Bup Feeds

The effect of telephonic patient support on treatment for opioid dependence: Outcomes at one year follow-up.

Addict Behav. 2012 Jan 25;

Authors: Ruetsch C, Tkacz J, McPherson TL, Cacciola J

Abstract
OBJECTIVE: The present study examined the impact of a telephonic patient support program known as HereToHelp™ (HTH) on compliance and treatment outcomes among opioid dependent (OD) patients new to buprenorphine treatment (BUP). METHOD: A total of 1426 OD patients new to BUP were randomized to receive BUP alone (standard care) or BUP plus the HTH patient support program. All patients completed the Addiction Severity Index (ASI) at the time of enrollment, and at 12months post-enrollment. RESULTS: Subjects randomized to the HTH support program who accepted at least 3 care coach intervention calls were more compliant with BUP than the standard care group at month 12 (64.4% vs. 56.1%, χ(2)=5.09, p<.025). Compared to patients who were non-compliant with BUP, compliant patients reported significantly lower scores on all 7 of the ASI composite scores, indicating lower severity on addiction-related problems. CONCLUSIONS: The HTH intervention seemed to improve patient treatment outcomes indirectly by improving compliance with BUP. Supplementing BUP with a structured, telephonic compliance-enhancement program is an effective way to improve compliance with medication which then improves patient outcomes.

PMID: 22348921 [PubMed - as supplied by publisher]

Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds.

J Neurosci Rural Pract. 2012 Jan;3(1):45-50

Authors: Whelan PJ, Remski K

Abstract
Heroin dependence is a major health and social problem associated with increased morbidity and mortality that adversely affects social circumstances, productivity, and healthcare and law enforcement costs. In the UK and many other Western countries, both methadone and buprenorphine are recommended by the relevant agencies for detoxification from heroin and for opioid maintenance therapy. However, despite obvious benefits due to its unique pharmacotherapy (eg, greatly reduced risk of overdose), buprenorphine has largely failed to overtake methadone in managing opioid addiction. The experience from the developing world (based on data from India) is similar. In this article we compare the advantages and disadvantages of the use methadone and buprenorphine for the treatment of opioid addiction from both a developed and developing world perspective; and explore some of the reasons why buprenorphine has not fulfilled the expectations predicted by many in the addictions field.

PMID: 22346191 [PubMed - in process]

A new study finds that many Americans support reducing nicotine in cigarettes to prevent people from becoming addicted to smoking.

In a survey of 511 nonsmokers and 510 smokers ages 18 and older, HealthDay reports that two-thirds support reducing nicotine levels in cigarettes to non-addictive levels.

Researchers also found that 77 percent would support the reduction to non-addictive levels if doing so would reduce the number of children who became addicted to cigarettes.

According to study author Gregory Connolly, director of the Center for Global Tobacco Control at the Harvard School of Public Health, a ban on cigarettes was supported by 43 percent of survey respondents.

The study was published online in the American Journal of Public Health.

New findings by a Yale team of scientists may help explain why the risk of drug abuse and addiction increase significantly when cocaine use begins in adolescence.

When a teen brain is first exposed to cocaine, it launches a defensive response designed to minimize the drug’s effects. As reported in Science Daily, in two recent studies, Yale and other scientists have identified key genes that regulate this response and demonstrate that interfering with this reaction dramatically increases a mouse’s sensitivity to cocaine.

Study results were published in the Journal of Neuroscience.

Research has demonstrated that vulnerability to cocaine is much higher in the teen years, when the brain is developing. Earlier studies at Yale have shown that in adolescence, neurons and their synaptic connections change shape when first exposed to cocaine through molecular pathway regulated by the gene integrin beta1, critical to the development of the nervous system of vertebrates.

As Anthony Koleske, professor of molecular biophysics, biochemistry and neurobiology, and senior author on both papers, elaborates, “This suggests that these structural changes observed are probably protective of the neurocircuitry, an effort of the neuron to protect itself when first exposed to cocaine.”

