Addiction, Author Interviews, CHEST, Toxin Research / 01.11.2016

MedicalResearch.com Interview with: Guy Soo Hoo, MD West Los Angeles VA Medical Center Los Angeles, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wound botulism occurs as a result of infection by material contaminated with C. botulinum. While typically associated with trauma and crush injury, it is also an infection associated with injection drug users especially with “skin popping”. Black tar heroin is an especially common vehicle for the development of wound botulism. Black tar heroin is the predominant form of heroin used in the western United States and there has been an epidemic of wound botulism cases associated with black tar heroin users especially in California. In fact, the vast majority of wound botulism cases in California occurs in injection drug users, specifically those who inject the drug subcutaneously or intramuscularly. The typical presentation in wound botulism in an acute neurologic illness with cranial nerve palsies, flaccid descending paralysis. Respiratory failure requiring mechanical ventilation may occur and may require an extended period of ventilator support for recovery. A high index of suspicion as well as general supportive care is needed for optimal treatment and recovery. Optimal treatment includes wound debridement, early administration of botulinum antitoxin and penicillin therapy. This case is unique in that the initial presentation was bilateral vocal cord paralysis and cranial nerve function was initially intact. The patient subsequently developed a flaccid paralysis that included cranial nerve palsies, functional quadriplegia and respiratory failure. He recovered to be discharged to a rehabilitation facility about six weeks after his initial presentation.
Addiction, Author Interviews, Opiods, Pediatrics / 30.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29333" align="alignleft" width="200"]Julie R Gaither, PhD, MPH, RN Postdoctoral Fellow in Biostatistics Yale School of Medicine Dr. Julie R Gaither[/caption] Julie R Gaither, PhD, MPH, RN Postdoctoral Fellow in Biostatistics Yale School of Medicine MedicalResearch.com: What is the background for this study? Response: In light of the prescription opioid epidemic that has affected the adult US population in recent years, our objective with this study was to examine how hospitalization rates for prescription opioid poisonings have changed over time in the pediatric population. In addition, because prescription opioids are thought to be a precursor to illicit opioid use, we examined in older adolescents hospitalization rates for heroin overdose. In all children, we determined whether the poisoning was of an accidental nature or could be attributed to suicidal intent. To address these questions, we used the Kids’ Inpatient Database, a nationally representatives sample of pediatric hospital records released every three years, starting in 1997.
Alcohol, Author Interviews, BMJ, Gender Differences / 27.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29071" align="alignleft" width="200"]Tim Slade, PhD Associate Professor National Drug and Alcohol Research Centre University of New South Wales Prof. Tim Slade[/caption] Tim Slade, PhD Associate Professor National Drug and Alcohol Research Centre University of New South Wales MedicalResearch.com: What is the background for this study? What are the main findings? Response: Historically, men have been more likely to drink alcohol than women and to drink in quantities that damage their health. However, evidence points to a significant shift in the drinking landscape with rates of alcohol use converging among men and women born in more recent times. In a bid to quantify this trend over time, we pooled data from 68 published research studies in 36 countries around the world. We looked at how the ratio of men’s to women’s alcohol use differed for people born in different time periods and found that the gap between the sexes consistently narrowed over the past 100 years or so. For example, among cohorts born in the early 1900s men were just over two times more likely than women to drink alcohol. Among cohorts born in the late 1900s this ratio had decreased to almost one meaning that men’s and women’s drinking rates have reached parity.
Alcohol, Author Interviews, Cannabis, Schizophrenia / 27.10.2016

MedicalResearch.com Interview with: Dr Stine Mai Nielsen Copenhagen University Hospital Mental Health Center Copenhagen Gentofte, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have tested whether use of substances can cause schizophrenia. However due to methodological limitations in the existing literature, uncertainties still remains. We aimed to investigate the association between several types of substance abuses and the risk of developing schizophrenia later in life. We did a nationwide, prospective cohort study using the detailed Danish registers, which enabled us to address some of the limitations from prior findings. Our cohort consisted of more than 3.13 mio. individuals, that we were able to follow up for more than 104 mio. years at risk. We found that dealing with a substance abuse increased the overall risk of developing schizophrenia by 6 times, with abuse of cannabis and alcohol presenting the highest associations (5 and 3 times increased risk). The risk was found to be significant even 10-15 years prior to a diagnosis of substance abuse.
