More Pharmacies Willing To Dispense Naloxone Without Prescription

MedicalResearch.com Interview with:
Kirk Evoy, PharmD, BCACP, BC-ADM, CTTS
"Wolf Administration Holds a Press Conference Expanding Access to Naloxone" by Governor Tom Wolf is licensed under CC BY 2.0Clinical Assistant Professor
 College of Pharmacy, The University of Texas at Austin
Adjoint Assistant Professor
 School of Medicine, University of Texas Health Science Center at San Antonio
Ambulatory Care Pharmacist
 Southeast Clinic, University Health System
 UT Health Science Center at San Antonio
Pharmacotherapy Education and Research Center
San Antonio, TX 78229 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Previous studies in Indiana and New York City, and the similar study in California published alongside ours identified that, despite the fact that laws designed to increase naloxone access had been in place for 2-3 years, patients were still not able to obtain naloxone without first seeing a doctor in many pharmacies.

Our study showed contrasting results to the previous studies, with a much higher proportion of pharmacies stocking naloxone and stating their willingness to dispense without an outside prescription. Among the 2,317 Texas chain community pharmacies we contacted, 83.7% correctly informed our interviewers that they could obtain naloxone without having to get a prescription from their doctor before coming to the pharmacy.  We also found that 76.4% of the pharmacies had at least one type of naloxone currently in stock. Continue reading

US Tops Opioids Deaths Among 13 High Income Countries

MedicalResearch.com Interview with:
"Drug Addiction" by Joana Faria is licensed under CC BY-NC-ND 4.0Yingxi (Cimo) Chen, MD, MPH, PhD
Postdoctoral Fellow
Radiation Epidemiology Branch, DCEG, NCI, NIH
Rockville MD 20850 

MedicalResearch.com: What is the background for this study?

Response: Death rates from drug overdose have more than doubled in the US in the 21st century. Similar increases in drug overdose deaths have been reported in other high-income countries but few studies have compared rates across countries.  Continue reading

Most Surgical Patients Only Use About 25% Of Their Prescribed Opioids

MedicalResearch.com Interview with:
"Trump: 'The opioid crisis is an emergency'" by Marco Verch is licensed under CC BY 2.0Joceline Vu, MD

Resident, PGY-5
Department of Surgery
University of Michigan 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This study examined how much opioid patients use after surgery, and looked at factors that might predispose some patients to use more or less.

Patient opioid use after surgery is an interesting question that’s gained a lot of attention recently, because it’s different from other uses for opioids. If you have chronic pain, you’re probably going to use all of your prescription. But if you have surgery, you may not take all of your pills, and this leaves people with leftover pills that can be dangerous later.

From this study, we found that patients only use, on average, about quarter of their prescription, meaning that a lot of them are left with leftover pills. Moreover, we found that the biggest determinant of how much they used wasn’t how much pain they reported, or any other factor—it was how big their original prescription was.

What this means is that opioid use after surgery isn’t just determined by pain, but also by what surgeons prescribe. It’s important to keep this in mind as we try to reduce unnecessary opioid prescribing after surgical procedures.  Continue reading

States Vary in Parental Opioid Use and Child Removal Rates

MedicalResearch.com Interview with:

Troy Quast, PhD Associate Professor in the University South Florida College of Public Health

Dr. Quast

Troy Quast, PhD
Associate Professor in the University
South Florida College of Public Healt

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the cited repercussions of the opioid epidemic is its effect on families. However, there is considerable variation in opioid misuse across the county. This is the first nation-wide study to investigate the relationship between opioid prescription rates and child removals at the state level.

I found that there are significant differences across states in the relationship between opioid prescription and child removal rates associated with parental substance abuse. In twenty-three states, increases in opioid prescription rates were associated with increases in the child removal rate. For instance, in California a 10% increase in the county average prescription rate was associated with a 28% increase in the child removal rate. By contrast, in fifteen states the association was flipped, where increases in the opioid prescription rate were associated with decreases in the child removal rate. There was no statistically significant relationship in the remaining states.  Continue reading

The US Opioid Crisis is Expanding and Worse Among Young People

MedicalResearch.com Interview with:
Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine Joshua Barocas, MD

Assistant Professor of Medicine
Section of Infectious Diseases
Boston Medical Center / Boston University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting.