In the latest study, Yale researchers reported when the pathway was knocked out, mice needed about three times less cocaine to induce behavioral change than mice with the pathway still in place. The findings suggest that the relative strength of the integrin beta1 pathway among individuals may explain why some cocaine users become addicted to the drug while others escape its worst effects, the authors suggest.

“If you were to become totally desensitized to cocaine, there is no reason to seek the drug,” Koleske said.

Babies born to mothers who smoke or use nicotine patches during pregnancy are more likely to have colic, a new study published in the March issue of Pediatrics finds.

The study found that exposure to nicotine, either from the mothers smoking cigarettes or from nicotine replacement therapy, was linked to a significantly increased risk of colic in their babies, ranging from 30 to 60 percent, HealthDay reports.

Researchers looked at data based on more than 63,000 interviews with mothers, who participated in the Netherlands-based study, with interviews conducted during pregnancy and six months after the moms gave birth to their babies.

The findings concluded that 8 percent of the babies had colic. About 74 percent of the moms didn’t smoke; 24 percent reported that they did smoke; 2 percent of the moms said they smoked and used nicotine replacement therapy, while 0.3 percent of the women used nicotine replacement therapy alone.

“The theory is that there are nicotine receptors in the GI [gastrointestinal] system and nicotine receptors that alter serotonin and these alterations affect the babies after birth, causing colic,” said Dr. Jennifer Wu, an Obstetrician-Gynecologist at Lenox Hill Hospital.

Dr. Wu added that the causes of colic aren’t well understood, nor are the reasons why nicotine might raise the risk of colic. Prior research has also shown smoking to be associated with colic. However, these studies do not prove cause and effect.

Senator Rand Paul (R-KY) has been blocking Senate action on legislation to outlaw a host of synthetic drugs, which are growing in popularity and have been linked to illnesses and deaths. The Kentucky Senator has impeded bills that appear to have minimal opposition, and has faced bi-partisan criticism from his fellow Senators and Kentucky anti-drug officials, The Courier-Journal reports.

At issue are three bills targeting legally sold synthetic drugs that mimic the effects of marijuana, cocaine and other controlled substances, but are marketed as safe alternatives to their illegal counterparts. The contested legislation would make illegal the use, possession and sale of certain chemicals used in production of synthetic drugs.

Manufacturers of the substances import them into the United States labeled as, among other things, incense, bath salts, snow remover and plant food.

“It is time for the Senate to take action,” said Senator Chuck Grassley of Iowa, the Senior Republican on the Senate Judiciary Committee and a sponsor of one of the bills. “We cannot let the will of just one Senator obstruct the will of many.”

“One Senator shouldn’t be able to prevent a vote on something that 99 percent of Americans want, that directly affects their health and safety and the health and safety of their children,” said Senator Charles Schumer (D-NY) sponsor of another bill aimed at synthetic drugs.

The Senate Judiciary Panel passed three measures by voice vote in July of last year, while the House of Representatives passed a companion bill in December on a bipartisan vote of 317-98.

Patterns of free (unconjugated) buprenorphine, norbuprenorphine, and their glucuronides in urine using liquid chromatography-tandem mass spectrometry.