Addiction, Author Interviews, Opiods / 27.10.2016

MedicalResearch.com Interview with: [caption id="attachment_29180" align="alignleft" width="200"]Brett Wolfson-Stofko, PhD, Post-Doctoral Fellow Behavioral Science Training Program Center for Drug Use and HIV/HCV Research Rory Meyers College of Nursing New York University New York, NY 10003 Research Associate Institute for Special Populations National Development & Research Institutes, Inc. Dr. Brett Wolfson-Stofko[/caption] Brett Wolfson-Stofko, PhD Post-Doctoral Fellow Behavioral Science Training Program Center for Drug Use and HIV/HCV Research Rory Meyers College of Nursing New York University New York, NY 10003 Research Associate Institute for Special Populations National Development & Research Institutes, Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drug overdose mortality rates per year continue to rise in the US. Previous research suggests that public bathrooms are among the most popular public injection locations for people who inject drugs (PWID) in New York City. Though syringe exchange programs provide sterile injection equipment they are not authorized to offer a safe and sanitary space for injection which leads many, particularly those that are unstably housed, to inject in public spaces. This study interviewed 86 business managers throughout NYC and 58% (n = 50) of these managers had encountered drug use in their business bathroom within the past 6 months. Over one-third found improperly disposed syringes and 14% encountered unresponsive individuals. Only 10% of managers reported some form of overdose recognition and naloxone training while 64% of managers thought overdose recognition and naloxone training would be useful for them and their staff.
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 18.10.2016

MedicalResearch.com Interview with: Bryan Sakamoto MD, PhD Department of Anesthesia Richard L. Roudebush, Veterans Affairs Medical Center Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana MedicalResearch.com: What is the background for this study? Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population.
Addiction, Author Interviews, CDC, Pediatrics / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28833" align="alignleft" width="133"]Steven A. Sumner, MD, MSc Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Division of Violence Prevention Atlanta GA Dr. Steven A. Sumner[/caption] Steven A. Sumner, MD, MSc Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Division of Violence Prevention Atlanta GA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2014, CDC was invited to Wilmington, Delaware, to conduct a study because the city had been experiencing a high level of homicides and shootings. Our investigation looked at multiple risk factors for youth violence involvement across a wide variety of areas of young people’s lives. For example, youth who had previously experienced a gunshot wound injury were 11 times more likely to later commit a gun crime than youth who had not been similarly injured. Study investigators looked at histories of violence victimization, educational problems, unemployment histories, child welfare experiences, and prior criminal involvement. The more adverse life experiences a young person had, the more likely they were to commit firearm violence.
Alcohol, Author Interviews, NIH, Pharmacology / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28814" align="alignleft" width="140"]Megan Ryan M.B.A. Clinical Program Director, DMD Technology Development Coordinator National Institute on Alcohol Abuse and Alcoholism National Institutes of Health Bethesda, MD Megan Ryan[/caption] Megan Ryan M.B.A. Clinical Program Director, DMD Technology Development Coordinator National Institute on Alcohol Abuse and Alcoholism National Institutes of Health Bethesda, MD MedicalResearch.com: What is the background for this study? Response: Alcohol use disorder (AUD) has been linked to the dysregulation of the brain stress systems (e.g. corticotropin-releasing factor, glucocorticoids, and vasopressin) creating a negative emotional state leading to chronic relapsing behavior. Several pre-clinical studies have shown that by blocking the V1b receptor with a V1b receptor antagonist, dependence induced compulsive-like alcohol intake is also blocked. This is the first multi-site trial to assess the efficacy of the V1b receptor antagonist novel compound (ABT-436) for the treatment of alcohol dependence.
