What Impact Have State-Level Laws Had on Marijuana Use?

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Christine Mauro PhD Assistant Professor Biostatistics Columbia University Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.  We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003). There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.    MedicalResearch.com: What should clinicians and patients take away from your report? Response:  The readers should take away several things.  First, despite men being more likely to use marijuana than women are in all age groups, there were relatively few gender differences in terms of the impact of medical marijuana on marijuana use. Second, we found no evidence of an effect of medical marijuana law enactment in any marijuana use outcome for both men and women aged 12-17.  Lastly, we did see an increase in both past-month use and daily use among past-year users in both men and women aged 26+ after enactment, but no changes in past year marijuana used disorder.    MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Because most states in our sample more recently passed medical marijuana laws, it is possible that not enough time has elapsed to observe meaningful and significant changes in Marijuana Use Disorder. Given the impact Marijuana Use Disorder may have on individuals, families, and society, the prevalence of Marijuana Use Disorder should continue to be monitored regularly.   Second, there is considerable variation across provisions included in different states’ medical marijuana laws; some aspects, such as allowances on home cultivation or dispensaries, might have a role in changes in several health outcome indicators.  In addition, eight states have now legalized recreational marijuana, which may also have an impact on marijuana use outcomes over time. Future analyses should account for this variability in marijuana related policies.   MedicalResearch.com: Is there anything else you would like to add? Response: As marijuana use becomes more prevalent, monitoring state-wide trends in marijuana use by age and gender is important for public health planning. In particular, efforts to prevent and limit injury that may be associated with specific activities, such as driving, may be needed as daily marijuana use increases among adults. Downstream effects, either positive or negative, of a growing proportion of the adult population reporting daily marijuana use in states with medical marijuana laws warrants further attention. Disclosure: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (grant R01 DA037866 to S. S. Martins).   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Christine M. Mauro, Paul Newswanger, Julian Santaella-Tenorio, Pia M. Mauro, Hannah Carliner, Silvia S. Martins. Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004–2013. Prevention Science, 2017; DOI: 10.1007/s11121-017-0848-3   Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.

Dr. Mauro

Christine Mauro PhD
Assistant Professor Biostatistics
Columbia University Medical Center 

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

Response: As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.

We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003).

There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.

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Half Of People Who Died of Opioid Overdoses Tested Positive For Fentanyl

MedicalResearch.com Interview with:
“no drugs” by Anderson Mancini is licensed under CC BY 2.0
Julie K. O’Donnell, PhD
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
CDC

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

Response: The opioid overdose epidemic has killed over 300,000 Americans from 1999 to 2015—including 33,091 in 2015. Over this time, the epidemic has evolved from being primarily driven by prescription opioids to increasingly being driven by illicit opioids. The first wave of the epidemic began in 1999 with a steep increase in deaths involving prescription opioids, such as hydrocodone, oxycodone, and morphine. The second wave began in 2010 with rapid increases in overdose deaths involving heroin. The third wave of the epidemic began in 2013, with significant increases in overdose deaths involving synthetic opioids—particularly those involving illicitly-manufactured fentanyl (IMF), which are commonly laced into heroin products. Most recently, the IMF market continues to evolve, with an ever-widening array of illicitly manufactured fentanyl analogs being distributed.

This report indicates that over half of people in 10 states who died of opioid overdoses tested positive for fentanyl during the second half of 2016. The report found that out of a total of 5,152 opioid overdose deaths, almost 3,000 tested positive for fentanyl, and over 700 tested positive for drugs that have similar chemical structures to fentanyl (fentanyl analogs) – including the extremely potent fentanyl analog, carfentanil, which is used to sedate large animals.

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Overdose Deaths Increase Across Urban Status, Sex and Race Lines

MedicalResearch.com Interview with:
“Pills” by Kurtis Garbutt is licensed under CC BY 2.0
Christopher M. Jones, PharmD
Office of the Assistant Secretary for Planning and Evaluation
Office of the Secretary
U.S. Department of Health and Human Services 

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

Response: Drug overdoses are the leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Although prescription drugs, in particular opioid pain relievers, were primarily responsible for the rapid expansion of this large and growing public health crisis, illicit drugs (heroin, illicit fentanyl, cocaine, and methamphetamines) now are contributing substantially to the problem. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies.

We found that the prevalence of self-reported past-month use of illicit drugs increased significantly across urban status (large metropolitan, small metropolitan, and nonmetropolitan) between 2003-2005 and 2012-2014. Prevalence was higher for males than females, however, in the large metropolitan group, the percentage increase in prevalence from 2003–2005 to 2012–2014 was greater for females (23.4%) than for males (21.6%). There were notable differences by age. During 2012–2014, respondents aged 18–25 years had the highest prevalence of past-month use of illicit drugs for all urban levels. For respondents in this age group, the prevalence increased slightly from 2003–2005 to 2012–2014 in large metropolitan areas while the prevalence remained stable among small metropolitan area respondents and nonmetropolitan area respondents. Past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years), with the largest decline among small metropolitan area youth.

