Urine Tests Useful in Primary Care Monitoring of Opioid and Cocaine Use

MedicalResearch.com Interview with:

Sarah M. Bagley MD, MSc Assistant Professor of Medicine and Pediatrics Director, CATALYST Clinic Boston University School of Medicine/Boston Medical Center Boston, MA

Dr. Bagley

Sarah M. Bagley MD, MSc
Assistant Professor of Medicine and Pediatrics
Director, CATALYST Clinic
Boston University School of Medicine/Boston Medical Center
Boston, MA

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

Response: Urine drug testing is a routine part of the management of primary care patients with opioid use disorder treated with medications such as buprenorphine. In addition, most providers also ask patients about recent drug use.

The point of this study was to see the agreement between the urine drug testing and what patients told a nurse and whether that changed the longer a patient was in treatment. We found that truthful disclosure of opioid and cocaine use increased with time in treatment and that urine drug tests are a useful tool to monitor patients. 

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Wisdom Tooth Extraction Can Lead To Persistent Opioid Use

MedicalResearch.com Interview with:

Calista Harbaugh, MD House Officer, General Surgery Clinician Scholar, National Clinician Scholars Program Research Fellow, Michigan Opioid Prescribing Engagement Network University of Michigan 

Dr. Harbaugh

Calista Harbaugh, MD
House Officer, General Surgery
Clinician Scholar, National Clinician Scholars Program
Research Fellow, Michigan Opioid Prescribing Engagement Network
University of Michigan 

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

Response: Wisdom tooth extraction is one of the most common procedures among teens and young adults, with more than 3.5 million young people having wisdom teeth pulled every year.

This procedure is commonly paired with a prescription for opioid pain medication. As the opioid epidemic sweeps the nation, we must pay attention to the long term effects of opioid prescribing for even routine procedures. This is particularly important for wisdom tooth extraction where there is evidence that opioid pain medications may be no more effective than anti-inflammatories alone.

Using commercial insurance claims, we evaluated the association between receiving an opioid prescription with wisdom tooth extraction and developing new persistent opioid use in the year after the procedure. We found nearly a 3-fold increase in odds of persistent opioid use, attributable to whether or not an opioid was prescribed. This translates to nearly 50,000 young people developing new persistent opioid use each year from routine opioid prescribing for wisdom tooth extraction.

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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.

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White Opioid Users Increasingly Hooked On Heroin

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

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

Dr. Martins: The background for this study is former studies showing links between nonmedical use of prescription opioids and transition to heroin and other illegal substances, prescription opioid-related and heroin-related fatal overdoses . In addition, a particular public health concern is that the transition to heroin and further injecting heroin may increase the risk of bloodborne infections.

We used data from the National Survey on Drug Use and Health, a large nationally representative household sample of 67,500 people, and self-reported heroin use within the last 12 months, the researchers examined the change in patterns of past-year non-prescription drug and heroin use between 2002-2005 and 2008-2011 across racial and ethnic groups. The most significant rise in heroin use was among Hispanics and non-Hispanic whites, where the rate of heroin use for the latter group increased by 75 percent in 2008-2011 compared to earlier years. Regarding frequency of use, for Hispanics, increases were significant only among those using opioids about 1-29 days in the past year. Among blacks and whites, significant increases in the rate of heroin use were observed among those using prescription opioids more frequently (100-365 days) in the past year.

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