin use within the last 12 months, the researchers examined the change in patterns of past-year non-prescription drug and heroin use between 2002-2005 and 2008-2011 across racial and ethnic groups. The most significant rise in heroin use was among Hispanics and non-Hispanic whites, where the rate of heroin use for the latter group increased by 75 percent in 2008-2011 compared to earlier years. Regarding frequency of use, for Hispanics, increases were significant only among those using opioids about 1-29 days in the past year. Among blacks and whites, significant increases in the rate of heroin use were observed among those using prescription opioids more frequently (100-365 days) in the past year. (more…)
Addiction, Author Interviews, Case Western, Psychological Science / 29.04.2015

Maria Pagano, PhD Case Western Reserve University School of Medicine Department of Psychiatry, Division of Child Psychiatry Cleveland, OHMedicalResearch.com Interview with: Maria Pagano, PhD Case Western Reserve University School of Medicine Department of Psychiatry, Division of Child Psychiatry Cleveland, OH MedicalResearch: What is the background for this study? Dr. Pagano: Socially anxious adolescents quickly figure out that alcohol and drugs can provide ease and comfort in social situations that are anxiety provoking.  Reaching for a substance to change how you feel can quickly become a knee-jerk reaction, can develop into an addiction, and robs youths of learning how to tolerate interpersonal differences and uncomfortable feelings, developing emotional maturity, and cultivating self acceptance. Adolescents who fear being criticized by their peers are likely to not speak up in group therapies during treatment, which can limit their benefit from treatment.  There is a lot of healing that comes sharing your insides with others. Socially anxious patients may not get this healing nor let others really get to know who they are and give input to their lives Higher peer helping in AA during treatment means getting active in low intensity tasks like putting away chairs, or making coffee at a 12-step meeting.  It is less about needing peer assistance or expecting praise or recognition from giving service.  It is more about adopting the attitude of "how can I be helpful?" (more…)
Author Interviews, Brigham & Women's - Harvard, Cannabis, JAMA, Lipids, Pediatrics / 06.04.2015

Holly Gooding, MD, MS Harvard T.H. Chan School of Public Health Instructor in Pediatrics at Harvard Medical School Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital Division of General Internal Medicine, Brigham and Women’s Hospital Boston, MAMedicalResearch.com Interview with: Holly Gooding, MD, MS Harvard T.H. Chan School of Public Health Instructor in Pediatrics at Harvard Medical School Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital Division of General Internal Medicine Brigham and Women’s Hospital Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Gooding: As an adolescent medicine physician, I primarily care for patients between the ages of 12 and 30, although I first trained in internal medicine.  One of the things I noticed when I started working with this age group is that pediatric and adult guidelines differ for many conditions.  Cholesterol treatment is one condition that comes up frequently, because the NHLBI and the AAP recommend screening youth ages 17 to 21 for cholesterol problems. The study team and I set out to discover the proportion of American youth ages 17 to 21 who would meet criteria for pharmacologic treatment of abnormal cholesterol levels if clinicians applied the pediatric versus the adult guidelines.  We found that 2.6% of young people ages 17 to 21 would qualify for pharmacologic treatment of abnormal LDL cholesterol levels under the pediatric guidelines, but less than 1% would qualify under the adult guidelines.  This translates to almost 500,000 youth qualifying for treatment under the pediatric guidelines, but only about 78,000 under the adult guidelines.  Those who met pediatric criteria had lower LDL levels but higher proportions of high blood pressure, smoking, and obesity. (more…)
Author Interviews, Dermatology, Opiods / 24.03.2015

Madhulika A. Gupta MD University of Western OntarioMedicalResearch.com Interview with: Madhulika A. Gupta MD  University of Western Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Gupta: Opioid (narcotic) analgesics (OA) are FDA-approved primarily for the symptomatic relief of pain in acute and chronic conditions. The prescription rates of Opioid analgesics in the US have increased significantly since 1989, and their possible inappropriate use has been declared a public health concern. We have recently reported (GuptaMA et al. J Dermatol Treat, 2014) that the use of Opioid analgesics in primarily skin disorders (with no reported non-dermatologic comorbidities) has increased from 1995-2010. Skin disorders are associated with psychiatric pathology in up to 30% of cases. Psychiatric disorders have been associated with an increased use of Opioid analgesics and other potentially addictive drugs. We examined psychiatric disorders, comorbidities and psychotropic drugs in patient visits with skin disorders and Opioid analgesics use (‘Skin Disorders+OA’). We examined nationally representative cross-sectional data collected between 1995-2010 by the NAMCS and NHAMCS. Up to 3 ICD9-CM diagnoses are coded for each patient visit; the following codes were used to create the ‘Skin Disorders’ variable: ICD9-CM codes 680-709 ‘Diseases of the Skin and Subcutaneous Tissue’ and ICD9-CM codes 172, 173, 216 and 232 for cutaneous malignancies. Ambulatory Care Drug Database System drug codes were used for creation of variables for Opioid analgesics and other psychotropics. (more…)
Author Interviews, JAMA, Opiods, Pharmacology / 13.03.2015