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Medicaid Patients Who Overdose Likely To Get More Opioids

MedicalResearch.com Interview with:

Julie M. Donohue, Ph.D. Associate professor in Pitt Public Health’s Department of Health Policy and  Management and Director of the Medicaid Research Center Pitt’s Health Policy Institute University of Pittsburgh

Dr. Donohue

Julie M. Donohue, Ph.D.
Associate professor in Pitt Public Health’s Department of Health Policy and
Management and Director of the Medicaid Research Center
Pitt’s Health Policy Institute
University of Pittsburgh 

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

Response: Medicaid enrollees have three times higher risk of opioid overdose than non-enrollees, and for every fatal opioid overdose, there are about 30 nonfatal overdoses, according to the U.S. Centers for Disease Control and Prevention (CDC). My colleagues and I analyzed claims data from 2008 to 2013 for all Pennsylvania Medicaid enrollees aged 12 to 64 years with a medical record of a heroin or prescription opioid overdose and who had six months of continuous enrollment in Medicaid before and after the overdose claim. The 6,013 patients identified were divided into two groups—3,945 who overdosed on prescription opioids and 2,068 who overdosed on heroin, all of whom received treatment for overdose in a hospital or emergency department setting.

We found that Pennsylvania Medicaid recipients who suffer an opioid or heroin overdose continue to be prescribed opioids at high rates, with little change in their use of medication-assisted treatment programs after the overdose. Opioid prescriptions were filled after overdose by 39.7 percent of the patients who overdosed on heroin, a decrease of 3.5 percentage points from before the overdose; and by 59.6 percent of the patients who overdosed on prescription opioids, a decrease of 6.5 percentage points.

Medication-assisted treatment includes coupling prescriptions for buprenorphine, methadone or naltrexone—medications that can reduce opioid cravings—with behavioral therapy in an effort to treat the opioid use disorder. Our team found that such treatment increased modestly among the patients using heroin by 3.6 percentage points to 33 percent after the overdose, and by 1.6 percentage points to 15.1 percent for the prescription opioid overdose patients.

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Almost 40% US Adults Used Prescription Opioids In Course of One Year

MedicalResearch.com Interview with:
Beth Han, MD, PhD, MPH

From Substance Abuse and Mental Health Services Administration, Rockville, Maryland
National Institute on Drug Abuse, Bethesda, Maryland and
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
Washington, DC. 

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

Response: Using the 2015 National Survey on Drug Use and Health (NSDUH), this is the first study examining the prevalence of overall prescription opioid use in addition to misuse, use disorders, and motivations for misuse in the U.S. adult population. The 2015 NSDUH collected nationally representative data on prescription opioid use, misuse, use disorder, and motivations for misuse among the U.S. civilian, noninstitutionalized population aged 12 or older. In 2015, NSDUH started to collect data on overall prescription opioid use as well as data on motivations for prescription opioid misuse.

This study found that in 2015, 91.8 million (37.8%) U.S. civilian, non-institutionalized adults used prescription opioids, 11.5 million (4.7%) misused them, and 1.9 million (0.8%) had a prescription opioid use disorder. Among adults who used prescription opioids, 12.5% reported misuse and, of those reporting misuse, 16.7% reported a prescription opioid use disorder.

The most common reported misuse motivation was to relieve physical pain (63.4%). Misuse and use disorders were most commonly reported in adults who were uninsured, were unemployed, had low income, or had behavioral health problems. Among adults with misuse, 59.9% reported using opioids without a prescription, and 40.8% obtained prescription opioids free from friends or relatives for their most recent misuse.

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More Babies Experiencing Neonatal Drug Withdrawal After Exposure To Opioids and Psychotropic Meds

MedicalResearch.com Interview with:

Krista F. Huybrechts, M.S., Ph.D. Assistant Professor of Medicine at Harvard Medical School Epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital. Boston, MA 02120

Dr. Krista Huybrechts

Krista F. Huybrechts, MS PhD
Assistant Professor of Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA 02120

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

Response: Neonatal drug withdrawal is common; in the U.S. about 1 infant is born every 25 minutes with signs of drug withdrawal. Neonatal drug withdrawal is a well-recognized complication of intrauterine exposure to illicit or prescription opioids, but other psychotropic medications can also cause signs of withdrawal. Psychotropic medications are frequently co-prescribed with opioids in pregnancy, and the use of both has increased significantly, raising concerns about an increase in the incidence and severity of neonatal drug withdrawal due to potential drug-drug interactions, but these risks are not well understood.

In this study, we found a 30-60% increase in the risk of neonatal drug withdrawal associated with co-exposure to antidepressants, benzodiazepines and gabapentin, compared to opioids alone; no significant increase in risk was observed for atypical antipsychotics and Z-drugs. Exposure to psychotropic polypharmacy along with opioids was associated with a two-fold increased risk of withdrawal.

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Drug-Related Deaths Among Whites Soar But Alcohol and Suicide Mortality Stable

MedicalResearch.com Interview with:
Andrea M. Tilstra
Doctoral Student, Department of Sociology
Population Program, Institute of Behavioral Science
University of Colorado Boulder and
Ryan K. Masters
Assistant Professor, Department of Sociology
Faculty Associate, Population Program and Health & Society Program
Institute of Behavioral Science
University of Colorado Boulder

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

Response:  “Despair” deaths – deaths from suicides, alcohol poisonings, and drug overdoses – have been a topic of interest in recent mortality research. For instance, existing findings suggest that mortality among white Americans has increased as a result of middle-aged whites experiencing elevated levels of despair and distress. These factors supposedly are driving white Americans to cope in unhealthy ways – excessive drinking, drug use, and suicides.