We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system.

We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015.  Continue reading

Brain Change in Addiction as Learning, Not Disease

MedicalResearch.com Interview with:

Marc Lewis, Ph.D. Klingelbeekseweg Arnhem The Netherlands

Prof. Lewis

Marc Lewis, Ph.D.
Klingelbeekseweg Arnhem
The Netherlands

MedicalResearch.com: What is the background for this study?

Response: According to the brain disease model, addiction is a chronic disease brought about by changes in brain systems that mediate the experience and anticipation of reward and higher-order systems underlying judgment and cognitive control. Its proponents propose that these changes are driven by exposure to drugs of abuse or alcohol. The brain disease model is the most prevalent model of addiction in the Western world.

The disease model’s narrow focus on the neurobiological substrates of addiction has diverted attention (and funding) from alternative models. Alternatives to the brain disease model highlight the social-environmental factors that contribute to addiction and the learning processes that translate these factors into negative outcomes. Learning models propose that addiction, though obviously disadvantageous, is a natural, context-sensitive response to challenging environmental contingencies, not a disease.

In this review I examine addiction within a learning framework that incorporates the brain changes seen in addiction without reference to pathology or disease.  Continue reading

Amphetamine-Related Hospitalizations Skyrocket Costing $2 Billion per Year

MedicalResearch.com Interview with:

Tyler Winkelman MD, MSc   Clinician-Investigator Division of General Internal Medicine, Hennepin Healthcare Center for Patient and Provider Experience, Hennepin Healthcare Research Institute Assistant Professor Departments of Medicine & Pediatrics University of Minnesota 

Dr. Winkelman

Tyler Winkelman MD, MSc  
Clinician-Investigator
Division of General Internal Medicine, Hennepin Healthcare
Center for Patient and Provider Experience, Hennepin Healthcare Research Institute
Assistant Professor
Departments of Medicine & Pediatrics
University of Minnesota 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Trends in amphetamine use are mixed across data sources. We sought to identify trends in serious, problematic amphetamine use by analyzing a national sample of hospitalizations.

Amphetamine-related hospitalizations increased over 270% between 2008 and 2015. By 2015, amphetamine-related hospitalizations were responsible for $2 billion in hospital costs. While opioid-related hospitalizations were more common, amphetamine-related hospitalizations increased to a much larger degree. After accounting for population growth, amphetamine hospitalizations grew 245% between 2008 and 2015, whereas opioid-related hospitalizations increased 46%. Amphetamine-related hospitalizations were more likely to be covered by Medicaid and be in the western United States compared with other hospitalizations. In-hospital mortality was 29% higher among amphetamine-related hospitalizations compared with other hospitalizations. 

Continue reading

2 Million Never-Smokers Now Use E-Cigarettes

MedicalResearch.com Interview with:
"Electronic Cigarette/E-Cigs/E-Cigarettes" by Chris F is licensed under CC BY 2.0Mohammadhassan (Hassan) Mirbolouk, MD
American Heart Association Tobacco Regulation Center (A-TRAC)
Johns Hopkins Hospital
Baltimore, MD 21224.

MedicalResearch.com: What is the background for this study?

Response: E-cigarettes were introduced first in US market as a less harmful method of nicotine delivery which potentially would help smokers to have a less harmful option.

However, overtime e-cigarette found its niche of consumers in the younger/tobacco naïve population. Our study is amongst the first studies that describes those who use e-cigarette without any history of combustible-cigarette smoking.  Continue reading

Fentanyl Strips Can Prevent Opioid Overdoses

MedicalResearch.com Interview with:
"150826-fentanyl-factory-underground-illicit.jpg" by r. nial bradshaw is licensed under CC BY 2.0
Jon Zibbell, PhD,
Senior public health scientist
Behavioral Health Research Division
RTI International
Research Triangle Park, NC, 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: For the first time in 2016, U.S. overdose deaths involving illicitly-manufactured fentanyl surpassed deaths from heroin and prescription deaths.

