MedicalResearch.com - Latest news, interviews, and insights into medical research, health and wellness, fitness and addiction.
Author Interviews, JAMA, Opiods, Toxin Research / 10.08.2016

MedicalResearch.com Interview with: Ann M. Arens, MD California Poison Control Center San Francisco, CA 94110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prescription opioid abuse is a significant public health threat that has garnered the attention of health care providers throughout medicine. With efforts to curb the number of prescriptions for opioid pain medications, users may begin to purchase prescription medications from illegal sources. Our study reports a series of patients in the San Francisco Bay Area who were exposed to counterfeit alprazolam (Xanax®) tablets found to contain large amounts of fentanyl, an opioid 100 times more potent than morphine, and in some cases etizolam, a benzodiazepine. The California Poison Control System – San Francisco division identified eight patients with unexpected serious health effects after exposure to the tablets including respiratory depression requiring mechanical ventilation, pulmonary edema, cardiac arrest, and one fatality. Patients reportedly purchased the tablets from drug dealers, and were unaware of their true contents. In one case, a 7 month-old infant accidentally ingested a counterfeit tablet dropped on the floor by a family member. (more…)
Addiction, Author Interviews, Opiods, Primary Care / 04.08.2016

MedicalResearch.com Interview with: Richard A. Deyo MD, MPH Kaiser Permanente Professor of Evidence-Based Family Medicine Department of Family Medicine Department of Medicine Department of Public Health and Preventive Medicine Oregon Institute of Occupational Health Sciences Oregon Health and Science University Portland, OR 97239 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Doctors and other prescribers often wonder how much and for how long they can prescribe opioids before inadvertently promoting long-term use. Unfortunately, few data are available to guide initial prescribing. Long-term opioid use is problematic because of substantial rates of dependence and misuse, and because the efficacy of long-term therapy remains unproven. Development of drug tolerance and increasing sensitivity to pain may limit long-term efficacy. Several factors may explain the emergence of inadvertent long-term use, including opioid dependence, recreational use, addiction, and illicit diversion to other users. We studied the risk of long-term use (defined as filling 6 or more opioid prescriptions in the subsequent year) with data from Oregon's Prescription Drug Monitoring Program, which captures all opioid prescriptions filled in Oregon pharmacies, regardless of who wrote the prescription or who paid for the prescription. We identified patients who had not received opioid medication in the previous year, but now received an initial prescription. There were over half a million such patients during the one-year study. Our most informative analysis was among people under age 45, which excluded most patients with a diagnosis of cancer, who were near the end of life, or who had chronic painful conditions such as arthritis. In this group, a patient who received just a three day supply of a moderate dose of opioids (For example, 10 mg. of hydrocodone plus acetaminophen 4 times daily for 3 days) had about a 2% risk of becoming a long term user. Someone who filled two prescriptions jumped to a 7% risk. Patients receiving a long-acting opioid as the first prescription had a higher risk of becoming long term users than those receiving short-acting opioids. Patients receiving a single prescription for such medications had almost a 16% likelihood of becoming long-term users compared to just 2% for those receiving short-term opioids. In some cases, long-term use may have been intended, but our exclusion of patients with cancer and end-of-life care made this less likely. (more…)
Accidents & Violence, Addiction, ADHD, Author Interviews / 29.07.2016

MedicalResearch.com Interview with: Anna Chorniy PhD Postdoctoral Research Associate Center for Health and Wellbeing Princeton University Princeton NJ 08544 MedicalResearch.com: What is the background for this study? Response: Attention-deficit/hyperactivity disorder (ADHD) is one of the common chronic mental conditions affecting children. In the U.S., 11% of children ages 4–17 (6.4 million) are estimated to have an ADHD diagnosis and almost 70% of them report taking medication for the condition (e.g. Visser et al., 2014). However, little evidence exists on the effects of ADHD treatment on children’s outcomes. We use a panel data set of South Carolina Medicaid claims paid out in 2003–2013 to investigate the effects of ADHD medication treatment on a seldom studied set of outcomes associated with this condition: adolescent risky behaviors and the incidence of injuries. The occurrence of injuries allows us to evaluate short-term effects of ADHD treatment, while substance abuse and risky sexual behavior outcomes speak for the long-term effects of medication. Second, we use Medicaid spending on treatment of these negative events to evaluate the impact of ADHD drugs on the severity of ADHD, and compare the cost of ADHD treatment with the costs of negative health events. (more…)
Author Interviews, Global Health, Lancet, Methamphetamine, OBGYNE, STD / 29.07.2016

