- Reducing Risky Alcohol Use: What Health Care Systems Can Do. [Journal Article]
- IBIssue Brief (Mass Health Policy Forum) 2016 Apr 27; (46):1-50
- Risky, non-dependent alcohol use is prevalent in the United States, affecting 25% of adults (Centers for Disease Control and Prevention, 2014b). Massachusetts has higher rates of alcohol use and bing...
Risky, non-dependent alcohol use is prevalent in the United States, affecting 25% of adults (Centers for Disease Control and Prevention, 2014b). Massachusetts has higher rates of alcohol use and binge drinking than most states (Substance Abuse and Mental Health Services Administration, 2015). Serious physical, social, and economic consequences result. Excessive alcohol use contributes to cancer, cardiovascular disease, sleep disorders, birth defects, motor vehicle injuries, and suicide, and it complicates management of chronic illnesses (Green, McKnight-Eily, Tan, Mejia, & Denny, 2016; Laramee et al., 2015; Mokdad, Marks, Stroup, & Gerberding, 2004; Rehm et al., 2009). Excessive alcohol use is one of the top causes of death, and over 240 alcohol-related deaths occur daily in the US (Mokdad et al., 2004; Stahre, Roeber, Kanny, Brewer, & Zhang, 2014). In comparison, 78 people die from an opioid overdose each day (Centers for Disease Control and Prevention, 2016). Excessive drinking is estimated to cost over $249 billion annually in the US and $5.6 billion in the Commonwealth (Sacks, Gonzales, Bouchery, Tomedi, & Brewer, 2015). This issue brief describes the scope of the risky drinking problem in the US and associated costs and consequences. The brief then examines the evidence base for tools to address risky drinking and outlines policy strategies that health care system stakeholders may employ to address further this critical public health issue. Screening and brief intervention (SBI) is an evidence-based, cost-effective practice to address risky alcohol use, typically using a short validated screening tool followed by a brief counseling session if a patient screens positive. Research shows SBI conducted in primary care outpatient settings significantly reduces alcohol use (Bertholet, Daeppen, Wietlisbach, Fleming, & Burnand, 2005b; Bien, Miller, & Tonigan, 1993; Kaner et al., 2009; Saitz, 2010a), hospitalizations (Fleming, Barry, Manwell, Johnson, & London, 1997b) and mortality (Cuijpers, Riper, & Lemmers, 2004). Alcohol SBI saves an estimated $217.95 per person screened (Barbosa, Cowell, Bray, & Aldridge, 2015).
- Improving Access to Substance Abuse Treatment and Reducing Incarceration and Recidivism. [Journal Article]
- IBIssue Brief (Mass Health Policy Forum) 2015 Nov 17; (44):1-46
- Massachuse��s faces an opioid and substance abuse crisis at the same ��me the U.S. and Massachuse��s have some of highest rates of incarcera��on in the world. This issue brief examines the problem an...
Massachuse��s faces an opioid and substance abuse crisis at the same ��me the U.S. and Massachuse��s have some of highest rates of incarcera��on in the world. This issue brief examines the problem and economic costs and consequences of untreated substance abuse. It examines the benefits of expanding access to treatment in the community, at arrest and ini��al deten��on, within the courts, within jails and prisons, at re‐entry and under community supervision, with the intent to reduce substance abuse, incarcera��on and recidivism and thereby improve health and public safety. The report recommends (1) implemen��ng a pre‐arrest program to divert low‐level drug offenders to treatment, (2) enhancing and expanding specialty courts throughout the state, (3) increasing access to medica��on‐assisted treatment (MAT), and (4) expanding a Medicaid enrollment program in DOC and HOC facili��es to improve access to healthcare services immediately upon release. To facilitate change and judicious invest of resources, it also recommends insta��ng governance structures to coordinate efforts between health and criminal jus��ce organiza��ons within the Execu��ve, Legisla��ve and Judiciary branches of government.
- Study protocol: a dose-escalating, phase-2 study of oral lisdexamfetamine in adults with methamphetamine dependence. [Journal Article]
- BPBMC Psychiatry 2016 Dec 01; 16(1):428
- CONCLUSIONS: Determining the safety of lisdexamfetamine will enable further research to develop pharmacotherapies for the treatment of methamphetamine dependence.