Fentanyl is an extremely potent synthetic opioid, and an illicitly-manufactured form of the drug is regularly being mixed with heroin and often sold to unwitting consumers. Fentanyl is 50 times more potent than heroin and its illicitly-manufactured version is extremely difficult to discern when mixed with heroin. Harm reduction organizations have started to distribute FTS and people consuming street-purchased opioids are using them to test drugs for fentanyl. Our objective was to assess whether this point-of-use form of drug checking was influencing people’s drug use behavior. The study was self-funded by the research institute RTI International.

Our findings show that consumers who tested street opioids with fentanyl test strips were five times more likely to engage in safer drug use behavior when the test comes back positive. The study was conducted among a group of 125 people who inject drugs in Greensboro, North Carolina.

Continue reading

More Liquor Stores, More Crime

MedicalResearch.com Interview with:

Pamela Trangenstein, PhD While she was a predoctoral fellow at Johns Hopkins Bloomberg School of Public Health's Center on Alcohol Marketing and Youth (CAMY) 

Dr. Trangenstein

Pamela Trangenstein, PhD
While  a predoctoral fellow at
Johns Hopkins Bloomberg School of Public Health’s Center on Alcohol Marketing and Youth (CAMY) 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Research repeatedly shows that alcohol outlet density (the number of businesses that sell alcohol in an area) is associated with violent crime, but studies disagree about whether alcohol outlets that are on premise (e.g., bars, restaurants) or off premise (e.g., liquor stores, beer and wine stores) have a stronger association with violent crime.

We used advanced methods that consider both the number of alcohol outlets and their locations to better understand how the association between alcohol outlets and violent crime differs by type of outlet.

We found that alcohol outlets that allow off-premise sales like liquor stores had a stronger association with homicide, aggravated assault, and robbery than on-premise outlets like bars and restaurants. We also found that disadvantaged neighborhoods had higher access to the types of alcohol outlets associated with the most harms: off-premise outlets.  Continue reading

Outbreak of Synthetic Cannabinoid–Associated Bleeding Disorders in Illinois

MedicalResearch.com Interview with:

Dr. Amar Kelkar MD Clinical Fellow Division of Hematology & Oncology, Department of Medicine University of Florida College of Medicine, UF Health Shands Hospital

Dr. Kelkar

Dr. Amar Kelkar MD
Clinical Fellow
Division of Hematology & Oncology, Department of Medicine
University of Florida College of Medicine, UF Health Shands Hospital

MedicalResearch.com: What is the background for this study? What are synthetic cannabinoids?

Response: Starting in March 2018, patients began reporting to hospitals and clinics with unexplained and prolonged bleeding symptoms, first in Chicago, Illinois, and then spreading to Peoria, Illinois and elsewhere. This gained a lot of press because the initial identifying factor was that all the patients had reported recent use of synthetic cannabinoids. As the matter was studied further, it was determined that these patients were likely exposed to an anticoagulant poison mixed in with the synthetic cannabinoids.

Synthetic cannabinoids are lab-derived illicit drugs that target the cannabinoid receptors that are also targeted by marijuana. They go by many names including synthetic marijuana, K2, and Spice.

Continue reading

The Impact of Alcohol Abuse and Dependency

alcohol-cdc-imageThe 2015 National Survey on Drug Use and Health reports that 26.9 percent of people over the age of 18 have engaged in binge drinking in the past year and 15.1 million adults have Alcohol Use Disorder. With alcohol as the center of many social events and lifestyles, many people can easily forget some of its long-term consequences. However, these consequences could have a major impact on your social life, as well as your health and legal environment.

Physical Life Impacts

An excessive amount of drinking can take a serious toll on your physical health. Alcohol interferes with the communication of pathways to the brain and therefore can disrupt your emotions or mood without any warning. Over time, drinking can also damage the heart and lead to stretching and drooping of the heart muscle known as cardiomyopathy, irregular heartbeat, stroke, or high blood pressure. It can also lead to liver inflammation, fibrosis, swelling of blood vessels, and cancer. Your immune system can also become affected by too much alcohol, leaving you susceptible to a variety of diseases such as pneumonia and tuberculosis.

