MedicalResearch.com Interview with: Christopher M. Jones, Pharm D., M.P.H. Senior advisor, Office of Public Health Strategy and Analysis Office of the Commissioner, Food...
MedicalResearch.com Interview with:
W. Michael Hooten, M.D
Professor of Anesthesiology
Mayo Clinic
Medical Research: What is the background for this study?
Dr. Hooten: The purpose of the study was to investigate a gap in knowledge related to the progression of short-term opioid use to longer-term use.
Medical Research: What are the main findings?
Dr. Hooten: The main findings are that a history of substance abuse or tobacco use is associated with the progression from short-term to a longer-term pattern of opioid prescribing.
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MedicalResearch.com Interview with:
Maria Pagano, PhD
Case Western Reserve University School of Medicine
Department of Psychiatry, Division of Child Psychiatry
Cleveland, OH
MedicalResearch: What is the background for this study?
Dr. Pagano: Socially anxious adolescents quickly figure out that alcohol and drugs can provide ease and comfort in social situations that are anxiety provoking. Reaching for a substance to change how you feel can quickly become a knee-jerk reaction, can develop into an addiction, and robs youths of learning how to tolerate interpersonal differences and uncomfortable feelings, developing emotional maturity, and cultivating self acceptance.
Adolescents who fear being criticized by their peers are likely to not speak up in group therapies during treatment, which can limit their benefit from treatment. There is a lot of healing that comes sharing your insides with others. Socially anxious patients may not get this healing nor let others really get to know who they are and give input to their lives
Higher peer helping in AA during treatment means getting active in low intensity tasks like putting away chairs, or making coffee at a 12-step meeting. It is less about needing peer assistance or expecting praise or recognition from giving service. It is more about adopting the attitude of "how can I be helpful?"
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MedicalResearch.com Interview with:
Theodore J. Cicero, PhD
Professor, Vice Chairman for Research
Department of Psychiatry, Washington University
St Louis, Missouri
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Cicero: Prescription opiate abuse (eg Vicodin, Percocet, OxyContin) has reached epidemic proportions in this country over the past decade. Although most people swallow the drugs whole, a relatively large number either chew the drugs to produce an immediate delivery of large quantities of drugs or they crush them and/or dissolve them in some solvent which makes them useful for intranasal (eg snorting) or intravenous administration. Non-oral routes, particularly injection, represent the most serious public health risk due to a high incidence of infection, including Hepatitis C and HIV, and the much greater severity of abuse. In an effort to reduce these practices, drug companies are introducing so-called abuse deterrent formulations (ADF) which are resistant to crushing or dissolving in an aqueous solution. In one such important effort, the company responsible for distributing one of the most widely abused prescription opiates, OxyContin, introduced an ADF in 2010. Although the abuse deterrent formulations was highly successful in reducing abuse of OxyContin by either chewing, crushing, or dissolving in water, there was none-the-less a clear limit to how effective it was. For example, some people simply switched to the oral route of administration or never did snort or inject the drug, whereas a small number found ways to defeat the abuse deterrent formulations and persisted in harmful patterns of abuse. Unfortunately, there was also an unintended result. ADF-OxyContin caused many individuals to abandon the use of OxyContin - a good thing - in favor of other opiates (a bad thing). Most serious, however, was that 70% of those who switched drugs moved from OxyContin to heroin abuse. Although by no means the only factor, the abuse deterrent formulations has contributed to the wide-spread reports of heroin abuse in suburban and rural Caucasian male and females, a group here-to-fore not the typical heroin users (i.e. poor minorities, living in large urban centers). (more…)
MedicalResearch.com Interview with:
Dr. Jennifer Lind PharmD, MPH
Division of Birth Defects and Developmental Disabilities,
CDC
Medical Research: What is the background for this study?
Dr. Lind: CDC and Florida investigators published a new report describing the characteristics of infants with neonatal abstinence syndrome (NAS) and their mothers. NAS is a group of signs exhibited by newborns exposed to addictive drugs taken by a mother during pregnancy. Infants with neonatal abstinence syndrome have prolonged hospital stays, experience serious medical complications, and are very costly to treat.
Medical Research: What are the main findings?
Dr. Lind: In this investigation, 242 infants with neonatal abstinence syndrome were identified in three Florida hospitals during a 2-year period (2010–2011). Nearly all of the infants with NAS were exposed to opioid painkillers during pregnancy (99.6%) and experienced serious medical complications, with more than 97% being admitted to an intensive care unit, where the average length of stay was 26 days. Despite a high prevalence of positive urine toxicology tests during the birth hospitalization, only a small proportion of mothers had documentation of referrals for drug counseling or rehabilitation.
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MedicalResearch.com Interview with:
Niclas Stephanson, PhD
Leg. Apotekare, Analytisk kemist
Karolinska Universitetssjukhuset
Stockholm
Medical Research: What is the background for this study? What are the main findings?