Addiction, Alcohol, Pediatrics, Tobacco Research / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28634" align="alignleft" width="80"]Dr Rebecca Lacey, PhD Research Associate Epidemiology & Public Health Institute of Epidemiology & Health Faculty of Pop Health Sciences University College London Dr. Rebecca Lacey[/caption] Dr Rebecca Lacey, PhD Research Associate Epidemiology & Public Health Institute of Epidemiology & Health Faculty of Pop Health Sciences University College London MedicalResearch.com: What is the background for this study? Response: We know from previous research that children who experience parental absence, whether due to death, divorce or some other reason, are more likely, on average, to have poorer health in later life. This includes being more likely to smoke and drink as an adult. However, what we didn’t know before we conducted our study was whether children who experienced parental absence were more likely to engage in the early uptake of risky health behaviours in childhood. This is what we looked at in our study.
Author Interviews, Cannabis, Cognitive Issues, Depression, Pediatrics / 12.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28754" align="alignleft" width="115"]Elizabeth Osuch, M.D. Associate Professor; Rea Chair Department of Psychiatry FEMAP--London Health Sciences Centre London, ON Dr. Elizabeth Osuch[/caption] Elizabeth Osuch, M.D. Associate Professor; Rea Chair Department of Psychiatry FEMAP--London Health Sciences Centre London, ON    MedicalResearch.com: What is the background for this study? What are the main findings? Response: As a researcher and psychiatrist doing clinical work in youth aged 16-25 with mood and anxiety disorders I often see patients who are depressed and believe that using marijuana (MJ) improves their mood.  Yet they remain depressed.  This was the clinical inspiration for this brain imaging study, where we investigated emerging adults with Major Depressive Disorder (MDD).  Subject groups included patients with MDD who did and did not use MJ frequently.  Our results showed that the MDD+MJ group did not have significantly less depression than the MDD alone group, and the brain abnormalities found in MDD were not corrected by MJ use in the MDD+MJ group.  In fact, some of the brain differences were worse with the addition of MJ, while others were just different.
Addiction, Author Interviews, NYU/NYMC, Pediatrics, Tobacco, Tobacco Research / 08.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28638" align="alignleft" width="150"]Professor Michael Weitzman MD New York University's College of Global Public Health and The Departments of Pediatrics and Population Health New York University School of Medicine NYU Langone Medical Center Dr. Michael Weitzman[/caption] Professor Michael Weitzman MD New York University's College of Global Public Health and The Departments of Pediatrics and Population Health New York University School of Medicine NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: There is a marked and rapidly increasing epidemic of hookah (waterpipe) use in the US. Hookah use appears to be as, or even more, dangerous than cigarette use. There are data suggesting that one hookah session is comparable to smoking 5 packs of cigarettes in terms of exposure to toxins. The CDC and WHO both have issued warnings that hookah pipe use may eradicate much or all of the progress of the past 50 years of tobacco control efforts.
Addiction, Author Interviews, Columbia, Opiods / 03.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28490" align="alignleft" width="165"]Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032 Dr. Silvia Martins[/caption] Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032 MedicalResearch.com: What is the background for this study? Response: Given the high probability of nonmedical use among adolescents and young adults, the potential development of prescription opioid use disorder secondary to nonmedical use among youth represents an important and growing public health concern. Still, no study had investigated time trends, specifically if prescription opioid use disorder has increased in the past decade among adolescents, emerging adults and young adults who are nonmedical users of prescription opioids.
Addiction, Author Interviews, Memory, University Texas, Weight Research / 27.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28356" align="alignleft" width="132"]U. H. Winzer-Serhan Ph.D. Associate Professor Department of Neuroscience and Experimental Therapeutics Texas A&M Health Science Center Dr. Ursula H. Winzer-Serhan[/caption] Ursala. H. Winzer-Serhan Ph.D. Associate Professor Department of Neuroscience and Experimental Therapeutics Texas A&M Health Science Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nicotine is a plant alkaloid that is naturally occurring in the tobacco plant. Smoking delivers nicotine to the brain where it acts as a stimulant. Tobacco and electronic cigarette smoking delivers many other chemicals to the body, which are harmful and can cause cancer. However, the drug nicotine by itself is relatively benign and poses few health risks for most people. Nicotine acts in the brain on nicotinic receptors, which are ion channels that are widely expressed in the brain. They play an important role in cognitive functions. Research with rodents and in humans has shown that nicotine can enhance learning and memory, and furthermore, can protect neurons during injuries and in the aging brain. With the increasingly older population, it becomes more and more important to delay cognitive decline in the elderly. Right now, there is no drug available that could delay aging of the brain.