However, there were two major problems with the existing research that supported this narrative. First, men and women were analyzed together, despite the knowledge that overall mortality levels and trends differ significantly by gender. Second, all three of the aforementioned causes of death were pooled together and analyzed as one group. This is highly problematic if deaths from suicides, alcohol use, and drug use are not, in fact, moving in conjunction with one another. We addressed these issues and expanded previous analyses by analyzing cause-specific death rates for men and women separately, for years 1980-2014, and decomposing the trends into period- and cohort- based analyses.

We find that there are huge gender differences in U.S. white mortality rates and that trends in mortality from the three causes of death are quite distinct from one another. Recent increases in U.S. white mortality are largely driven by period-based increases in drug poisoning deaths and cohort-based increases in metabolic disease deaths.

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Opioid Prescriptions Decrease But Still Elevated Compared To 20 Years Ago

MedicalResearch.com Interview with:

Deborah Dowell, MD, MPH Chief Medical Officer, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention

Dr. Dowell

Deborah Dowell, MD, MPH
Chief Medical Officer, Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention 

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

Response: CDC analyzed retail prescription data from QuintilesIMS which provides estimates of the number of opioid prescriptions dispensed in the United States from approximately 59,000 pharmacies, representing 88% of prescriptions in the United States. CDC assessed opioid prescribing in the United States from 2006 to 2015, including rates, amounts, dosages, and durations prescribed. CDC examined county-level prescribing patterns in 2010 and 2015.
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Optimistic Results From Phase 3 Study of RBP-6000 Buprenorphine Monthly Depot for Treatment of Opioid Use Disorder

Medical Research.com Interview with:

Dr. Christian Heidbreder, PhD Chief Scientific Officer Indivior Inc. Richmond, VA 23235, USA

Dr. Heidbreder

Dr. Christian Heidbreder, PhD
Chief Scientific Officer
Indivior Inc.
Richmond, VA 23235, USA

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

Response: This pivotal Phase 3 clinical trial (RB-US-13-0001) evaluated the efficacy and safety of RBP-6000, an investigational once-monthly injectable buprenorphine in the ATRIGEL® delivery system for the treatment of adults with moderate-to-severe opioid use disorder (OUD) as part of a complete treatment plan to include counseling and psychosocial support1.

The 24-week Phase 3 study met its primary and key secondary endpoints, demonstrating statistically significant differences in percentage abstinence and treatment success across both dosage regimens of RBP-6000 versus placebo1.

The findings also showed that outcomes with RBP-6000 are consistent across other secondary clinical endpoints, including control of craving and withdrawal symptoms, as compared to placebo. These outcomes were associated with buprenorphine plasma concentrations ≥ 2 ng/mL and predicted whole brain mu-opioid receptor occupancy of ≥ 70%, and were also maintained for the one-month dosing intervals and for the entire treatment duration1.

The results were confirmed by exposure-response analyses demonstrating a relationship between buprenorphine plasma concentrations, abstinence, withdrawal symptoms and opioid craving1.

RBP-6000 was generally well tolerated and had a safety profile consistent with that of transmucosal buprenorphine. Injection site reactions were not treatment-limiting. The most common (reported in ≥ 5% of subjects) treatment-emergent adverse events (TEAEs) reported in the active total group were constipation, headache, nausea, injection site pruritus, vomiting, increased hepatic enzyme, fatigue and injection site pain1.

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Lost Your Connection? Internet Withdrawal Can Mirror Addiction Symptoms

MedicalResearch.com Interview with:

Dr. Phil Reed,  D.Phil. Professor Psychology Swansea University

Dr. Reed

Dr. Phil Reed,  D.Phil.
Professor Psychology
Swansea University

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

Response: Problematic internet use has been a growing concern for many people and bodies over the last decade, and more study has been requested into various aspects of this possible disorder.  One of the key questions is whether people overuse the internet, due to an addiction.  If it is an addiction, then there should be signs of withdrawal when people, who report having this problem, stop using the internet.  In this study, 144 participants, aged 18 to 33, had their heart rate and blood pressure measured before and after a brief internet session.  Their anxiety and self-reported internet addiction were also assessed.

The results showed increases in heart rate and systolic blood pressure on terminating the internet session for those with problematically-high internet usage.  These increases in physiological arousal were mirrored by increased feelings of anxiety.  However, there were no such changes for those participants who reported no internet-usage problems.

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Most Youth With Opioid Disorders Do Not Receive Medications For Addiction

MedicalResearch.com Interview with:

Scott Hadland, MD, MPH, MS Youth Addiction Specialist Assistant Professor of Pediatrics Boston University School of Medicine

Dr. Hadland

Scott Hadland, MD, MPH, MS
Youth Addiction Specialist
Assistant Professor of Pediatrics
Boston University School of Medicine
Director, Urban Health and Advocacy Track, Boston Children’s Hospital and Boston Medical Center
Associate Program Director, Boston Combined Residency Program in Pediatrics, Boston Medical Center

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

Response: Almost no data have been available on this topic to date.  A recent study showed that teens in subspecialty treatment for opioid addiction were significantly less likely than adults to receive a medication.  Our study was the first to comprehensively look across the health care system, including looking at adolescents and young adults diagnosed with opioid use disorder in outpatient clinics, emergency departments, and inpatient hospitals.