Social and Lifestyle Impacts

Excessive drinking can lead to an impact on family, work, and social life. It can have an impact on work performance and cause many people to call off work or miss obligations. Financial problems can also arise when spending too much money on alcohol, which can lead to further family and marital problems. Many alcoholics also tend to lose friends because of the way they act while under the influence and can also face limited career opportunities because of alcohol-related offenses.

Legal Consequences Associated with Alcoholism

Studies have shown that alcohol can contribute to criminal behavior as it reduces inhibitions and diminishes the thought processes and shields you would normally have while you are sober. Some alcohol-related offenses include assault, property damage, disorderly conduct, offensive behavior, and resisting arrest. One legal consequence that is directly related to alcohol consumption is drunk driving. According to this Mesa DUI attorney, a DUI penalty can also lead to further social, emotional, and physical consequences. You could receive jail time, counseling, fines and fees, and a revocation of your driving privileges.

What to Do If You or Your Loved One is Abusing Alcohol

If you or your loved one is experiencing any issues with alcohol, it is important to reach out to a licensed professional. You can partake in counseling, therapy, or other medical treatments. Remember that you’re not alone and that you can change your lifestyle or situation. 

Sep 24, 2018 @ 3:33 pm

 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Addiction Withdrawal Treatment Using Transcranial Magnetic Stimulation

MedicalResearch.com Interview with:

Crystal meth – illicit methamphetamine hydrochloride

Crystal meth – illicit methamphetamine hydrochloride

TiFei YuanPhD
School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China
Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
School of Psychology, Nanjing Normal University, Nanjing, China

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Addiction is causing serious challenge to public health. Few drugs can treat or even alleviate addiction.

In recent years, non-invasive brain stimulation has been used to modulate craving responses in different types of drug addicts (heroin, methamphetamine, cocaine), and to prevent smoking or alcohol abuse.

However it is unknown if brain stimulation can also help addicts get rid of the aversive symptoms in the early withdrawal period.

The present study is to our knowledge, the first trial to alleviate drug withdrawal symptoms and associated insomnia with non-invasive transcranial magentic stimulation.  Continue reading

Adolescents Face Large Addiction-Treatment Gap

MedicalResearch.com Interview with:

Scott E. Hadland, MD, MPH, MS Assistant Professor of Pediatrics Boston Medical Center / Boston University School of Medicine

Dr. Hadland

Scott E. Hadland, MD, MPH, MS
Assistant Professor of Pediatrics
Boston Medical Center / Boston University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Amidst a worsening overdose epidemic in the United States, adolescents and young adults have not been spared. Although evidence-based medications like buprenorphine, naltrexone, and methadone are recommended for adolescents and young adults, the extent to which youth receive these medications — and whether these medications help retain youth in addiction treatment — isn’t yet known.

Continue reading

Illicit Drug Use Spikes During Special Events

MedicalResearch.com Interview with:
Bikram Subedi, PhD Assistant Professor of Analytical Chemistry Murray State University, Murray KYBikram Subedi, PhD

Assistant Professor of Analytical Chemistry
Murray State University, Murray KY

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The USA is one of the major consumers of diverse neuropsychiatric and illegal drugs, and recently declared a national public health emergency on opioid abuse. Law enforcement typically utilized conventional methods of determining drug consumption rate which are based on survey questionnaire, hospital admissions, drug-related crime statistics, and self-reported information. Conventional methods typically underestimate the actual consumption rate of drugs.

Our new approach of determining consumption rates of drugs in community is time and cost effecting and comprehensive. Based on levels of drugs quantified from raw sewage, the per capita consumption rates of several illicit drugs including methamphetamine, amphetamine, cocaine, and THC in two communities of Western Kentucky (similar population and only ~50 miles apart) were significantly different. During special events such as July 4th and 2017 solar eclipse, the consumption rates were found even higher. The consumption rate of methamphetamine was among one of the highest ever reported in the country.  Continue reading

Veterinarians Fear Humans May Divert Opioids Intended for Pets

MedicalResearch.com Interview with:
“Pets” by GRANT DAWSON is licensed under CC BY 2.0Derek S. Mason, MPH

Colorado University School of Medicine
MD Candidate, Class of 2022
Anschutz Medical Campus, Aurora, CO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this report stems from a focus group of veterinarians that was held and identified that opioid diversion could be occurring within clinics.