Author Interviews, Cost of Health Care, Opiods, Pain Research / 26.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28168" align="alignleft" width="200"]Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. Dr. Jared Howard[/caption] Jaren Howard, PharmD, BCPS Associate Director Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: The existing scientific literature estimating the healthcare burden of opioid misuse disorders often combines all patients within the broad category of “opioid abuse,” defined as opioid abuse, dependence, or overdose/poisoning. Collectively, these three conditions can significantly increase healthcare costs among commercially insured patients. • Real world medical coding practices present challenges to researchers aiming to separately analyze excess costs by diagnosis, though combining these diagnoses may mask some variation in excess costs. • Furthermore, little is known about the specific drivers of excess costs in terms of medical conditions driving excess costs or places of service at the diagnosis-level.
Author Interviews, JAMA, Opiods / 21.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28220" align="alignleft" width="130"]Bradley D. Stein, MD, MPH, PhD RAND Corporation University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Dr. Bradley Stein[/caption] Bradley D. Stein, MD, MPH, PhD RAND Corporation University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: The United States is in the midst of a serious opioid abuse epidemic and we know that medically assisted treatment is one of the best ways to help people with addiction to opioids. The drug buprenorphine has advantages over methadone, the historic medical treatment, because it can be prescribed by physicians in the community who receive a waiver allowing them to prescribe it after undergoing eight hours of training.. Methadone is dispensed at special clinics that many people with opioid addition may be unable to get to with the frequency required by effective treatment. To better understand patterns of the use of buprenorphine, we examined treatment patterns in the states with the most buprenorphine-waivered physicians (California, Florida, Massachusetts, Michigan, New York, Pennsylvania and Texas). Our data came from a prescription records that account for over 80 percent of the retail pharmacies in the nation. We examined use patterns among 3,200 physicians who treated 250,000 patients. We had two surprising findings:  First, the median length of treatment with buprenorphine was 53 days, which is much shorter than the duration that most individuals are likely to need for optimal results. Second, despite concerns that federal limits on the number of patients and waivered physician can treat being a significant barrier for many individuals obtaining treatment, we found that most physicians were treating far fewer patients than would be allowed by the patient limits. In fact, 22 percent of the physicians treated an average of 3 patients per month and just 9 percent treated 75 or more patients per month.
Addiction, Author Interviews, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: Thomas Alfieri, PhD Director, Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: When researchers assess the abuse potential of opioids, they follow current FDA guidance, which stipulates that questions such as “Do you like this drug?” and “How much would you like to take this drug again?” be asked of recreational drug users. We think that assessing abuse potential among recreational users provides useful information, however, we believe that the questions designed to be asked of recreational users are not appropriate for use with pain patients. These items can confuse the liking of a drug for pain relief with the liking of a drug to get high – two very different reasons that a pain patient might want to take a drug again. In theory, abuse potential could be overestimated among pain patients because of the somewhat general nature of the items used in the survey instrument.
Author Interviews, Cost of Health Care, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28168" align="alignleft" width="200"]Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. Dr. Jared Howard[/caption] Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: Opioid abuse, dependence, overdose, and poisoning (referred to collectively for the purposes of this study as “abuse”) represent a costly public health concern to payers. Excess annual costs for a diagnosed opioid abuser range from $10,000-$20,000 per patient. Current literature does not sufficiently address the drivers of excess costs in terms of medical conditions driving costs or places of service.
Author Interviews, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: Angela DeVeaugh-Geiss, PhD Director, Epidemiology, Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: Due to widespread abuse, including abuse via non-oral routes (eg, snorting, injecting), OxyContin was reformulated with abuse deterrent properties in August 2010. In this study we explored changes in nonmedical use of OxyContin after the reformulation using public use data files from the National Survey on Drug Use and Health (NSDUH). NSDUH has included questions about nonmedical use of OxyContin (including pill images) since 2004. Nonmedical use is defined as use without a prescription or use that occurred simply for the experience or feeling the drug caused.