We had three important findings.  First, looking at a large sample of 9.7 million adolescents and young adults between the age of 13 and 25 years, we found that the number of youth diagnosed with opioid use disorder increased six-fold from 2001 to 2014.  This is perhaps not surprising given the national opioid crisis we know to be occurring.

Second, we found that only a minority of youth (1 in 4) received buprenorphine or naltrexone, the two medications available for opioid addiction that can be prescribed in usual medical settings.  These two medications are evidence-based and their use is recommended by the American Academy of Pediatrics.  Utilizing them is critical to ensure that we offer effective treatment early in the life course of addiction, which can help prevent the long-term harms of addiction.

Third, we found significant differences in who received medications.  Whereas approximately 1 in 3 young adults in our study received a medication, only 1 in 10 of the 16- and 17-year-olds we studied received one, and among adolescents under 15 years of age, 1 in 67 received a medication.  Females were less likely than males to receive medications, as were black youth and Hispanic youth relative to white youth.

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Opioids Withdrawal in Babies Adding Millions To Health Care Costs

MedicalResearch.com Interview with:

Tammy E. Corr, D.O. Assistant Professor of Pediatrics Division of Newborn Medicine Penn State Hershey College of Medicine

Dr. Corr

Tammy E. Corr, D.O.
Assistant Professor of Pediatrics
Division of Newborn Medicine
Penn State Hershey College of Medicine

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

Response: Recent literature has revealed hospital charges related to neonatal abstinence syndrome (NAS) have increased. However, there are no data available regarding costs of an NAS admission. Because charges are variable and influenced by a number of factors, provider costs to care for a patient offer more meaningful information.

Therefore, we endeavored to determine the incidence of NAS in the United States and estimate the total annual costs and hospital length of stay for an neonatal abstinence syndrome admission as well as the incremental costs and hospital days of admission for an NAS patient compared to a non-NAS admission.

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College Binge Drinkers Also Smoking More Pot In States Where Marijuana Legal

MedicalResearch.com Interview with:

David Kerr PhD Associate professor in the School of Psychological Science College of Liberal Arts Ohio State University 

Dr. Kerr

David Kerr PhD
Associate professor in the School of Psychological Science
College of Liberal Arts
Ohio State University 

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

Response: Oregon legalized sale and use of marijuana for recreational purposes and the part of the law (regarding use) took effect in July 2015. However, there have been no controlled studies of which we’re aware of the possible effects of the Oregon law that take into account the trends toward increased marijuana use across the country and differences in use rates between states that predated the law.

We used survey data on college students in Oregon and in 6 states without recreational legalization to examine the issue.

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Heroin Epidemic Costs US Over $50 Billion Per Year

MedicalResearch.com Interview with:

A. Simon Pickard, PhD

Dr. Pickard

A. Simon Pickard, PhD
Professor, Dept of Pharmacy Systems, Outcomes and Policy
University of Ilinois at Chicago
College of Pharmacy

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

Response: The heroin epidemic, which has left virtually no part of American society unscathed, can be viewed as an illness.  Unlike some illnesses, however, it was largely manufactured by stakeholders in the healthcare system, wittingly or unwittingly.

The main finding, that heroin addiction costs us just over $50 billion per year, is likely a conservative estimate.

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Recreational Cocaine Use Activates Addiction Related Brain Mechanisms Sooner Than Previously Realized

MedicalResearch.com Interview with:

Marco Leyton, Ph.D. Professor, Department of Psychiatry McGill University

Dr. Marco Leyton

Marco Leyton, Ph.D.
Professor, Department of Psychiatry
McGill University

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

Response: Drug-related cues are potent triggers for eliciting conscious and unconscious desire for the drug. In people with severe substance use disorders, these cues also activate dopamine release in the dorsal striatum, a brain region thought to be involved in hard-to-break habits and compulsions.

In the present study we found evidence that drug cues also activate this same dopamine response in non-dependent ‘recreational’ cocaine users.

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Animal Study Suggests Lorcaserin (Belviq®) May be Useful to Reduce Opioid Intake

MedicalResearch.com Interview with:
Christina R. Merritt and Kathryn A. Cunningham
Center for Addiction Research
University of Texas Medical Branch
Galveston, TX 77555

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

Response: Opioid use disorder (OUD) is one of the top public health problems in the United States. Overdoses on prescription opioids, heroin and fentanyl accounted for 33,091 deaths in the U.S. in 2015 (https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm); each day, 91 Americans die from an opioid overdose (https://www.cdc.gov/drugoverdose/epidemic/). The first-ever Surgeon General’s Report on Alcohol, Drugs and Health (https://addiction.surgeongeneral.gov/ ) observed that more people used prescription opioids than tobacco in 2015. Furthermore, individuals with OUD, the most problematic pattern of opioid abuse, often relapse, particularly in environments associated with past drug use, and new means to help maintain abstinence are needed.

Serotonin (5-hydroxytryptamine; 5-HT) function in the brain, particularly through its cognate 5-HT2C receptor, is an important regulator of the abuse liability of cocaine and other psychostimulants. Previous studies suggested that the weight loss medication and selective 5-HT2C receptor agonist lorcaserin (Belviq®) can curb cocaine- and nicotine-seeking in preclinical models, even when tested in tempting environments. We administered lorcaserin to rats who were trained to take the powerful painkiller oxycodone (OxyContin®), a prescription opioid currently approved for treatment of acute and chronic pain with characteristically high abuse potential. Lorcaserin suppressed oxycodone intake as well as the drug-seeking behaviors observed when rats were exposed to cues such as the lights and sounds previously associated with drug intake. Taken together, these findings highlights the therapeutic potential for lorcaserin to extend abstinence and enhance recovery from OUD.