Dr. Stephanson: Drug testing is most commonly performed using urine samples, which is based on a long and comprehensive experience. The methodology and regulations for reliable urine testing are well developed and can be considered the current gold standard for drug testing. However, one problem with urine testing is related to the sample collection, often perceived as inconvenient and privacy-overriding by those undergoing the test. To overcome this problem a group of researchers from the Department of Laboratory Medicine at the Karolinska Institute in Sweden have worked on developing a more donor-friendly alternative to urine testing for drugs by focusing on exhaled breath.
Doctor Niclas Stephanson in the research group led by Professor Olof Beck, has developed the first fully validated and robust screening method for the routine measurement of drugs of abuse in exhaled breath. The procedure involves a simple method of sample collection and preparation, which is followed by a highly sensitive analytical technique known as LC-MS (Liquid chromatography–mass spectrometry). The drug groups which are identified: amphetamine, methamphetamine, cannabis, cocaine and heroin.
The underlying mechanism in exhaled breath drug testing is believed to be the formation of aerosol particles from the airway lining fluid by the breathing process. These aerosol particles may contain drugs present in the body, which enables drugs to be analyzed. A simple collection device is currently available which selectively collects the micrometer aerosol particles on a filter and enables further laboratory investigation of possible drug content.
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MedicalResearch.com Interview with:
Dr. Zhou Yang
Office of the Associate Director for Policy
Centers for Disease Control and Prevention, Atlanta, GA
Medical Research: What is the background for this study?
Response: Prescription drug misuse and abuse, largely those involving opioid painkillers, have been characterized as an epidemic. According to a CDC report, drug-related overdose has surpassed traffic crashes to become the leading cause of injury death in the U.S. in 2009. Medicaid programs in most states implement Patient Review and Restriction (PRR) programs, also called ‘lock-in’ program. The PRR programs use a set of behavioral indicators to identify patients at higher risk of opioid drug misuse and abuse, and ‘locks’ them in to a designated provider, pharmacy, or both. Pharmacy shopping is one of the key indicators employed by the PRR program. However, definition of pharmacy shopper varies widely across states. In addition, the PRR programs have not paid attention to the indicators of prescribing overlapped drugs, which we see as a missed opportunity to help the PRR program to better target users at high risk of overdose.
Medical Research: What are the main findings?
Response: Among a number of currently used definitions of pharmacy shopping, we found that the definition of ‘four or more pharmacies visited within any 90-day period’ is the most effective one. We also found that having overlapping opioid prescriptions is associated with an elevated risk of overdose. In fact, patients who exhibited both pharmacy shopping and having overlapping prescription had more than twice the risk of overdose than those who only exhibited pharmacy shopping.
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MedicalResearch.com Interview with:
William Brinkman, MD, MEd, MSc
Associate Professor of Pediatrics
Director, Research Section, Division of General & Community Pediatrics
Research Director, Cincinnati Pediatric Research Group
James M. Anderson Center for Health Systems Excellence
Cincinnati Children’s Hospital Medical Center
MedicalResearch.com: What is the background for this study?
Dr. Brinkman: Early onset of substance use is a significant public health concern as those who use substances before the mid-teen years are more likely to develop dependence than those who start later. The association of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) with tobacco and alcohol use has not been assessed in a young adolescent sample representative of the U.S. population.
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MedicalResearch.com Interview with
David A. Fiellin, M.D.
Professor of Medicine, Investigative Medicine and Public Health
Yale University School of Medicine
Medical Research: What are the main findings of the study?
Dr. Fiellin: The main finding of our randomized clinical trial, conducted in primary care, was that among prescription opioid dependent patients, ongoing buprenorphine therapy resulted in better treatment retention and reduced illicit opioid use when compared to buprenorphine taper (detoxification).
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MedicalResearch.com Interview with:
Theodore J. Cicero, PhD
Professor, Vice Chairman for Research
Department of Psychiatry
Washington University in St Louis
St Louis, Missouri
MedicalResearch: What are the main findings of the study?
Dr. Cicero: Heroin users nowadays are predominantly white men and women in their late 20s living outside large urban areas who were first introduced to opioids through prescription drugs compared to the 1960s when heroin users tended to be young urban men whose opioid abuse started with heroin.
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MedicalResearch.com Interview with:
Richard Saitz, MD MPH
Professor of Medicine and Epidemiology
Boston University Schools of Medicine and Public Health
Clinical Addiction Research and Education Unit, Boston Medical Center, Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?
Dr. Saitz: Chronic care management in primary care did not improve health outcomes (abstinence from cocaine, opioids or heavy drinking; or any other clinical outcomes, like addiction consequences, emergency or hospital use, health-related quality of life, addiction severity) for people with alcohol or other drug dependence.
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Courtney A. Miller, PhD
Assistant Professor
Department of Metabolism & Aging
Department of Neuroscience
The Scripps Research Institute
Jupiter, FL 33458
MedicalResearch.com: What are the main findings of the study?
Dr. Miller: The relapse rate for drug abusers, smokers and alcoholics is high because abstinence is so difficult. A major factor is the craving that drug associations can trigger. These range from seeing the neighborhood where someone used to buy, in the case of illicit drugs, to social drinking for a smoker. We’ve found a way to disrupt these drug-associated memories without affecting other, more benign memories.
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