Theodore J. Cicero, PhD Professor, Vice Chairman for Research Department of Psychiatry, Washington University St Louis, MissouriMedicalResearch.com Interview with: Theodore J. Cicero, PhD Professor, Vice Chairman for Research Department of Psychiatry, Washington University St Louis, Missouri MedicalResearch: What is the background for this study? What are the main findings? Dr. Cicero: Prescription opiate abuse (eg Vicodin, Percocet, OxyContin) has reached epidemic proportions in this country over the past decade. Although most people swallow the drugs whole, a relatively large number either chew the drugs to produce an immediate delivery of large quantities of drugs or they crush them and/or dissolve them in some solvent which makes them useful for intranasal (eg snorting) or intravenous administration. Non-oral routes, particularly injection, represent the most serious public health risk due to a high incidence of infection, including Hepatitis C and HIV, and the much greater severity of abuse. In an effort to reduce these practices, drug companies are introducing so-called abuse deterrent formulations (ADF) which are resistant to crushing or dissolving in an aqueous solution. In one such important effort, the company responsible for distributing one of the most widely abused prescription opiates, OxyContin, introduced an ADF in 2010. Although the abuse deterrent formulations was highly successful in reducing abuse of OxyContin by either chewing, crushing, or dissolving in water, there was none-the-less a clear limit to how effective it was. For example, some people simply switched to the oral route of administration or never did snort or inject the drug, whereas a small number found ways to defeat the abuse deterrent formulations and persisted in harmful patterns of abuse. Unfortunately, there was also an unintended result. ADF-OxyContin caused many individuals to abandon the use of OxyContin - a good thing - in favor of other opiates (a bad thing). Most serious, however, was that 70% of those who switched drugs moved from OxyContin to heroin abuse. Although by no means the only factor, the abuse deterrent formulations has contributed to the wide-spread reports of heroin abuse in suburban and rural Caucasian male and females, a group here-to-fore not the typical heroin users (i.e. poor minorities, living in large urban centers). (more…)
Addiction, Author Interviews, CDC, OBGYNE, Pediatrics / 11.03.2015

Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDCMedicalResearch.com Interview with: Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, CDC Medical Research: What is the background for this study? Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers.  NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat. Medical Research: What are the main findings? Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation. (more…)
Addiction, Author Interviews / 11.03.2015

Niclas Stephanson, PhD Leg. Apotekare, Analytisk kemist Karolinska Universitetssjukhuset StockholmMedicalResearch.com Interview with: Niclas Stephanson, PhD Leg. Apotekare, Analytisk kemist Karolinska Universitetssjukhuset Stockholm Medical Research: What is the background for this study? What are the main findings? Dr. Stephanson: Drug testing is most commonly performed using urine samples, which is based on a long and comprehensive experience. The methodology and regulations for reliable urine testing are well developed and can be considered the current gold standard for drug testing. However, one problem with urine testing is related to the sample collection, often perceived as inconvenient and privacy-overriding by those undergoing the test. To overcome this problem a group of researchers from the Department of Laboratory Medicine at the Karolinska Institute in Sweden have worked on developing a more donor-friendly alternative to urine testing for drugs by focusing on exhaled breath. Doctor Niclas Stephanson in the research group led by Professor Olof Beck, has developed the first fully validated and robust screening method for the routine measurement of drugs of abuse in exhaled breath. The procedure involves a simple method of sample collection and preparation, which is followed by a highly sensitive analytical technique known as LC-MS (Liquid chromatography–mass spectrometry). The drug groups which are identified: amphetamine, methamphetamine, cannabis, cocaine and heroin. The underlying mechanism in exhaled breath drug testing is believed to be the formation of aerosol particles from the airway lining fluid by the breathing process. These aerosol particles may contain drugs present in the body, which enables drugs to be analyzed. A simple collection device is currently available which selectively collects the micrometer aerosol particles on a filter and enables further laboratory investigation of possible drug content. (more…)
Alcohol, Author Interviews, Primary Care / 27.02.2015