After this, we became concerned that human patients were indeed diverting opioids for abuse and misuse and we wanted to get a broader sense from the veterinary medical community if they had been aware of opioid diversion happening within their clinics.

Additionally, we noticed that there was a gap in the scientific literature on how the veterinary medical community feels about the opioid epidemic. As prescribers of opioids, we felt that their input was highly valuable and should be included in the discussion on how to prevent opioid abuse and misuse.  Continue reading

Experimental Injection Reduces Cocaine Craving

MedicalResearch.com Interview with:

Ana-Clara Bobadilla, Ph.D. Postdoctoral scholar in the laboratory of Peter Kalivas, Ph.D MUSC  Photo by Sarah Pack Medical University of South Carolina

Dr. Ana-Clara Bobadilla (Sarah Pack, photographer)

Ana-Clara Bobadilla, Ph.D.
Postdoctoral scholar
in the laboratory of Peter Kalivas, Ph.D
MUSC 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The Brain-derived neurotrophic factor (BDNF) is a growth factor that has well-described effects in the survival, growth and differentiation of neurons during development of the central nervous system, but it also maintains a role during adulthood in learning, memory and various disorders such as addiction. Several clinical studies show increased BDNF levels in the serum of cocaine- or alcohol-dependent patients compared to controls (D’Sa et al., 2011; D’Sa et al., 2012). In preclinical research, a wealth of studies shows that chronic exposure to drugs of abuse impacts BDNF expression in different parts of the brain, including the main regions comprised in the reward circuitry, the cortex and the nucleus accumbens (for a comprehensive review, see Li & Wolf, 2015). Conversely, altering BDNF expression or transmission has profound effects on the response of the brain to drugs (see McGinty et al., 2010). Importantly, BDNF effects are often region-specific, meaning that an increase in BDNF expression in one region can decrease the effects of drug exposure in the brain while the same increase in another region can have opposite effects (Li et al., 2013). Because BDNF transmission can modify the expression of a wide range of genes leading to long-term modifications, numerous studies administer BDNF early in the drug exposure protocol and focus on the long-term changes induced by the growth factor.

In this study, we microinjected BDNF directly in the nucleus accumbens minutes before measuring cocaine craving in a well-known rodent model of relapse. We found that BDNF induces a robust decrease in craving that lasts for at least 3 days post-treatment. The inhibitory effect of BDNF is not seen when animals are tested for sucrose, a very strong reward for rats, suggesting that this effect is specific to cocaine.

Moreover, cocaine craving is only decreased when BDNF is microinjected before the craving test, but has no effect when injected a day before the craving test or in the home cage, indicating a time-specificity in addition to the region-specificity previously described.  Continue reading

LUCEMYRA (Lofexidine) Now Available to Reduce Opioid Withdrawal Symptoms

MedicalResearch.com Interview with:

Mark Pirner, MD, PhD Senior Medical Director Clinical Research and Medical Affairs US WorldMeds

Dr. Mark Pirner

Mark Pirner, MD, PhD
Senior Medical Director
Clinical Research and Medical Affairs
US WorldMeds

MedicalResearch.com: What is the background for this announcement? How does lofexidine differ from other opioid withdrawal medications?

Response: LUCEMYRA™ (lofexidine) was FDA-approved on May 16 as the first and only non-opioid, non-addictive medication for the management of opioid withdrawal in adults.
LUCEMYRA mitigates the acute and painful symptoms of opioid withdrawal by suppressing the neurochemical surge in the brain that occurs when opioids are abruptly discontinued.

In clinical studies, patients receiving treatment with LUCEMYRA experienced greater symptom relief and were significantly more likely to complete their withdrawal. LUCEMYRA is not an opioid drug and is not a treatment for opioid use disorder; it should be used as part of a longer-term treatment plan.

