Addiction, Author Interviews, Opiods / 08.08.2019

MedicalResearch.com Interview with: [caption id="attachment_43644" align="alignleft" width="200"]Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509 Dr. Piper[/caption] Brian J Piper, PhD MS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, Pennsylvania  MedicalResearch.com: What is the background for this study? Response: All states have a Prescription Monitoring Program to collect data about controlled substance prescriptions. Maine also had a Diversion Alert Program to obtain information about arrests involving prescription and illicit drugs. Buprenorphine is a treatment for an opioid use disorder. Naloxone is an opioid antagonist. Prior pharmacoepidemiology research found that buprenorphine accounted for half of prescriptions for males in their twenties in Maine.1 This study examined the current status of the opioid crisis using three complementary data sources: 1) Arrests as reported to the Diversion Alert Program; 2) Medical opioid use as reported by the Drug Enforcement Administration; and 3) Overdoses as reported to the medical examiner.
Author Interviews, CDC, Emergency Care, Occupational Health, Opiods / 02.05.2019

MedicalResearch.com Interview with: Sophia K. Chiu, MD Epidemic Intelligence Service, CDC Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health CDC  MedicalResearch.com: What is the background for this study? Response:  Responders across the United States are reporting work-related health effects during incidents in which suspected opioids (including fentanyl) and other illicit drugs such as cocaine, methamphetamine, cathinones, and synthetic cannabinoids are present, often as a mixture. These health effects have interfered with responders’ ability to perform their job duties. Since 2018, a number of responder organizations have requested that NIOSH investigate the health effects experienced by emergency responders during these response incidents. These organizations are looking for ways to protect their responders and prevent the symptoms responders have reported experiencing, so that they can in turn better serve the public. NIOSH’s goal is to increase awareness among responders of how they can remain safe while providing the care the public needs.
Author Interviews, JAMA, Opiods / 28.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48846" align="alignleft" width="200"]Leah LaRue, PharmD, PMPAssociate Director, Clinical AffairsMillennium Health Dr. LaRue[/caption] Leah LaRue, PharmD, PMP Associate Director, Clinical Affairs Millennium Health MedicalResearch.com: What is the background for this study? Response: Drug overdose deaths continue to increase, despite the leveling off of prescription opioid use and policy changes limiting opioid prescribing. While fentanyl has garnered most of the attention, overdose deaths involving cocaine and methamphetamine also have increased markedly over the past few years. It is possible that those increases are due not just to those drugs, but to concomitant use with fentanyl. To better understand what is causing this rapid increase in overdose deaths, it is important to characterize the emerging combination of other illicit drugs with fentanyl, which increases the risk of overdose. The purpose of this study was to determine whether rates of the combination of nonprescribed fentanyl with cocaine or methamphetamine have changed in urine drug test (UDT) results through time.
Author Interviews, Opiods / 25.02.2019

MedicalResearch.com Interview with: [caption id="attachment_47585" align="alignleft" width="200"]Dr-Mathew Vinhhoa Kiang Dr. Kiang[/caption] Mathew Vinhhoa Kiang, PhD Postdoctoral Research Fellow Primary Care and Outcomes Research Stanford University School of Medicine Stanford, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation's capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate.
Author Interviews, Opiods / 24.02.2019

MedicalResearch.com Interview with: [caption id="attachment_43644" align="alignleft" width="200"]Brian J. Piper, PhD, MS Department of Basic Sciences Geisinger Commonwealth School of Medicine Scranton, PA 18509 Dr. Brian Piper[/caption] Brian J. Piper, PhD, MS Assistant Professor of Neuroscience Geisinger Commonwealth School of Medicine MedicalResearch.com: What is the background for this study? Response: Fentanyl is an important opioid for pain management but also has exceptional potential for misuse. Illicitly manufactured fentanyl accounts for a large portion of opioid overdoses. Seven states including Maine, Connecticut, Massachusetts, New York, Rhode Island, and Vermont have recently implemented opioid prescribing laws. The objectives of this study were to:
  • 1) characterize how medical use of fentanyl, fentanyl analogues like sufentanil, alfentanil, and remifentanil, and other opioid use changed over the past decade, and
  • 2) determine whether opioid prescribing laws impacted fentanyl use in the US. The Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is the gold-standard for pharmacoepidemiology research of controlled substances in the US for its comprehensiveness. 
Author Interviews, JAMA, Opiods, Pediatrics / 26.10.2018