Dr. Kristy Barnes Le MD Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NCMedicalResearch.com Interview with: Dr. Kristy Barnes Le MD Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, NC Medical Research: What is the background for this study? What are the main findings? Response: Because about 1 in 6 Americans binge drink, it is important that physicians know how to screen for at-risk drinking and be able to effectively address alcohol use with their patients.   Alcohol screening and brief intervention (SBI) has been shown to be an effective tool to detect and reduce hazardous alcohol use, but it has not yet gained wide acceptance in practice or in medical education.  We know that lack of confidence contributes to practicing physicians’ hesitancy to screen and intervene with at-risk drinkers, but this had not been studied in resident physicians. We set out to determine how primary care resident physicians screen and intervene with their patients who drink, how they feel about discussing at-risk drinking, and what barriers they have to performing  Alcohol screening and brief intervention. Our main findings are: 1.)  Resident physicians are using the wrong screening instruments at the wrong times, and are not adequately performing the brief intervention when they do detect hazardous drinking. Less than 20% of residents in this study used screening instruments that are capable of detecting at-risk or binge drinking, while the remainder used instruments designed to detect alcohol use disorders.  And, only 17% screened for at-risk drinking at acute-care visits, where the consequences of binge drinking (such as injuries) are most likely to appear.  Additionally, when a brief intervention was performed, only a quarter of residents usually or always included the three recommended elements of feedback, advice, and goal-setting. 2.)  Resident physicians do not feel confident addressing at-risk drinking with their patients. Only 21% felt they could help their patient with hazardous drinking cut down or stop using alcohol and only 17% felt they had been successful in doing so in the past.  Interestingly, U.S.-born residents and those reporting no religious affiliation were even more likely to express lack of confidence. 3.)  Lastly, residents report barriers that include lack of adequate training (53 %), the belief that talking with patients is unlikely to make a difference (44 %), and just being too busy (39%).  The hours of reported  Alcohol screening training did not vary with residency year, perhaps indicating that most of it was done prior to residency. Clearly, the several hours they report getting (mean of 9.8 hours) is either not covering the right topics, or not teaching them in a way that leads to changes in practice. (more…)
Author Interviews, CDC, Opiods, Pharmacology / 21.02.2015

Dr. Zhou Yang Office of the Associate Director for Policy Centers for Disease Control and Prevention, Atlanta, GAMedicalResearch.com Interview with: Dr. Zhou Yang Office of the Associate Director for Policy Centers for Disease Control and Prevention, Atlanta, GA Medical Research: What is the background for this study? Response: Prescription drug misuse and abuse, largely those involving opioid painkillers, have been characterized as an epidemic. According to a CDC report, drug-related overdose has surpassed traffic crashes to become the leading cause of injury death in the U.S. in 2009. Medicaid programs in most states implement Patient Review and Restriction (PRR) programs, also called ‘lock-in’ program. The PRR programs use a set of behavioral indicators to identify patients at higher risk of opioid drug misuse and abuse, and ‘locks’ them in to a designated provider, pharmacy, or both. Pharmacy shopping is one of the key indicators employed by the PRR program. However, definition of pharmacy shopper varies widely across states. In addition, the PRR programs have not paid attention to the indicators of prescribing overlapped drugs, which we see as a missed opportunity to help the PRR program to better target users at high risk of overdose. Medical Research: What are the main findings? Response: Among a number of currently used definitions of pharmacy shopping, we found that the definition of ‘four or more pharmacies visited within any 90-day period’ is the most effective one. We also found that having overlapping opioid prescriptions is associated with an elevated risk of overdose. In fact, patients who exhibited both pharmacy shopping and having overlapping prescription had more than twice the risk of overdose than those who only exhibited pharmacy shopping. (more…)
Alcohol, Author Interviews, Personalized Medicine / 18.02.2015

Sean M. Murphy, Ph.D. Assistant Professor Department of Health Policy & Administration Washington State University MedicalResearch.com Interview with: Sean M. Murphy, Ph.D. Assistant Professor  Department of Health Policy & Administration Washington State University Medical Research: What is the background for this study? What are the main findings? Dr. Murphy: Professional healthcare advice regarding excessive alcohol consumption has been shown to reduce demand in a controlled setting. However, success in a clinical trial isn’t always indicative of an intervention’s effectiveness in everyday use. Studies testing the effect of provider advice on alcohol demand in a non-controlled environment are few, and have failed to control for non-moderate drinkers.  Therefore, it is possible that the estimated effect of professional-health advice primarily reflected moderate-drinkers’ responses. The distinction between moderate and non-moderate drinkers is an important one, as society bears a large cost for those who consume above-moderate quantities, while moderate drinkers have been shown to be relatively productive and healthy. Excise taxes may not be efficient given that they impose negative externalities on moderate drinkers, while excessive drinkers have been shown to be relatively unresponsive to price increases. We found that personalized information from a healthcare professional was negatively associated with reported alcohol consumption among both “risky” and “binge" drinkers. Moreover, we found that personalized drinking advice may have an impact on those who are reluctant to state that they were given such advice. (more…)
Addiction, Author Interviews, Methamphetamine / 13.02.2015