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Some Retirees Begin Risky Alcohol Consumption

MedicalResearch.com Interview with:
Jaana Halonen, Docent and Senior Researcher

Finnish Institute of Occupational Health

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

Response: Retirement is a significant life transition when substantial changes in daily life are experienced as retirees adapt to life without work. After retirement people have more leisure time and more opportunities for different activities, and less stress. These changes are positive, but retirement can also lead to reduced social control and loss of social contacts and therefore be perceived as a stressful life transition. Both the positive and negative aspects related to changes in leisure time, stress, and social networks around retirement may affect drinking behaviours. However, little is known about how risky alcohol consumption changes around the retirement transition.

Thus, in our study we wanted to examine how and for whom risky drinking changes around the time of retirement. To do that we followed up public sector workers with questionnaires before and after their old-age retirement.

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Buprenorphine Prescriptions for Opioid Use Disorder Rise With Medicaid Expansion

MedicalResearch.com Interview with:

Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health

Dr.Hefei Wen

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health

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

Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder.

We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.

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Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

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

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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Cannabidiol Reduces Fear and Anxiety in Various Preclinical Models

MedicalResearch.com Interview with:
Carl Stevenson, PhD

Assistant Professor of Neuroscience
BSc Animal Science Admissions Tutor
Local Group Rep, British Neuroscience Association
School of Biosciences
University of Nottingham
Loughborough, UK

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

Response: Anxiety-related and substance abuse disorders can be serious forms of mental illness that are not always treated effectively by psychological therapies or medications. One strategy to enhance their treatment is to boost the effects of psychological therapy by combining it with medication.

This study reviewed the literature on the effects of cannabidiol, a chemical found in the cannabis plant, in preclinical models of these disorders. Cannabidiol is safe to use in humans and doesn’t cause the ‘high’ associated with cannabis. This means that cannabidiol might be useful for treating certain symptoms without the unwanted side effects linked to medical cannabis.

Our review confirmed that cannabidiol reduces fear and anxiety in various preclinical models, when given on its own or in conjunction with behavioural interventions that model psychological treatment for anxiety-related disorders. Our review suggested that it can also reduce relapse in some preclinical models of addiction, although research looking at the effects of cannabidiol in substance abuse disorders is still in its infancy.

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Fentanyl Laced Heroin Contributing To Spike In Heroin Overdoses in Miami-Dade County

MedicalResearch.com Interview with:
Alexander Diaz Bode

M.D. Candidate
University of Miami Leonard M. Miller School of Medicine
Miami, FL

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

Response: Our country is in the midst of an opiate epidemic. This is particularly evident in the emergency department (ED), which continues to see an alarmingly large number heroin overdose. With the shutdown of “pill-mills”, where opioid prescriptions would be prescribed indiscriminately, Florida has seen particularly large increases in opiate use and overdose. In Miami, we noticed that during the summer of 2016, there was a disproportionate increase in heroin overdose being treated at our hospital relative to previous years. Our recently published study showed that fentanyl or fentanyl analog laced heroin likely contributed to this massive spike in heroin overdose observed during the summer of 2016.

Fentanyl and its synthetic analogs are opioid receptor agonists that bind with hundreds of times higher affinity than diamorphine, aka heroin. Naloxone, better known by the brand name Narcan®, is used to reverse heroin overdose in the ED. This drug works by competitively inhibiting the opioid receptor, effectively “knocking off” the bound heroin. Using naloxone dosing as a surrogate marker of heroin purity, our study found that during the investigated spike there was a disproportionate increase in the amount of naloxone used in our ED to reverse overdose relative to the increase in opiate overdose. This indicated that a stronger opioid receptor agonist, such as fentanyl or fentanyl analogs, likely was involved in the massive spike in overdose observed during the summer of 2016.

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Memory Retrieval and Extinction Reduces Craving For Cigarettes

MedicalResearch.com Interview with:

Michael E. Saladin, Ph.D. Professor, Department of Health Sciences and Research College of Health Professions Medical University of South Carolina Charleston, SC

Dr. Michael Saladin

Michael E. Saladin, Ph.D.
Professor, Department of Health Sciences and Research
College of Health Professions
Medical University of South Carolina
Charleston, SC

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

Response: To the extent that learning and memory processes govern all aspects of behavior, they also govern dysregulated or maladaptive behaviors such as addiction and anxiety states. In the former case, stimuli associated with drug administration can acquire the ability to control drug-related motivational states (urges and craving) as well as drug seeking behavior. To illustrate the point, the simple act of observing a person light up a cigarette will cause the typical smoker to desire a cigarette and engage in smoking. A nonsmoker, by contrast, would not be similarly affected because they have no history where stimuli associated with smoking (e.g., sight of a lighter, cigarettes, plumes of smoke) are reliably paired with, or followed by, the rewarding effects of nicotine.