Continue reading

Bariatric Surgical Approach To Increase Bile Acids May Reduce Cocaine Reward

MedicalResearch.com Interview with:

Aurelio Galli, Ph.D. Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science Associate Director for Research Strategy Vanderbilt Brain Institute

Dr. Galli

Aurelio Galli, Ph.D.
Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science
Associate Director for Research Strategy
Vanderbilt Brain Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The study builds on evidence that bile acids influence the brain’s reward system. Bile acids are normally released from the gall bladder into the upper part of the small intestine, where they emulsify fats for absorption, before being recycled further down the small intestine. In bile diversion surgery, an experimental treatment for weight loss, bile is released at the end of the small intestine, increasing the amount of bile acids that enter the general circulation.

Mice treated with this surgery have less appetite for high-fat foods, which suggests that bile acids affect brain reward pathways.

We demonstrated that mice receiving the surgery also showed less preference for the cocaine-associated chamber, indicating that cocaine was probably less rewarding. Continue reading

Opioid Prescription Rates Higher in South, Appalachia and Rural West

MedicalResearch.com Interview with:

Dr. Lyndsey Rolheiser MD Postdoctoral Research Fellow at Harvard Center for Population Studies Cambridge, Massachusetts

Dr. Rolheiser

Dr. Lyndsey Rolheiser PhD
Postdoctoral Research Fellow at Harvard Center for Population Studies
Cambridge, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The opioid crisis was declared a “public health emergency” in 2017. Opioid related overdoses and prescribing rates have increased dramatically over the past decade and previous literature has identified a relationship between high-dose prescriptions and overdose deaths. Thus, understanding the variation and trends in the opioid prescribing rate is crucial in understanding the nature of the opioid epidemic. Opioid prescribing data is publicly available at the county and state level.

County level data represents an administrative boundary that lacks political representation and accountability. In contrast, the congressional district represents a geography that has both of these characteristics. Further, knowing the congressional district level rates allows for policy makers and researchers to observe the variation that exists within states.

The main findings are high prescribing rate districts are concentrated in the South, Appalachia and the rural West. Low-rate districts are concentrated in urban centers.

MedicalResearch.com: What should readers take away from your report?

Response: There is a great deal of variation across congressional districts, but there are also very clear geographical patterns. In terms of policy, this paper highlights the importance of constructing and disseminating crucial public health data at a politically relevant boundary.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our hope is that the estimates we have created can be used within health related public policy research.

Citation: Lyndsey A. Rolheiser, Jack Cordes, BSPH, S.V. Subramanian. Opioid Prescribing Rates by Congressional Districts, United States, 2016. American Journal of Public Health, 2018; e1 DOI: 10.2105/AJPH.2018.304532

Jul 22, 2018 @ 11:46 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Age 21 Can Define Lifelong Drinking Patterns

MedicalResearch.com Interview with:
“undefined” by Iñaki Queralt is licensed under CC BY 2.0Richard Saitz, MD, MPH, FACP, DFASAM

Chair and Professor,Department of Community Health Sciences
Boston University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Most of what we know about the time course of drinking too much (at-risk use) is from people in treatment or special groups and not adults in the US population at large. That’s why we did this study. We need to know how often at-risk drinking persists, how often it resolves, and how often it appears de novo.

Risky drinking means exceeding limits that are associated with health consequences. It includes people with an alcohol use disorder but the vast majority of people drinking risky amounts do not have a disorder, they are simply drinking amounts that can harm their health. Even low amounts can harm health (e.g. breast cancer risk increases at <1 drink a day) but substantial increases in risk occur over 7 in a week on average (for women, and 14 for men) or >5 for men (>4 for women) on an occasion. The latter are associated with acute consequences (e.g. injury, unwanted sex), and the former with chronic conditions (e.g. cirrhosis). People should be aware of their risks and then they can make choices about what risks they want to take (and for those with a disorder, they may need help with those choices and help changing behavior like treatment).