Accidents & Violence, Author Interviews, Cannabis, Columbia, Opiods / 17.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28045" align="alignleft" width="163"]June H. Kim Doctoral candidate,Department of Epidemiology Mailman School Public Health Columbia University June Kim[/caption] June H. Kim Doctoral candidate,Department of Epidemiology Mailman School Public Health Columbia University MedicalResearch.com: What is the background for this study? What are the main findings? Response: A previous study indicated that states with medical marijuana laws had a reduced rate of opioid overdoses. If this is true, we'd expect to see similar reductions in opioid use associated with these laws. For this study, we used data from the FARS, a national surveillance system that records any crash events on US public roads that result in a fatality. Some states provide uniform testing of the majority of their deceased drivers, year to year. Among these states, we found that there was a lower prevalence of positive opioid toxicology tests among drivers crashing in states with an operational medical marijuana versus drivers crashing in states before a future medical marijuana law is implemented, particularly among drivers aged 21-40.
Addiction, Alcohol, Author Interviews, Psychological Science / 16.09.2016

MedicalResearch.com Interview with: [caption id="attachment_28028" align="alignleft" width="150"]Kristina J. Berglund Department of Psychology University of Gothenburg Dr. Kristina J. Berglund[/caption] Kristina J. Berglund Department of Psychology University of Gothenburg MedicalResearch.com: What is the background for this study? What are the main findings? Response: In Sweden, care providers do offer different treatment strategies for individuals who have alcohol problems, where some offer a treatment where the goal is abstinence and other offer a treatment where the goal is low-risk consumption. We wanted to investigate how important it was for having a successful treatment when there was congruence between the patient’s goals and the advocated goal of the treatment, and when there was not. The main findings was that that if the patient had a goal of abstinence than it was much more likely to reach that goal if the patient went to a treatment that advocated abstinence. It was less likely to reach the goal if a patient had a goal of low-risk consumption and went to a treatment that advocated low-risk consumption. The treatment that advocated abstinence was also more effective when the patient were ambivalent of his/her own goal.
Author Interviews, CDC, Emory, Opiods / 15.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27960" align="alignleft" width="180"]Curtis Florence, PhD National Center for Injury Prevention and Control and Assistant professor, Department of Health Policy Management Rollins School of Public Health at Emory Curtis Florence, PhD[/caption] Curtis Florence, PhD National Center for Injury Prevention and Control and Assistant professor, Department of Health Policy Management Rollins School of Public Health Emory MedicalResearch.com: What is the background for this study? Response:
  • This study presents most recent CDC estimates of the economic burden of prescription opioid abuse, dependence and overdose in the United States.
  • In 2013, over 16,000 persons died of prescription opioid overdoses, and almost 2 million people met the diagnostic criteria for abuse and/or dependence.
Author Interviews, Cannabis, Lancet, NIH / 06.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27683" align="alignleft" width="125"]Dr. Wilson Compton MD, Deputy Director National Institute on Drug Abuse Dr. Wilson Compton[/caption] Dr. Wilson Compton MD, Deputy Director National Institute on Drug Abuse MedicalResearch.com: What is the background for this study? What are the main findings? Response: The study found that overall past year marijuana use by adults in the U.S. increased by more than 30% in the past dozen years, and 10 million more people were using marijuana in 2014 than in 2002. Use of marijuana on a daily (or near daily) basis increased even more markedly. In 2002, 3.9 million adults in the U.S. reported using marijuana daily or nearly every day, and the number more than doubled to 8.4 million by 2014. Along with this increase in use, we found that U.S. adults perceptions of the potential harms from using marijuana greatly decreased. Despite scientific evidence of potential harms, adults are much less convinced about dangers associated with using marijuana. These reductions in perceived harm were strongly associated with the increases in use.