The research we conducted recently was based on neuroscience research showing that retrieved drug-associated memories (prompted with drug-paired cues) can be updated with information that decreases drug craving and/or administration. One such study showed that heroin craving in heroin addicts can be decreased by retrieving memories for heroin use via a brief heroin cue presentation (video of people using heroin) and then, a short time later, presenting an extensive variety of heroin cues (video, pictures and heroin use paraphernalia) over a 1-hour period. The logic of this intervention was that once the heroin memories were prompted into a labile state by the brief video presentation, the extensive heroin cue exposure would serve to update the content of the original memories with new information (i.e., cues are not followed by heroin reward) that is inconsistent with the original cue-drug contingency (i.e., cues are followed with heroin reward). Remarkably, just two sessions of this type of training, which we call retrieval-extinction training, resulted in significant reductions in heroin craving that persisted for six months. This study was done with heroin addicts who were inpatients so there was no way to assess the effects of this treatment on actual heroin use.

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Competitive Athletes At Risk For Addiction

MedicalResearch.com Interview with:
Laurie de Grace

Master’s graduate from the Faculty of Physical Education and Recreation
University of Alberta

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

Response: Little is known about the development of substance addiction in the context of sport. There is substantial evidence showing a positive association between sport participation and alcohol use, particularly the binge drinking that is more commonly associated with athletes than non-athletes. However, the connection between sport participation and the use of other substances is not clear. We undertook this study to learn from the perspective of those in recovery from substance addiction, how sport may or may not have played a role in their substance use and subsequent addiction.

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Scientists Block Cocaine Addiction in Mice by Increasing Cadherin “glue” at Synapses

MedicalResearch.com Interview with:

Andrea K. Globa, Ph.D. Candidate Graduate Program in Neuroscience Life Sciences Institute University of British Columbia Vancouver, BC, Canada

Andrea Globa

Andrea K. Globa, Ph.D. Candidate
Graduate Program in Neuroscience
Life Sciences Institute
University of British Columbia
Vancouver, BC, Canada

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

Response: Addiction is a complex disease, characterized by continued substance use despite serious negative consequences, increased drug tolerance, and withdrawal. In fact, the statistics show that over 40 million Americans abuse or are addicted to nicotine, alcohol or other drugs. This is a huge public health issue, so naturally, scientists are interested in figuring out why people get addicted, and in particular why certain people are more prone to addiction than others.

Studies examining genetic differences in addicted populations have shown that there are many mutations in genes that are important for brain function. One group of genes affected encode proteins that act as ‘glue’ to hold cells together. These proteins are called cadherins. In the brain, cadherins are important for holding brain cells together at spots where they communicate with one another – and these points where brain cells talk to one another are called synapses.

Many neuroscientists believe that addiction is actually a type of “pathological” learning, where there are changes at synapses in a brain circuit involved in reward and motivation. So we decided to examine the molecular mechanisms that are important for the strengthening of synapses in this brain circuit.

To put it very simply, to learn something you have to make your synapses stronger, and this involves adding more cadherin or ‘glue’ to the synapse. We wanted to see if these same rules held true in addiction.

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Brain-Reward Circuit Both Under and Over Responsive in Addiction and Gambling

MedicalResearch.com Interview with:

Guillaume Sescousse, PhD Senior post-doc Donders Centre for Cognitive Neuroimaging The Netherlands

Dr. Guillaume Sescousse

Guillaume Sescousse, PhD
Senior post-doc
Donders Centre for Cognitive Neuroimaging
The Netherlands
with collaborators Maartje Luijten, PhD,
and Arnt Schellekens, MD PhD

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

Response: People with an addiction process rewards in their brain differently from people who are not addicted. However, whether this is associated with “too much” or “too little” brain activity is an open question. Indeed, past research has produced conflicting findings.

In order to get a reliable answer, we have combined 25 studies investigating brain reward sensitivity in more than 1200 individuals with and without addiction to various substances such as alcohol, nicotine or cocaine but also gambling. By analyzing the brain images from these studies, we have discovered an important difference in brain activity between expecting a reward and receiving a reward. Compared with non-addicted individuals, individuals with substance or gambling addiction showed a weaker brain response to anticipating monetary rewards. This weaker response was observed in the striatum, a core region of the brain reward circuit, possibly indicating that individuals with an addiction have relatively low expectations about rewards. In contrast, this same region showed a relatively stronger response to receiving a reward in individuals with substance addiction compared with non-addicted individuals.

This stronger response possibly indicates a stronger surprise to getting the reward, and is consistent with low expectations. This same effect was not found among people addicted to gambling.

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Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain

MedicalResearch.com Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva

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

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.

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Which Patients Stick With Office Based Opioid Treatment with Buprenorphine?

MedicalResearch.com Interview with:

Zoe M. Weinstein MD Assistant Professor of Medicine, Boston University Director, Addiction Consult Service, Boston Medical Center 801 Massachusetts Ave. Crosstown 2 #2039 Boston MA 02118

Dr. Zoe Weinstein

Zoe M. Weinstein MD
Assistant Professor of Medicine, Boston University
Director, Addiction Consult Service
Boston Medical Center
Boston MA 02118

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

Response: Like other chronic, life-long medical conditions such as hypertension or diabetes, opioid use disorder (OUD) requires long-term engagement in therapy; however many individuals who participate in Office Based Addiction Treatment are not able to be retained in care long-term.

This observational study followed more than 1,200 patients over 12 years with the goal of identifying patient-specific factors associated with retention in the treatment program for longer than one year. While the study found that older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year.