- Behavioral Characterization of Kappa Opioid Receptor Agonist Spiradoline and Cannabinoid Receptor Agonist CP55940 Mixtures in Rats. [Journal Article]
- JPJ Pharmacol Exp Ther 2016 Nov 30
- Pain is a significant clinical problem and there is a need for more effective treatments with reduced adverse effects that currently limit the use of mu opioid receptor agonists. Synthetic kappa opio...
Pain is a significant clinical problem and there is a need for more effective treatments with reduced adverse effects that currently limit the use of mu opioid receptor agonists. Synthetic kappa opioid receptor agonists have no abuse liability and well-documented antinociceptive effects; however, adverse effects (diuresis, dysphoria) preclude their use in the clinic. Combining kappa opioids with non-opioid drugs (cannabinoid receptor agonists) allows for smaller doses of each drug to produce antinociception. This study tested whether a potentially useful effect of the kappa opioid receptor agonist spiradoline (antinociception) is selectively enhanced by the cannabinoid receptor agonist CP55940. Cumulative dose-response functions were determined in 8 male Sprague Dawley rats for spiradoline (0.032-32.0 mg/kg, i.p.) and CP55940 (0.0032-1.0 mg/kg, i.p.) for antinociception, hypothermia, food-maintained responding, and diuresis. Alone, each drug dose-dependently increased tail withdrawal latencies from 50oC water, decreased body temperature by ~4oC, and eliminated food-maintained responding. Spiradoline but not CP55940 significantly increased urine output at doses that eliminated responding. Smaller doses of spiradoline and CP55940 in mixtures (3:1, 1:1, and 1:3 spiradoline:CP55940) had effects comparable to those observed with larger doses of either drug administered alone: the interaction was additive for antinociception and additive or greater than additive for hypothermia and food-maintained responding. Collectively these data fail to provide support for the use of these mixtures for treating acute pain; however, kappa opioid/cannabinoid mixtures might be useful for treating pain under other conditions (e.g., chronic pain), but only if the adverse effects of both drugs are not enhanced in mixtures.
- Prescription drug abuse - A timely update. [Journal Article]
- AFAust Fam Physician 2016; 45(12):862-866
- CONCLUSIONS: Data from the Coroners Court of Victoria list the main drugs that contributed to drug-related deaths in 2009-15. Analysis of the data reveals that pharmaceutical drugs contributed to 80% of overdose deaths; benzodiazepines and opioids were the main drug groups involved. Strategies for reducing and managing prescription drug abuse in primary care settings are outlined in this article, including references to published evidence-based clinical guidelines from The Royal Australian College of General Practitioners (RACGP). The safety profile of buprenorphine/ naloxone over methadone is noted and raised as a consideration for clinicians when assessing a patient for opioid replacement therapy.
- Biased agonists of the kappa opioid receptor suppress pain and itch without causing sedation or dysphoria. [Journal Article]
- SSSci Signal 2016 Nov 29; 9(456):ra117
- Agonists targeting the kappa opioid receptor (KOR) have been promising therapeutic candidates because of their efficacy for treating intractable itch and relieving pain. Unlike typical opioid narcoti...
Agonists targeting the kappa opioid receptor (KOR) have been promising therapeutic candidates because of their efficacy for treating intractable itch and relieving pain. Unlike typical opioid narcotics, KOR agonists do not produce euphoria or lead to respiratory suppression or overdose. However, they do produce dysphoria and sedation, side effects that have precluded their clinical development as therapeutics. KOR signaling can be fine-tuned to preferentially activate certain pathways over others, such that agonists can bias signaling so that the receptor signals through G proteins rather than other effectors such as βarrestin2. We evaluated a newly developed G protein signaling-biased KOR agonist in preclinical models of pain, pruritis, sedation, dopamine regulation, and dysphoria. We found that triazole 1.1 retained the antinociceptive and antipruritic efficacies of a conventional KOR agonist, yet it did not induce sedation or reductions in dopamine release in mice, nor did it produce dysphoria as determined by intracranial self-stimulation in rats. These data demonstrated that biased agonists may be used to segregate physiological responses downstream of the receptor. Moreover, the findings suggest that biased KOR agonists may present a means to treat pain and intractable itch without the side effects of dysphoria and sedation and with reduced abuse potential.