J Anal Toxicol. 2012 Mar;36(2):81-7

Authors: McMillin GA, Davis R, Carlisle H, Clark C, Marin SJ, Moody DE

Abstract
Patterns of buprenorphine and metabolites were examined in 1946 positive urine samples analyzed by liquid chromatography-tandem mass spectrometry for free (unconjugated) buprenorphine and norbuprenorphine (quantitative, 2 to 1000 ng/mL) and buprenorphine-glucuronide (B3G) and norbuprenorphine-glucuronide (N3G) (semi-quantitative, 5 to 1000 ng/mL). Two distribution patterns predominated with 49.1% positive for norbuprenorphine, B3G, and N3G and 41.6% positive for buprenorphine, norbuprenorphine, B3G, and N3G. Buprenorphine, positive in 45.5% of samples, was mostly < 5 ng/mL (median 6.1 ng/mL), but 9.8% were > 1000 ng/mL. Norbuprenorphine, B3G, and N3G had semi-Gaussian distributions with medians of 64.7, 108, and 432 ng/mL, respectively. With buprenorphine < 100 ng/mL (767 samples) or ≥ 100 ng/mL (19 quantifiable samples), the respective median metabolic ratios (free norbuprenorphine/free buprenorphine) were 25.0 and 0.15. In 12 retested "> 1000 ng/mL" buprenorphine samples, free buprenorphine was 4160 to 39,400 ng/mL and free naloxone 2140 to 9560 ng/mL. In 87 subsequent samples with buprenorphine < 20 ng/mL, naloxone concentrations were < 50 ng/mL. Concentrations of buprenorphine > 100 ng/mL (particularly with low metabolite concentrations) are suspect of urine adulteration with medication (4% in the database) that can be checked in most cases by concurrent analysis for naloxone.

PMID: 22337776 [PubMed - in process]

The good news is that youth cigarette consumption has declined significantly over the past decade due to several factors, including effective tobacco control initiatives, higher prices, advertising and marketing restrictions and stringent laws limiting indoor and outdoor smoking. The new Food and Drug Administration (FDA) regulatory authority over tobacco products will hopefully contribute to additional declines.  

The bad news is that while cigarette use has decreased, sales of cigars have increased dramatically. Current data show that cigar rates appear to be highest among 18-25 year olds, with most of these smokers using little cigars and cigarillos. Maryland’s recent Youth Tobacco Survey found that in 2010, an alarming 79 percent of high school students reported using a tobacco product other than cigarettes. In Maryland, from 2001 to 2011, the total number of cigarette packs sold dropped by 33.6 percent. During the same 10 year period, sales of cigars increased by more than 176 percent. Other states surveying cigar use are seeing similar trends. 

There are several reasons contributing to an increase in cigar use. There’s a mistaken belief that cigar products are less harmful than cigarettes. Little cigars and cigarillos are less expensive than cigarettes, sold individually and available in an array of sweet and candy-like flavors that appeal to youth. The Maryland study found that more than 76 percent of high school cigar smokers used flavored cigars, which mask the harsh taste of the tobacco and toxins and make addiction easier. 

Cigars of all sizes contain many of the same harmful compounds as cigarettes and can be just as addictive. They pose significant health risks similar to cigarettes, including cancers of the mouth, lung, esophagus and larynx. And, cigars contain more tobacco than cigarettes. They burn longer, giving off greater amounts of harmful secondhand smoke. 

What can be done? The Family Smoking Prevention and Tobacco Control Act, which granted FDA the authority to regulate tobacco products, explicitly addressed cigarettes and smokeless tobacco, but not cigars. Congress gave the FDA the ability to expand its authority to all tobacco products including cigars. Legacy® encourages the FDA to assert jurisdiction over cigars and apply many of the same restrictions on cigarettes to cigar products, including banning of all flavored products, requiring graphic warning labels, restricting advertising and marketing of cigars and taking measures to reduce youth access. What do you think?

Diane Canova
Vice President, Government Affairs
Legacy®

Watching movies with scenes that feature alcohol consumption doubles the likelihood that teens will start drinking alcohol, according to a new study published in the journal BMJ Open. The two-year study of more than 6,500 American kids, ages 10 to 14, also found that teens who are exposed to alcohol-fueled movies are more likely to progress to binge drinking (five or more drinks in a row) HealthDay reports.

Study findings show that the proportion of kids who started drinking alcohol more than doubled from 11 percent to 25 percent, and the proportion of those who started binge drinking tripled from 4 percent to 13 percent.