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Incidence, Risk factors and Prevention of Hepatitis C Reinfection

MedicalResearch.com Interview with:
Naveed Zafar Janjua, MBBS, MSc, DrPH
Senior Scientist, Clinical Prevention Services
BC Centre for Disease Control
Clinical Associate Professor, School of Population and Public Health
University of British Columbia

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

Response: Hepatitis C is a viral infection that affects the liver. About quarter of people infected with hepatitis C clear their infection spontaneously rest develop chronic infection. Left untreated, hepatitis C could results in scarring of liver (liver cirrhosis), liver cancer or death. New anti-viral drugs are highly effective in curing hepatitis C, about than 95 per cent of those treated can be cured. However, people who engage in high risk activities such as people who inject drugs (PWID) remain at risk of reinfection. As the cost of treatment is very high, re-infection is a concern among physicians and policy makers in Canada and around the world.

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Opioid Emergencies Increased Almost 100% in Some States

MedicalResearch.com Interview with:
Claudia Steiner, M.D., MPH.

Agency for Healthcare Research and Quality (AHRQ)
Rockville, MD

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

Response: The Agency for Healthcare Research and Quality (AHRQ) has a longstanding project and partnership, The Healthcare Cost and Utilization Project (HCUP, pronounced “H-Cup”). HCUP is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership. HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level health care data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels.

The HCUP Partners recognized the urgency of providing descriptive statistics to help inform the growing opioid epidemic in the U.S., and therefore agreed to supporting this statistical brief as well as the Opioid-Related Hospital Use path on Fast Stats: http://www.hcup-us.ahrq.gov/faststats/landing.jsp

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Rural Babies Increasingly Affected By Opioid Epidemic

MedicalResearch.com Interview with:
Nicole Villapiano, MD, MSc

Robert Wood Johnson Clinical Scholar
Internal Medicine/Pediatrics
Institute for Healthcare Policy & Innovation
University of Michigan

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

Response: Over the past few years, research has highlighted that the opioid epidemic is accelerating at a rapid pace across the United States, including in rural areas. What we don’t know is how the opioid crisis is affecting rural moms and their infants.
As a doctor that takes care of kids, I was concerned about this. So our team took on this study to explore the differences in rates of maternal opioid use and neonatal abstinence syndrome in rural and urban areas of the US from 2004-2013.

Neonatal abstinence syndrome is what happens to babies who are exposed to opioids in their mothers’ womb. When these babies are born and no longer have opioid exposure from mom, they go through a period of opioid withdrawal. These babies can have symptoms that range from difficulty taking a bottle, jitteriness, difficulty sleeping, irritability, and discomfort to more serious problems like prematurity, difficulty breathing, and seizures. Symptoms can last several days to many weeks. Babies with neonatal abstinence syndrome are in the hospital longer than the average newborn, and sometimes require special treatment to help control their symptoms.

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Drug Positivity in U.S. Workforce Rises to Highest Level in a Decade

MedicalResearch.com Interview with:

Dr. Barry Sample PhD Senior director, science and technology Quest Diagnostics Employer Solutions A business of Quest Diagnostics

Dr. Barry Sample

Dr. Barry Sample PhD
Senior director, science and technology
Quest Diagnostics Employer Solutions
A business of Quest Diagnostics

MedicalResearch.com: What is the background for this study of drug testing of the U.S. workforce?

Response: As a leader in the drug testing industry, our primary goal at Quest Diagnostics Employer Solutions is to help employers maintain drug-free workplaces and combat the impacts of substance abuse such as higher absenteeism, increased risk of injury and lower productivity and performance.

One way we support these efforts is to offer analysis and information from resources like the Quest Diagnostics Drug Testing Index™, which we publish as a public service for government, media, and industry. We’ve published the Drug Testing Index since 1988, which is also the year that Congress passed the Drug-Free Workplace Act.
The Drug Testing Index examines positivity rates – the proportion of positive drug test results – among three major testing populations: federally-mandated, safety-sensitive workers; the general (private sector) U.S. workforce; and the combined U.S. workforce. Thresholds for positivity are determined by cutoff levels as established by the administrating authority; these cutoff levels determine the threshold for positivity for a specific substance. Should a metabolite appear at or above the level of the cutoff, a test is determined to be positive.

Over the last few decades, testing policies have evolved to serve a dual purpose of protecting the health, safety, and welfare of both employees and the general public. That’s especially important in certain industries, such as transportation, where an impaired driver, pilot, or operator can create substantial public risk. The positivity rate in 1998, the year of the first Drug Testing Index, was 13.6 percent. Over the last 25 years, as we have tracked the overall positivity rate, we have noted other significant trends in the American workforce based on workplace drug tests. For example, our 2003 analysis revealed that amphetamine positivity had grown by 70 percent over the previous five years. The 2011 Drug Testing Index found that hydrocodone and oxycodone led U.S. general workforce positives. In both 2010 and 2011, the overall drug positivity rate was 3.5 percent, the lowest rate since we began publishing the Drug Testing Index. This year, we found positivity is at a ten-year high.

What that tells us is that trends come and go, and that we cannot rely on assumptions about drug use.