- Opioid Misuse/Abuse and Quality Persistent Pain Management in Older Adults. [Journal Article]
- JGJ Gerontol Nurs 2016 Dec 1; 42(12):21-30
- The United States is amid an epidemic of prescription opioid drug abuse, bringing with it not only high rates of overdose, but growing rates of heroin abuse and addiction. Liberal opioid drug prescri...
The United States is amid an epidemic of prescription opioid drug abuse, bringing with it not only high rates of overdose, but growing rates of heroin abuse and addiction. Liberal opioid drug prescribing on the part of well-meaning clinicians has in part fueled this epidemic, being correlated to opioid death and addiction treatment admission rates. Misuse and abuse of prescription opioid drugs is greatest among young adults (ages 18 to 25); however, the fastest growing age group for opioid drug misuse/abuse is older (ages 50 to 64). Prescription opioid drug use issues may emerge in the context of persistent pain, and risk factors for misuse/abuse and overdose in older patients with pain require further description. In keeping with national initiatives to combat prescription opioid drug abuse and overdose, current clinical guidelines reflect an "opioid-sparing" approach. To the degree that these guidelines improve persistent pain and opioid drug misuse/abuse outcomes, significant public health benefits will be accrued. Efforts to reduce both require action and are national priorities. [Journal of Gerontological Nursing, 42(12), 21-30.].
- Use of Risk Mitigation Practices by Family Nurse Practitioners Prescribing Opioids for the Management of Chronic Non-Malignant Pain. [Journal Article]
- SASubst Abus 2016 Nov 29; :0
- CONCLUSIONS: Although RMPs are recommended for use in all CNMP patients receiving ongoing opioid therapy, FNPs do not consistently implement them. In the midst of the current opioid epidemic, FNPs must be vigilant about using appropriate opioid prescribing practices.
- Naloxone and Metabolites Quantification in Cord Blood of Prenatally Exposed Newborns and Correlations with Maternal Concentrations. [Journal Article]
- ARAJP Rep 2016; 6(4):e385-e390
- Objective To quantify naloxone and metabolite concentrations in newborns prenatally exposed to sublingual buprenorphine/naloxone and to correlate neonatal and maternal metabolite concentrations. Meth...
Objective To quantify naloxone and metabolite concentrations in newborns prenatally exposed to sublingual buprenorphine/naloxone and to correlate neonatal and maternal metabolite concentrations. Methods This is a prospective observational cohort study. Eleven pregnant women treated for opioid use disorder with sublingual buprenorphine/naloxone were enrolled. Maternal and newborn blood was collected and analyzed for naloxone, buprenorphine, and metabolites via liquid chromatography tandem mass spectrometry. Descriptive statistics and correlation coefficients were utilized to analyze data. Results Maternal daily naloxone and buprenorphine doses were 1 to 5 mg and 4 to 20 mg, respectively; the mean (standard deviation) time from medication until delivery was 9.9 (4.3) hours. Naloxone was below the limits of quantification (LOQ) in five infants and six mothers with a range of less than LOQ to 0.3 μg/L. There was a strong positive correlation between maternal and newborn naloxone concentrations: Spearman's ρ = 0.89 (p < 0.01). There were strong positive correlations between maternal and neonatal assays for the buprenorphine analyte concentrations: buprenorphine ρ = 0.88 (p < 0.01), norbuprenorphine ρ = 0.71 (p = 0.01), and norbuprenorphine-glucuronide ρ = 0.98 (p < 0.01), but not for buprenorphine-glucuronide, ρ = 0.53 (p = 0.10). Conclusion Naloxone and buprenorphine are transferred to the fetus during prenatal exposure to maternal sublingual buprenorphine/naloxone. The quantity of naloxone transferred from maternal circulation is minimal and highly correlated with maternal concentrations.
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- Effectiveness of social work intervention with a systematic approach to improve general health in opioid addicts in addiction treatment centers. [Journal Article]
- PRPsychol Res Behav Manag 2016; 9:309-315
- CONCLUSIONS: Thus, the nature of the presence of social workers in addiction treatment centers has been effective and can have a significant influence by reducing anxiety and insomnia and somatic symptoms, improving patients' self-understanding and self-recognition, and enhancing social functioning.