Teens being exposed to movies that feature alcohol use led to 28 percent of kids drinking alcohol and of those teens, 20 percent moved on to binge drinking, noted the survey. Researchers also underscored that the association was not only seen with movie characters who drank on-screen, but also with alcohol product placement throughout the movies.

Other factors that were associated with underage drinking were, coming from a family where parents drink and where alcohol was available in the home, but this finding was not linked to progression to binge drinking.

“Product placement in movies is forbidden for cigarettes in the U.S.A., but is legal and commonplace for the alcohol industry, with half of Hollywood films containing at least one alcohol-brand appearance, regardless of film rating,” James Sargent, of Norris Cotton Cancer Center, Dartmouth Medical School and colleagues wrote in the report.

A decontamination foam, previously used to clean up federal office buildings and mailrooms during anthrax attacks more than a decade ago, is now being used to decontaminate illegal methamphetamine (meth) labs Science Daily reports.

The foam renders all types of chemical and biological agents harmless, according to officials at Sandia’s Chemical & Biological Systems, the makers of the decontamination foam.

Sandia’s decontamination foam is comprised of a collection of mild, nontoxic and noncorrosive chemicals found in common household products, such as hair conditioner and toothpaste. It contains both surfactants, which lift agents off a surface, and mild oxidizers, which break down the agent’s molecules into nontoxic pieces that can be washed down a household drain like detergent or dish soap.

According to the Department of Justice, the chemicals used to cook meth and its byproducts produce toxic fumes, vapors and residues that have lasting effects to local neighborhoods and the environment. Anyone exposed to these byproducts, especially children, could suffer serious health problems and prolonged exposure to meth byproducts may cause cancer, damage the brain, the immune system and may result in birth defects.

Illegal meth labs are a growing problem in America and the U.S. Drug Enforcement Administration’s Clandestine Meth Lab registry lists thousands of locations across the country where law enforcement agencies have found chemicals or paraphernalia linked to either clandestine drug laboratories or meth lab dumpsites.

Incidents related to meth production, including seizures of labs, dumpsites or chemical and glassware, increased to 11,239 in 2010, after falling to 6,095 in 2007, according to the Drug Enforcement Administration.

A legislative panel in Oklahoma approved a bill requiring drug testing of welfare recipients.

House Bill 2388 passed 6-2 by a budget subcommittee on human services and now moves on to the full House, reports The Oklahoman. Before receiving money through the federal cash-assistance Temporary Assistance for Needy Families program, it would require adult applicants to be tested for drug use. About 5,000 adults get assistance from the program.

The bill’s main author, Rep. Guy Liebmann, said its purpose is to stop government money from going to people who spend it on illegal drugs, adding its similarity to a 2011 Florida law that has been challenged in federal court. 

The state currently screens clients for drug and alcohol abuse and requires testing if the screening indicates it is necessary. Individuals who test positive, currently five percent, are sent for treatment but not allowed to receive the benefit, said Sandra Harrison, Oklahoma’s Department of Human Services’ chief administrative officer. She added that the assistance is revoked if the individual stops going to work or school.

Oklahoma joins the growing number of states considering drug testing for welfare recipients. A group of lawmakers in Kansas are supporting a proposal that would require one-third of welfare recipients to undergo random drug screening. Officials in Pennsylvania announced they are introducing a new drug testing program for certain welfare recipients. Pennsylvania’s program will randomly test those with a felony drug conviction within the past five years, and those on probation for such crimes. A program introduced in Florida last year to test all welfare recipients was blocked by a federal judge.

To reduce the number of methamphetamine labs in the state, Oklahoma prosecutors are asking lawmakers to make the tablet form of pseudoephedrine a prescription drug.

A common drug found in cold and allergy medication, pseudoephedrine is used to make methamphetamine.

Tulsa World reports that all of the state’s 27 district attorneys back the proposal. However, a measure making the pill for a prescription didn’t make it through a Senate subcommittee last week. Other measures are awaiting a House committee. 