The main findings were….that 3 years later, 3/4ths of adults drinking risky amounts were still doing so. But importantly, a quarter had stopped drinking risky amounts. It is important to know that things change. One factor associated with that positive change was having kids—presumably a positive social change even if stressful.  Of those adults not drinking risky amounts when first interviewed, 15% started doing so 3 years later. Again having children was protective but the main factor associated with starting was young age, particularly those who became of legal drinking age. Despite the fact that youth may be able to access alcohol illegally, this finding confirms that the drinking age of 21 in the US does in fact restrict access, and that turning 21 increases use and risky use by making alcohol more accessible. Continue reading

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

MedicalResearch.com Interview with:

Beatrice Ugiliweneza, PhD, MSPH Assistant Professor Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science School of Public Health and Information Sciences University of Louisville

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

MedicalResearch.com: What should readers take away from your report? 

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

MedicalResearch.com: Is there anything else you would like to add?

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures. 

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH1, Zaid Aljuboori, MD1, Miriam A.Nuño, PhD2, Doniel Drazin, MD3, and  Maxwell Boakye, MD, MPH, MBA1

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Potentially 70,000 Opioid-Related Overdose Deaths Undercounted

MedicalResearch.com Interview with:

Jeanine M. Buchanich, Ph.D. Research associate  Professor in the University of Pittsburgh Graduate  School of Public Health’s Department of Biostatistics

Dr. Buchanich

Jeanine M. Buchanich, Ph.D.
Research associate
Professor in the University of Pittsburgh Graduate
School of Public Health’s Department of Biostatistics

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In the U.S., cause of death codes are assigned by the National Center for Health Statistics (NCHS) using information reported by the coroner or medical examiner completing the death certificate. Drug-specific overdose deaths are identified by the contributory causes of death, which are categorized as “T codes” and are assigned based on the specific drugs recorded by the coroner or medical examiner completing the death certificate. A code of T50.9 means “other and unspecified drugs, medicaments and biological substances.”

My colleagues and I extracted death data by state for 1999 through 2015 from the NCHS’s Mortality Multiple Cause Micro-data Files. We grouped overdose deaths into opioid-related, non-opioid-related and unspecified codes. In five states – Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – more than 35 percent of the overdose deaths were coded as unspecified.

We then calculated the change in percentage of overdose deaths that fell into each category from 1999 to 2015 by state. In those 17 years, opioid-related overdose deaths rose 401 percent, non-opioid-related overdose deaths rose 150 percent and unspecified overdose deaths rose 220 percent.

This allowed us to extrapolate how many of the unspecified overdose deaths were likely opioid-related. By our calculations, potentially 70,000 opioid-related overdose deaths were not included in national opioid-related mortality estimates since 1999 because coroners and medical examiners did not specify the drug that contributed to the cause of death when completing the death certificates.  Continue reading

Buprenorphine Exposures Among Children and Adolescents

MedicalResearch.com Interview with:

Gary Smith, MD, DrPH Director, Center for Injury Research and Policy Nationwide Children’s Hospital Columbus, OH

Dr. Smith

Gary A. Smith, MD, DrPH
Director, Center for Injury Research and Policy
Nationwide Children’s Hospital
Columbus, OH

MedicalResearch.com: What is the background for this study?

Response: Buprenorphine is a prescription opioid medication commonly used to treat opioid use disorder. From 2005 to 2010, the annual number of individual patients who received a buprenorphine prescription increased from 100,000 to more than 800,000. Although buprenorphine is important for the treatment of opioid use disorder, pediatric exposure to this medication can result in serious adverse outcomes.

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More Medicaid Enrollees Receiving Treatment for Opioid Use Disorder, But Disparities Remain

MedicalResearch.com Interview with:

Bradley D. Stein MD PhD Senior Physician Policy Researcher Pittsburgh Office Rand Corporation

Dr. Stein

Bradley D. Stein MD PhD
Senior Physician Policy Researcher
Pittsburgh Office
Rand Corporation

MedicalResearch.com: What is the background for this study?

Response: Increasing use of medication treatment for individuals with opioid use disorders, with medications like methadone and buprenorphine, is a critical piece of the nation’s response to the opioid crisis. Buprenorphine was approved by the FDA in 2002 for treatment of opioid use disorders, but there was little information about to what extent buprenrophine’s approval increased the number of Medicaid-enrollees who received medication treatment in the years following FDA approval nor to what extent receipt of such treatment was equitable across communities.

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