MedicalResearch.com Interview with: Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine Joshua Barocas, MD Assistant Professor of Medicine Section of Infectious Diseases Boston Medical Center / Boston University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Massachusetts has been particularly hard hit by the opioid epidemic despite lower opioid prescribing rates, near universal health insurance, and availability of opioid treatment. That said, it is difficult to estimate the population with or at-risk for opioid use disorder. It is generally a highly stigmatized disease and typical methods to estimate of opioid use disorder relay on contact with the healthcare system and/or patient reporting. We used a unique and powerful methodology coupled with a first-in-the-nation linked database in Massachusetts to obtain both an accurate count of people with opioid use disorder who are known to the healthcare system and estimate the number who are out there but not yet known to the system. We found that more than 275,000 people – or 4.6 percent of people over the age of 11 in Massachusetts– have opioid use disorder, a figure nearly four times higher than previous estimates based on national data. In 2011 and 2012, the prevalence of opioid use disorder in Massachusetts for those over the age of 11 was 2.72 percent and 2.87 percent, respectively. That increased to 3.87 percent in 2013, and even more, to 4.6 percent in 2015. Those between the ages of 11 and 25 experienced the greatest increase in prevalence of all age groups. The number of “known” persons increased throughout the study period – from 63,989 in 2011 to 75,431 in 2012, and 93,878 in 2013 to 119,160 in 2015. 
Addiction, Author Interviews, Opiods / 05.10.2018

MedicalResearch.com Interview with: "150826-fentanyl-factory-underground-illicit.jpg" by r. nial bradshaw is licensed under CC BY 2.0 Jon Zibbell, PhD, Senior public health scientist Behavioral Health Research Division RTI International Research Triangle Park, NC,  MedicalResearch.com: What is the background for this study? What are the main findings? Response: For the first time in 2016, U.S. overdose deaths involving illicitly-manufactured fentanyl surpassed deaths from heroin and prescription deaths. Fentanyl is an extremely potent synthetic opioid, and an illicitly-manufactured form of the drug is regularly being mixed with heroin and often sold to unwitting consumers. Fentanyl is 50 times more potent than heroin and its illicitly-manufactured version is extremely difficult to discern when mixed with heroin. Harm reduction organizations have started to distribute FTS and people consuming street-purchased opioids are using them to test drugs for fentanyl. Our objective was to assess whether this point-of-use form of drug checking was influencing people’s drug use behavior. The study was self-funded by the research institute RTI International. Our findings show that consumers who tested street opioids with fentanyl test strips were five times more likely to engage in safer drug use behavior when the test comes back positive. The study was conducted among a group of 125 people who inject drugs in Greensboro, North Carolina.
Author Interviews, Emergency Care, Opiods / 08.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41064" align="alignleft" width="136"]Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia Dr. Scheuermeyer[/caption] Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia  MedicalResearch.com: What is the background for this study? Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome. Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose.
Author Interviews, Cannabis, Cost of Health Care, Opiods / 07.02.2018