One district attorney, Tim Harris, from Tulsa County, said it will take “political courage” to get the measure passed.

In the first installment of this series, I discussed the fallacy of rescheduling as part of the “medical” marijuana issue. This final part focuses on the issues brought up by the governors in their rescheduling petition: a so-called “consensus” opinion of doctors who approve of raw marijuana as medicine, and, the issue brought on by the California Medical Association that essentially says research on marijuana cannot go forward without legalization. I will tackle each at a time.

The governors’ petition asserts that there is a “consensus of medical opinion concerning medical acceptability of cannabis amongst the largest groups of physicians in the United States.” In support of this statement, the petition cites the American Medical Association’s (AMA) alleged “reversal” of its position that marijuana should remain a Schedule I substance. However, contrary to the governors’ petition, the AMA does not believe that there has been sufficient research to justify making herbal marijuana itself available as a prescription medication: “Despite more than 30 years of clinical research, only a small number of randomized, controlled trials have been conducted on smoked cannabis.”1

Furthermore, while the AMA’s Report does state that the Schedule I status should be “reviewed,” it limits the purpose of such review to the “goal of facilitating clinical research and development of cannabinoid-based medicines, and alternate delivery methods.”2 AMA does not recommend that marijuana should be rescheduled in order that it can be directly prescribed and dispensed in its raw form to patients. In fact, the AMA recommendation goes on to caution: “This should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.” In the body of its report, AMA further clarified its position:

The future of cannabinoid-based medicine lies in the rapidly evolving field of botanical drug substance development, as well as the design of molecules that target various aspects of the endocannabinoid system. To the extent that rescheduling marijuana out of Schedule I will benefit this effort, such a move can be supported.3

The term “botanical drug substance” is derived from an FDA guidance document: “Guidance for Industry: Botanical Drug Products.”4 It refers, not to herbal plant material, but to extracts or similar preparations of the active botanical components. Rather than accepting that marijuana meets the “current, modern accepted standard for what constitute medicine,” the AMA is essentially stating that research into crude marijuana plant material is a dead end.

Rescheduling is not necessary to make marijuana products available for research

A committee of the California Medical Association recently called for the rescheduling of marijuana “so it can be tested and regulated.” However, it is not necessary for marijuana to be rescheduled in order for legitimate research to proceed. Schedule I status does not prevent a product from being tested and researched for potential medical use. The FDA (and its Controlled Substances Staff or CSS) will allow an investigational product containing a controlled substance (including Schedule I substances) to be tested in clinical (human) trials if there is adequate evidence of safety from non-human studies.5 The CSA imposes stringent security, record keeping, and other requirements, but these apply equally to Schedule I and Schedule II substances.

Under the CSA, the only differences between Schedule I and II are rather technical:6 Before granting a Schedule I research registration, the DEA will separately inquire whether the FDA believes that the researcher is qualified and competent and the trial design will elicit scientifically valid data.7 A Schedule I research registration must be renewed each year, whereas research registrations for other controlled substances are valid for 3 years. Schedule I research registrations are protocol, as well as substance, specific. By contrast, a Schedule II registration is valid for research into all Schedule II substances and protocols. Physicians, if they possess registrations to prescribe and administer products containing controlled substances, may conduct research (if permitted by the FDA and the relevant ethics committee) on any Schedule II substance; they need not obtain a separate research registration from DEA.

These additional Schedule I restrictions can delay a research program but are not insurmountable. Furthermore, it may be possible to make minor amendments to the CSA to “equalize” Schedule I and Schedule II research requirements without necessitating a rescheduling of marijuana. Now that would be an interesting thing for governors and the CMA to call for, but apparently neither seemed bothered enough to do the homework required to make such an argument.