MedicalResearch.com Interview with: N. Saman Wijesooriya Public Health Advisor/Technical Advisor Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? What are the main findings? Response: The article Global burden of maternal and congenital syphilis in 2008 and 2012: a health systems modeling study by Wijesooriya, et al published in the August 2016 issue of The Lancet Global Health (Open source - http://dx.doi.org/10.1016/S2214-109X(16)30135-8) estimates the incidence and prevalence of maternal and congenital syphilis for both time periods and identifies gaps antenatal care access and syphilis testing and treatment services to assess progress in the global elimination of congenital syphilis, or mother-to-child transmission of syphilis, as a public health problem. Untreated maternal syphilis is understood to be transmitted from mother-to-child in utero in 50% of cases resulting in tragic adverse pregnancy outcomes, or congenital syphilis infections, including early fetal death, stillbirth, preterm birth, low birthweight, neonatal death, and congenital infections in infants. Since most maternal syphilis infections are asymptomatic, it is recommended that screening for syphilis use a combination of serological tests for pregnant women and treatment of syphilis seropositive women with at least 2.4 million units of benzathine penicillin intramuscularly early in pregnancy to prevent most congenital syphilis infections. In 2007, the World Health Organization responded to estimates indicating 2 million maternal and 1.5 congenital syphilis infections would occur annually without treatment and launched the global initiative for the Elimination of Congenital Syphilis (ECS). The strategy includes reducing the prevalence of syphilis in pregnant women and mother-to-child transmission of syphilis. The objective is for countries to achieve high performing antenatal care systems providing access to antenatal care to more than 95% of pregnant women, syphilis testing for more than 95% of pregnant women, and treatment for more than 95% of seropositive women to attain a congenital syphilis rate of 50 or fewer cases per 100,000 live births. (more…)
Accidents & Violence, Author Interviews, Cannabis, Pediatrics / 28.07.2016

MedicalResearch.com Interview with: Graeme Gordon CEO and Founder at SneakGuard - Home of Safe Responsible StorageGraeme Gordon CEO and Founder at SneakGuard - Home of Safe Responsible Storage MedicalResearch.com: What is the background for SneakGuard™? Response: SneakGuard™ creator and founder, Graeme Gordon recognized the urgent need to keep adventurous young snoopers from unintentionally ingesting cannabis. Founded in 2014, SneakGuard™ is a locking, vacuum and thermally insulated container that provides responsible storage of medications and cannabis, with the passion to protect, save and enhance everyday quality of life. Gordon explains “As a father of a 8 year old I understand how pressing it is for adults to protect children, teens, and even pets from unintended ingestion, so I created a unique storage unit to provide a solution.” (more…)
AHA Journals, Author Interviews, Cannabis, Pulmonary Disease, UCSF / 27.07.2016

MedicalResearch.com Interview with: Matthew L. Springer, Ph.D. Professor of Medicine Division of Cardiology University of California, San Francisco San Francisco, CA MedicalResearch.com: What is the background for this study? Response: We've known for many years that secondhand smoke from tobacco cigarettes is harmful, and the vast majority of deaths thought to result from secondhand smoke are from cardiovascular disease. However, very little has been known about cardiovascular consequences of exposure to secondhand smoke from marijuana, and people tend to mistake the lack of evidence that it is harmful, for evidence that is it not harmful. As a result, many people seem relatively unconcerned about smoking marijuana and being exposed (or exposing others) to marijuana secondhand smoke. Politicians and policy makers also seem less willing to limit where people can smoke marijuana (under legal circumstances) than tobacco. What has been lacking is research into how exposure to marijuana smoke affects cardiovascular health. It has been difficult to do such experiments because marijuana is illegal in the eyes of the federal government. However, we have been studying the harmful effects of secondhand tobacco smoke on the function of rat blood vessels, which is similar to its harmful effects on human blood vessels, and we now have studied how the function of rat blood vessels is affected by exposure to secondhand marijuana smoke. (more…)
Author Interviews, Cannabis, JAMA, Pediatrics / 25.07.2016