MedicalResearch.com Interview with: Kyoon Lyoo, M.D., Ph.D Ewha W. University Seoul, South Korea MedicalResearch: What is the background for this study? What are the main findings? Dr. Lyoo: Recent studies increasingly suggested that the developing brain shows unique characteristics of neuroplasticity to environmental stimuli. Still, it remains unclear whether the adolescent brain would undergo adaptive or dysfunctional changes when exposed to highly neurotoxic substances including methamphetamine. However, despite an increasing prevalence of methamphetamine use in this population, human studies have not yet found clear answers to these questions regarding the effects of methamphetamine exposure on the adolescent brain. This study reports novel in vivo findings in adolescent methamphetamine users, and thus provides a new perspective regarding adolescent-specific brain correlates of methamphetamine-induced neurotoxicity. Using cortical thickness and diffusion tensor image analyses, we found greater and more widespread gray and white matter alterations, particularly affecting the frontostriatal system, in adolescent methamphetamine users compared with adult users. Our findings highlight that the adolescent brain, which undergoes active myelination and maturation, is much more vulnerable to methamphetamine-induced neurotoxicity than the adult brain. This may help explain why adolescent-onset methamphetamine users show more severe and chronic clinical course than adult-onset users. (more…)
Author Interviews, NEJM, Opiods, Pharmacology / 29.01.2015

Richard C. Dart, M.D., Ph.D Denver Health & Hospital Authority Professor, University of Colorado School of MedicineMedicalResearch.com Interview with: Richard C. Dart, M.D., Ph.D Denver Health & Hospital Authority Professor, University of Colorado School of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Dart: For the past two decades, prescription opioid medication abuse has increased significantly in the US. An estimated 25 million people initiated nonmedical use of pain relievers between 2002 and 2011.  In 2010 the number of death attributed to prescription opioid medications reached 16,651. The  RADARS® System (Researched Abuse, Diversion and Addiction Related Surveillance) has been monitoring prescription drug abuse and diversion for over 13 years. We use a “mosaic” approach, measuring abuse and diversion from multiple perspectives, to describe this hidden phenomenon as comprehensively as possible. For the current publication we used 5 separate RADARS® System programs to collect data and the study period was from January 2002 through December 2013. We noticed a substantial increase  of prescription drug abuse from 2002 through 2010, followed by a flattening or decrease in 2010 and, lastly, a decline in 2011 through 2013. We also noticed a similar pattern in opioid-related deaths. Nonmedical use did not change significantly among college students. (more…)
Alcohol, Author Interviews, Gastrointestinal Disease / 28.01.2015

Gro Askgaard MD Department of Hepatology, Copenhagen University Hospital, Rigshospitalet National Institute of Public Health, University of Southern Denmark Copenhagen DenmarkMedicalResearch.com Interview with Gro Askgaard MD Department of Hepatology, Copenhagen University Hospital, Rigshospitalet National Institute of Public Health, University of Southern Denmark Copenhagen Denmark Medical Research: What is the background for this study? Dr. Askgaard: Alcohol is the main risk factor of cirrhosis in Europe, where 1.8% of all deaths are attributable to liver disease. Alcohol amount is known to be a significant factor of development of cirrhosis - the greater alcohol amount, the greater risk. Less is known about drinking pattern - how the way you drink alcohol affects your risk. In this study we evaluated the influence of drinking frequency (drinking days/week), of lifetime alcohol consumption versus recent alcohol consumption, and alcohol type (wine, beer, liquor). (more…)
Author Interviews, CDC, OBGYNE, Opiods / 25.01.2015

Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDCMedicalResearch.com Interview with: Dr. Jennifer Lind PharmD, MPH Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC Medical Research: What is the background for this study? Dr. Lind:  CDC researchers published a new study estimating the proportion of women aged 15-44 years who filled a prescription for opioid pain medications.  Opioids are prescribed by healthcare providers to treat moderate to severe pain. They are also found in some prescription cough medications. Opioids include medications like codeine, oxycodone, hydrocodone, or morphine. For this study, researchers used data from two large insurance claims datasets—one on Medicaid and one on private insurance—and looked at data from 2008-2012. Medical Research: What are the main findings? Dr. Lind: Opioid medications are widely used among women of reproductive age in the United States, regardless of insurance type. On average, more than a third (39 percent) of women aged 15-44 years enrolled in Medicaid, and more than one fourth (28 percent) of those with private insurance filled a prescription for an opioid pain medication each year during 2008-2012. Taking these medications early in pregnancy, often before women know they are pregnant, can increase the risk for some birth defects (such as spina bifida) and other poor pregnancy outcomes (such as preterm birth or low birth weight). (more…)
Addiction / 20.01.2015

Katharine A. Neill PhD Alfred C. Glassell III Postdoctoral Fellow in Drug Policy Baker Institute, Rice University Houston, TX 77005MedicalResearch.com Interview with: Katharine A. Neill  PhD Alfred C. Glassell III Postdoctoral Fellow in Drug Policy Baker Institute, Rice University Houston, TX 77005 Medical Research: What is the background for this study? What are the main findings? Dr. Neill: This study is a historical review of drug policy in 20th century United States. It examines drug policy decisions and consequences through a socio-political lens and argues that the prominence of the law-and-order approach to dealing with drug offenders--that emphasizes punishment and incarceration over prevention and treatment--is a result of the construction of drug offenders as social deviants that threaten society. This punitive model has been especially harmful because it has occurred to the detriment of harm reduction approaches to drug use that have greater potential to negate the negative individual and public health consequences of drug use. (more…)
Alcohol, Author Interviews, Circadian Rhythm / 20.01.2015

Timo Partonen MD, Research Professor National Institute for Health and Welfare Helsinki, FinlandMedicalResearch.com Interview with: Timo Partonen MD, Research Professor National Institute for Health and Welfare Helsinki, Finland Medical Research: What is the background for this study? What are the main findings? Response: Alcohol-use disorders are often comorbid conditions with mood and anxiety disorders. Clinical studies have demonstrated that there are abnormalities in circadian rhythms and intrinsic clocks in patients with alcohol-use disorders. Circadian clock gene variants are therefore a fruitful target of interest. The main findings are that variants of key clock genes, namely those of ARNTL, ARNTL2, PER1 and PER2, have association with alcohol consumption, with alcohol abuse, or with alcohol dependence. It is of interest that variants of a fifth clock gene of key importance, that is those of CLOCK, are associated with alcohol-use disorders only if comorbid with depressive disorders. (more…)
Alcohol, Author Interviews, BMJ, Occupational Health / 14.01.2015

Professor Marianna Virtanen PhD Unit of Expertise for Work and Organizations Finnish Institute of Occupational Health Helsinki, Finland.MedicalResearch.com Interview with: Professor Marianna Virtanen PhD Unit of Expertise for Work and Organizations Finnish Institute of Occupational Health Helsinki, Finland. Medical Research: What is the background for this study? What are the main findings? Professor Virtanen: Risky alcohol use is common among working populations but the contribution of work-related factors such as long working hours has rarely been studied. In the present study we performed the first systematic analysis on published studies regarding long working hours and risky alcohol use and added unpublished individual participant data to the analyses. Altogether 61 studies were included in the cross sectional analysis and 20 studies in the prospective analysis. The pooled cross sectional analysis showed 11% higher alcohol use associated with long working hours. In the prospective analysis we found that working 49-54 hours a week was associated with a 13% increase in the probability of new-onset risky alcohol use and working 55 hours or more with a 12% increased risk. (more…)
Alcohol, Author Interviews, Insomnia / 23.12.2014

Michael Nadorff, PhD, Assistant professor Mississippi State University Starkville, Miss.MedicalResearch.com Interview with: Michael Nadorff, PhD, Assistant professor Mississippi State University Starkville, Miss. Medical Research: What is the background for this study? What are the main findings? Dr. Nadorff: A growing literature has found that insomnia symptoms are associated with suicidal behavior, and several studies suggest that this relation may be independent of several different forms of psychopathology.  However, little research has examined the role sleep disorders, such as insomnia, play in explaining why known risk factors, such as alcohol use, are associated with suicidal behavior.  In our study, we examined whether insomnia symptoms explained a significant portion of the relation between alcohol symptoms and suicide risk.  We found that for both men and women insomnia symptoms explained a significant amount of the variance in the relation between alcohol use and suicide risk. (more…)