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Childhood Trauma Associated With Greater Risk of Adult Drug Abuse

MedicalResearch.com Interview with:

Kelly Quinn, PhD, MPH Assistant Professor Department of Population Health NYU Langone Medical Center New York, NY 10016-6481

Dr. Kelly Quinn

Kelly Quinn, PhD, MPH
Assistant Professor
Department of Population Health
NYU Langone Medical Center
New York, NY 10016-6481

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

Response: The prescription pain reliever misuse epidemic in the United States has contributed to a dramatic increase in overdoses and overdose mortality and is linked to injection drug use. Identification of upstream drivers of drug misuse is crucial for prevention strategies. We aimed to further the knowledge of the association between traumatic experiences in childhood and drug misuse in adulthood.

Using nationally-representative data from The National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined the associations of nine childhood traumas (neglect; emotional, physical, and sexual abuse; parent binge drinking and incarceration; and witnessing, being threatened with, and experiencing violence) with prescription pain reliever misuse and injection drug use in emerging adulthood and adulthood. Some, but not all, traumas independently predicted drug misuse. However, this analysis found that the cumulative number of traumas predicted drug misuse in a dose-response fashion. That is, relative to children reporting no trauma, increasing number of traumas in childhood was associated with higher odds of initiating drug misuse later in life.

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

Response: These findings add to evidence that the trauma load during stress-sensitive childhood has negative health consequences throughout the life course and have immediate public health significance. Prescribing patterns for prescription pain relievers must be carefully monitored in order to prevent misuse, addiction, and escalation to heroin use and drug injection. Screening for and addressing childhood trauma may be an important strategy to prevent initiation of drug use, and for drug users, trauma-informed interventions throughout the life course are important for treatment and mitigation of relapse.

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

Response: Future research is needed to elucidate causal mechanisms, to better understand the influence of age at childhood trauma, and to clarify escalation from misusing prescription pain relievers to injecting drugs.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

APHA 2016 abstract and publication

Associations between Childhood Traumatic Events and Adulthood Prescription Pain Pill Misuse and Injection Drug Use in the United States
Quinn, Kelly et al.
Drug & Alcohol Dependence , Volume 0 , Issue 0
Published online: October 04, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Rapid Rise in Opioid Poisonings and Hospitalizations Among Children and Adolescents

MedicalResearch.com Interview with:

Julie R Gaither, PhD, MPH, RN Postdoctoral Fellow in Biostatistics Yale School of Medicine

Dr. Julie R Gaither

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.

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New Drug Blocks Frequency of Drinking Alcohol, But Not Amount Once Drinking Starts

MedicalResearch.com Interview with:

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

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.

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Children Who Experience Early Parental Absence More Likely To Smoke or Drink Before Age 11

MedicalResearch.com Interview with:

Dr Rebecca Lacey, PhD Research Associate Epidemiology & Public Health Institute of Epidemiology & Health Faculty of Pop Health Sciences University College London

Dr. Rebecca Lacey

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.

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Sharp Rise in Heroin Use Among Young Adults Who Use Nonmedical Prescription Opioids

MedicalResearch.com Interview with:

Silvia S. Martins, MD, PHD Associate Professor of Epidemiology  Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032

Dr. Silvia Martins

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.

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Opioid Overdose Associated With Even Higher Health Care Costs Than Dependence or Abuse

MedicalResearch.com Interview with:

Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P.

Dr. Jared Howard

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.

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Fewer Physicians Than Anticipated Treat Opioid Use Disorder With Buprenorphine

MedicalResearch.com Interview with:

Bradley D. Stein, MD, MPH, PhD RAND Corporation University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania

Dr. Bradley Stein

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.

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Survey Attempts To Separate ‘Liking’ A Drug For Pain Relief vs Recreational Use

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.

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Changes in Nonmedical Use of OxyContin After Reformulation With Abuse Deterrent Properties

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.

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Need for Congruent Treatment Goals Between Alcohol-Dependent Patients and Caregivers

MedicalResearch.com Interview with:

Kristina J. Berglund Department of Psychology University of Gothenburg

Dr. Kristina J. Berglund

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.

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Costs of Prescription Opioid Overdose, Abuse and Dependence Top $75 Billion

MedicalResearch.com Interview with:

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

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.

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Cancer Drug May Mitigate Compulsive Cocaine Memories

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.

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Law Enforcement Agencies Report Large Increases in Synthetic Opioid–Involved Overdose Deaths

MedicalResearch.com Interview with:

R. Matthew Gladden, PhD Surveillance and Epidemiology Team Division of Unintentional Injury Prevention Centers for Disease Control and Prevention

Dr. R. Mathew Gladden

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).

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Illicitly-Manufactured Fentanyl Contributing To Increasing Numbers of Heroin Deaths

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.

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Specific Type of Brain Neurons Control Excessive Alcohol Intake

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

Dr. Jun Wang

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.

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At Lower Dose, Addiction Drug Naltrexone May Have Anti-Cancer Effects

MedicalResearch.com Interview with:

Dr Wai Liu Senior Research Fellow St George's University of London London

Dr. Wai Liu

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.

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Prescribing Naloxone To Patients on Chronic Opioids Reduces ER Visits for Opioid Concerns

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

Dr. Phillip Coffin

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.

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Why People With Cocaine Addiction Don’t Change?

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.

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Childhood Trauma Associated With Lifetime Drug Use in Teens

MedicalResearch.com Interview with:

Hannah Carliner, ScD MPH Post Doctoral Fellow in Substance Abuse Epidemiology Mailman School of Public Health Columbia University

Dr. Hannah Carliner

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.

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