MedicalResearch.com Interview with: George Sam Wang MD FAAP Assistant Professor of Pediatrics Section of Emergency Medicine, Medical Toxicology Department of Pediatrics University of Colorado Anschutz Medical Campus Children's Hospital Colorado MedicalResearch.com: What is the background for this study? Response: Many states have allowed medical and now recreational marijuana. The impact on pediatric population has not been fully described. MedicalResearch.com: What are the main findings? Response: Unintentional exposures presenting to our children's hospital and calls to our regional poison center significantly increased after our state allowed recreational marijuana. MedicalResearch.com: What should readers take away from your report? Response: Exposures in children are increasing in our state that allows medical and recreational Marijuana, many were edible products. Marijuana products should be treated like medications and household products in home and properly and safely stored. States looking to legalize marijuana need to consider safety rules and regulations during rule making processes. (more…)
Alcohol, Author Interviews, Columbia, OBGYNE, Tobacco / 21.07.2016

MedicalResearch.com Interview with: Dr. Qiana L. Brown, PhD, MPH, LCSW Postdoctoral Research Fellow Columbia University Mailman School of Public Health Department of Epidemiology Substance Abuse Epidemiology Training Program MedicalResearch.com: What is the background for this study? Dr. Brown: Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health. Tobacco and alcohol are the most commonly used substances among pregnant women and non-pregnant women of reproductive age, and are leading causes of preventable adverse health outcomes for both mother and baby. Women with health insurance have more prenatal visits, and present for prenatal care earlier than uninsured women, which may increase their exposure to health messaging around substance abuse prevention at prenatal visits. Additionally, treatment for substance use disorders and maternal and child health care are part of the Essential Health Benefits covered by the Affordable Care Act, which may encourage patients and providers to engage in discussions around alcohol and tobacco use prevention during pregnancy. Given these factors, we examined the relationship between health insurance coverage and both past month tobacco use and past month alcohol use among a nationally representative sample of reproductive age women in the United States. We sampled 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health in 2010 to 2014. Among these women, 3.28% (n=3,267) were pregnant. We specifically investigated whether the relationship between health insurance and alcohol or tobacco use differed between pregnant and non-pregnant women. (more…)
Alcohol, Author Interviews, Memory / 19.07.2016

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com 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. MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Mary P. Heitzeg, PhD Assistant Professor Department of Psychiatry University of Michigan MedicalResearch.com: 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

MedicalResearch.com Interview with: Dr Wai Liu Senior Research Fellow St George's University of London London MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Professor Ellen Meara, PhD Professor The Dartmouth Institute for Health Policy and Clinical Practice MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com Interview with: Dr Karen Ersche PhD University of Cambridge Department of Psychiatry Brain Mapping Unit Herchel Smith Building Cambridge UK MedicalResearch.com: 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

MedicalResearch.com Interview with: Stefania I. Papatheodorou, MD, PhD Cyprus International Institute for Environmental and Public Health Limassol, Cyprus MedicalResearch.com: 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

MedicalResearch.com Interview with: Hannah Carliner, ScD MPH Post Doctoral Fellow in Substance Abuse Epidemiology Mailman School of Public Health Columbia University MedicalResearch.com: 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

MedicalResearch.com Interview with: Dr. Sarah Saxena Université Libre de Bruxelles MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Professor Claire Roberts PhD Robinson Research Institute Adelaide University MedicalResearch.com: 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

MedicalResearch.com Interview with: Mr. Brian C. Tefft Senior Research Associate AAA Foundation for Traffic Safety MedicalResearch.com: 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

MedicalResearch.com 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. MedicalResearch.com: 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

MedicalResearch.com Interview with: William Eggleston, PharmD Fellow in Clinical Toxicology/Emergency Medicine Upstate Medical University Upstate New York Poison Center MedicalResearch.com: 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. MedicalResearch.com: 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

MedicalResearch.com Interview with: Shelly B. Flagel, PhD Molecular and Behavioral Neuroscience Institute Department of Psychiatry University of Michigan, Ann Arbor, MI 48109 MedicalResearch.com: 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

MedicalResearch.com 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 MedicalResearch.com: 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

MedicalResearch.com Interview with: Paola Grimaldi, PhD Associate Professor of Anatomy Department of Biomedicine and Prevention, School of Medicine, University of Rome Tor Vergata Rome, Italy MedicalResearch.com: 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

MedicalResearch.com 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…)