Addiction, Anesthesiology, Author Interviews, Opiods / 02.09.2016

MedicalResearch.com Interview with: [caption id="attachment_27601" align="alignleft" width="125"]N. Nick Knezevic, MD, PhD Vice Chair for Research and Education Associate Professor of Anesthesiology and Surgery at University of Illinois Advocate Illinois Masonic Medical Center Department of Anesthesiology Chicago, IL 60657 Dr. N. Nick Knezevic[/caption] N. Nick Knezevic, MD, PhD Vice Chair for Research and Education Associate Professor of Anesthesiology and Surgery at University of Illinois Advocate Illinois Masonic Medical Center Department of Anesthesiology Chicago, IL 60657 MedicalResearch.com: What is the background for this study? Response: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic non-cancer pain, still many Americans seek pain relief through opioid consumption. The purpose of this study was to accurately assess compliance of chronic opioid consuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing could improve compliance.
Author Interviews, Cocaine / 01.09.2016

MedicalResearch.com Interview with: Dr Stefania Fasano Cardiff University MedicalResearch.com: What is the background for this study? Response: Exposure to drugs of abuse such as cocaine produces intense and long-lasting memories that are critical in the transition from recreational drug-taking to uncontrolled drug use. In the brain, addictive drugs usurp cellular circuits and signalling molecules involved in normal memory processes; hence, these drug-related memories resist extinction and contribute to high rates of relapse. Despite almost five decades of experimental research, there are currently no approved medications for cocaine dependence.
Addiction, Author Interviews, CDC, Opiods / 30.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27499" align="alignleft" width="125"]Alexis B. Peterson, PhD Alexis B. Peterson, PhD[/caption] Alexis B. Peterson, PhD (Epidemic Intelligence Service Officer) [caption id="attachment_27435" align="alignleft" width="125"]R. Matthew Gladden, PhD Surveillance and Epidemiology Team Division of Unintentional Injury Prevention Centers for Disease Control and Prevention Dr. R. Mathew Gladden[/caption] R. Matthew Gladden, PhD (Behavioral Scientist) MedicalResearch.com What is the background for this study? Response: In March and October 2015, the Drug Enforcement Administration and the Centers for Disease Control and Prevention (CDC) issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl, as a threat to public health and safety. During 2013-2014, Ohio and Florida reported significant increases in fentanyl-involved overdose deaths (fentanyl deaths) and fentanyl submissions (drug products obtained by law enforcement that tested positive for fentanyl). Fentanyl is a synthetic opioid 50-100 times more potent than morphine. The University of Florida and the Ohio Department of Public Health with CDC assistance compared trends in fentanyl deaths, fentanyl submissions, and fentanyl prescribing during January 2013–June 2015. In-depth review of medical examiner and coroner reports of fentanyl deaths occurring in Ohio’s 14 high-burden counties were performed to identify circumstances surrounding fentanyl overdose death.
Addiction, Author Interviews, CDC, Opiods / 29.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27435" align="alignleft" width="153"]R. Matthew Gladden, PhD Surveillance and Epidemiology Team Division of Unintentional Injury Prevention Centers for Disease Control and Prevention Dr. R. Mathew Gladden[/caption] R. Matthew Gladden, PhD Surveillance and Epidemiology Team, Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention MedicalResearch.com: What is the background for this study? Response: In March and October 2015, the Drug Enforcement Administration (DEA) and CDC, respectively, issued nationwide alerts identifying illicitly manufactured fentanyl (IMF) as a threat to public health and safety.IMF is unlawfully produced fentanyl, obtained through illicit drug markets, includes fentanyl analogs, and is commonly mixed with or sold as heroin. Starting in 2013, the production and distribution of IMF increased to unprecedented levels, fueled by increases in the global supply, processing, and distribution of fentanyl and fentanyl-precursor chemicals by criminal organizations. Fentanyl is a synthetic opioid 50?100 times more potent than morphine. Multiple states have reported increases in fentanyl-involved overdose (poisoning) deaths (fentanyl deaths). This report examined the number of drug products obtained by law enforcement that tested positive for fentanyl (fentanyl submissions) and synthetic opioid-involved deaths other than methadone (synthetic opioid deaths), which include fentanyl deaths and deaths involving other synthetic opioids (e.g., tramadol).