MedicalResearch.com Interview with: [caption id="attachment_39890" align="alignleft" width="130"]MedicalResearch.com Interview with: David Powell  PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica     MedicalResearch.com:  What is the background for this study?  What are the main findings?   Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall.  However, medical marijuana laws are very different across states and they have changed over time as well.  We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse.  We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries.  We found that <a href=michigan dispensaries and other dispensaries across America are critical to reduce opioid-related overdoses and substance abuse. We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters. MedicalResearch.com: What should readers take away from your report? Response: We find that the introduction of medical marijuana dispensaries has the potential to reduce opioid-related harms quite significantly. More broadly, it also suggests that, when we think about the opioid crisis, improving access to pain management alternatives may be a useful mechanism for reducing dependence on opioids. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: During most of the time period that we studied, prescription opioids were driving the opioid crisis, but it has recently transitioned to the point where heroin and illicit synthetic opioids are playing more prominent roles. We are hesitant to suggest that medical marijuana access will have the same scope in a climate in which synthetic opioids and heroin are the primary substances of abuse. Future work could do more to explore the potential of different types of medical marijuana laws to reduce overdoses related to these substances. Citations: Do medical marijuana laws reduce addictions and deaths related to pain killers? ? •David Powella, , , • Rosalie Liccardo Paculaa, b, Mireille Jacobsonb RAND, Santa Monica, United States NBER Cambridge, MA, United StatesUniversity of California, Irvine, United States Received 14 November 2015, Revised 15 August 2017, Accepted 30 December 2017, Available online 3 February 2018 Journal of Health Economics Volume 58, March 2018, Pages 29–42 https://doi.org/10.1016/j.jhealeco.2017.12.007 [wysija_form id="3"] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website." width="130" height="150" /> Dr. Powell[/caption]David Powell PhD Economist; Core Faculty, Pardee RAND Graduate School RAND, Santa Monica MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been some research suggesting that the adoption of state medical marijuana laws leads to reductions in prescriptions for opioid analgesics among certain populations and opioid-related overdoses overall. However, medical marijuana laws are very different across states and they have changed over time as well. We wanted to understand what components of a medical marijuana law could potentially lead to reductions in overdoses and substance abuse. We focused specifically on the role of dispensaries, given their importance in providing access to medical marijuana, and tested for different effects in states with and without legally-protected and operational dispensaries. We found that dispensaries are critical to reduce opioid-related overdoses and substance abuse. We also found evidence that more recently-adopting states have experienced smaller reductions in overdoses and opioid substance abuse, potentially because the more recent adopters tend to enforce more stringent guidelines for dispensaries than the early adopters.
Addiction, Author Interviews, JAMA, Opiods / 01.02.2018

MedicalResearch.com Interview with: “Drugs” by Ben Harvey is licensed under CC BY 2.0William G. Honer, MD, FRCPC, FCAHS Jack Bell Chair in Schizophrenia Professor and Head, Department of Psychiatry University of British Columbia Vancouver, BC MedicalResearch.com: What is the background for this study? Response: The Province of British Columbia, Canada, has experienced a tremendous increase in the number of opioid related overdoses and deaths. In 2012, there were 269 drug overdose deaths, five years later in 2017 the overdose deaths are predicted to have increased 500%. Toxicology studies of deaths, and examination of seized drugs indicate fentanyl is the major cause. These indirect measures suggest widespread exposure to fentanyl in opioid users, however direct studies of the extent of exposure of opioid users to fentanyl in the community are lacking. We carried out a community-based, longitudinal study using fentanyl testing in urine samples from volunteer participants. (It is called the “Hotel Study” since many of the participants live, or have lived in single room occupancy hotels) 
Addiction, Author Interviews, CDC, Opiods / 03.11.2017

MedicalResearch.com Interview with: “no drugs” by Anderson Mancini is licensed under CC BY 2.0Julie 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.
Addiction, Author Interviews, Emergency Care, Opiods / 02.03.2017

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.
Author Interviews, Pain Research / 04.12.2013

Morten Sejer Hansen Department of Anaesthesia 4231 Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, DenmarkMedicalResearch.com Interview with: Dr. Morten Sejer Hansen Department of Anaesthesia 4231 Centre of Head and Orthopaedics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark MedicalResearch.com: What are the main findings of the study? Answer: Out-of-hospital administration of intranasal fentanyl in doses of 50 and 100 microgram appears to be safe and well tolerated, with a low incidence of side effects Secondly, intranasal fentanyl appeared effective in a wide range of patients, although no firm conclusions on analgesic efficacy can be provided due to the lack of a placebo control.