Addiction, Author Interviews, CDC, Opiods, Pain Research / 27.08.2016

MedicalResearch.com Interview with: John Halpin, MD, MPH, Medical officer Prescription Drug Overdose Epidemiology and Surveillance Team CDC Injury Center MedicalReseach.com editor’s note: Dr. Halpern discusses the CDC alert of August 25, 2016 regarding the increase in fentanyl-related unintentional overdose fatalities in multiple states. MedicalResearch.com: What is the background for this alert? Response: The current health alert is an update to a previous alert in October, 2015 from CDC which described the geographic spread of states in which forensic labs were increasingly detecting fentanyl in the drug submissions that they receive from law enforcement, and how many of these same states were beginning to report fentanyl-related overdose deaths by their departments of public health. Further investigation by CDC and DEA have revealed that the great majority of fentanyl now present in the illicit drugs market is clandestinely-produced, and most commonly mixed with and sold as heroin, and is responsible for the great majority of fentanyl-related overdose deaths. Indications at the time of that alert pointed to a likely continuous rise in the supply of illicitly-manufactured fentanyl, and the potential for increasing numbers of fentanyl-related overdose deaths, particularly among those who use heroin.
Addiction, Author Interviews, Compliance, Opiods, Pharmacology / 23.08.2016

MedicalResearch.com Interview with: [caption id="attachment_27243" align="alignleft" width="190"]F. Leland McClure III, MSci, PhD, F-ABFT Medical science liaison director Quest Diagnostics Dr. F. Leland McClure[/caption] F. Leland McClure III, MSci, PhD, F-ABFT Medical science liaison director Quest Diagnostics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many physicians associate Quest Diagnostics with their lab service needs because of our leadership in laboratory testing. But Quest is more than a lab, which is why we refer to ourselves as a diagnostic information services provider. This means that we help providers, health plans and even patients use the insights we derive from our lab testing data to deliver better care, quality and outcomes, both for the patient and the managed population. Our 2016 Quest Diagnostics Health Trends(TM) Prescription Drug Monitoring Report is an example of how we provide important health insights from Quest's laboratory data. Prescription drug misuse is a major epidemic in the United States. Laboratory testing can help identify if a patient is using or misusing prescribed medications. For instance, lab tests can show evidence of additional medications and other drugs in a patient’s urine specimen, suggesting potentially dangerous drug combinations. Earlier this year, the CDC issued guidelines that call for laboratory testing for patients prescribed certain medications, such as opioids, that carry a risk of abuse. Quest's prescription drug monitoring services help the physician identify if a patient is taking or not taking up to about four dozen drugs, such as oxycodone, Adderall XR® and Percocet®. For the Quest analysis, we analyzed more than 3 million de-identified lab test results. In this report, we found that 54 percent of patients’ results tested in 2015 showed evidence of drug misuse, slightly above the 53 percent misuse rate in 2014. That is certainly unacceptably high, but it’s a significant decline from the high of 63 percent we observed in 2011. We also found that an increasing proportion of patients who misuse medications combine their prescription medication with non-prescribed drugs. Among patients with inconsistent test results, forty-five percent of these patients showed evidence of one or more other drug(s) in addition to their prescribed drug regimen. That’s much higher than our findings of 35 percent in 2014 and 2013, 33 percent in 2012, and 32 percent in 2011. Finally, we were alarmed by the data showing the connection between heroin and benzodiazepines misuse. Our data showed one in three heroin users combine their drug use with benzodiazepines, the vast majority of which were unprescribed. This is an extremely dangerous practice given that benzodiazepines can have strong respiratory depressant effects when combined with other substances. Drug combinations, but particularly of heroin with benzodiazepines, can be potentially very dangerous, leading to coma and even death in some cases.
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.
Addiction, Author Interviews, Opiods, Primary Care / 04.08.2016

MedicalResearch.com Interview with: [caption id="attachment_26700" align="alignleft" width="133"]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 Dr. Richard Deyo[/caption] 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.