Today, Schedule I research certainly does go forward. In a recent pharmaceutical company-sponsored human clinical study investigating a product derived from marijuana extracts, the DEA registered approximately 30 research sites in the U.S. and also registered an importer to bring the product into the U.S. from the U.K., where it was manufactured (this is for a drug called, Sativex, which combines two of marijuana’s active ingredients). What other research projects are happening? That will be the subject of a soon-to-be released report I am working on – stay tuned.

We should also mention the marijuana-based medications already on the market today. Dronabinol (Marinol ®) and Nabilone (Cesamet ®) are concentrated, synthetic versions of the most active ingredient in marijuana – THC – taken as a pill. They are in Schedule III and Schedule II, respectively, and they have been shown to be effective in the treatment of nausea and vomiting caused by chemotherapy in people who have already taken other medications without good results. These have undergone FDA’s process and are completely legal under the Controlled Substances Act.

By contrast to the careful and detailed structure of the Controlled Substances Act, the governors’ petition offers no criteria or guidelines that would clearly identify the scope of legitimate “medical use.” The CMA report also misstates the facts. At present in California, and several other states, it is widely recognized that the concept of “medical use” of marijuana is highly questionable. For payment of a small cash sum, almost anyone can obtain a physician’s “recommendation” to purchase, possess, and use marijuana for alleged medical purposes. Indeed, numerous studies have shown that the most customers of these dispensaries do not suffer from chronic, debilitating conditions such as HIV/AIDS or cancer and are instead otherwise healthy individuals.8,9 Both sides of the argument agree that this system has essentially legalized marijuana for recreational use, at least amongst those individuals able and willing to buy a recommendation.10 The governor’s petition would potentially expand that system on a national scale, permitting any physician in any state to prescribe any form of marijuana for any medical condition. The CMA call, while a great way to generate publicity on legalization, is also predicated on a false assertion that the only way to do research into marijuana is to legalize the drug. Sadly, vociferous calls for rescheduling and legalizing like these simply further muddle and confuse an already highly charged debate.

Kevin A. Sabet, PhD, Policy Consultant and Assistant Professor, University of Florida, College of Medicine, Division of Addiction Medicine, Department of Psychiatry. To read more from Dr. Sabet, visit www.kevinsabet.com or follow him on Twitter @kevinsabet.

[1] Id. at p. 15.

[2] AMA, Council on Science and Public Health, “Use of Cannabis for Medicinal Purposes,” http://www.ama-assn.org/resources/doc/csaph/i09csaph3ft.pdf (2009) (hereinafter AMA Report).

[3] Id. at p.16.

[4] http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM070491.pdf.

[5] In order for any investigational product to move into advanced clinical research (and ultimately to new drug approval), many additional criteria must be met. Robust data must demonstrate a product’s pharmacological activity, quality (including consistent composition, extent of impurities, and stability), toxicity of various types, and efficacy in a particular patient population for a specific medical condition.

[6] See AMA Report, page 9.

[7] 21 U.S.C.§823(f).

[8] O’Connell, T and Bou-Matar , C.B. (2007). Long term marijuana users seeking medical cannabis in California (2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants. Harm Reduction Journal,  http://www.harmreductionjournal.com/content/4/1/16.

[9] Nunberg, Helen; Kilmer, Beau; Pacula, Rosalie Liccardo; and Burgdorf, James R. (2011) “An Analysis of Applicants Presenting to a Medical Marijuana Specialty Practice in California,” Journal of Drug Policy Analysis: Vol. 4: Iss. 1, Article 1. Available at: http://www.bepress.com/jdpa/vol4/iss1/art1.

[10] According to Allen St. Pierre of NORML, “in California, marijuana has also been de facto legalized under the guise of medical marijuana.” See Transcript of Don Lemon CNN Television Show with Kevin Sabet and Allen St. Pierre: http://transcripts.cnn.com/TRANSCRIPTS/0905/09/cnr.04.html. Accessed January 22, 2012.

National Guard soldiers who do not have a history of alcohol abuse have a significant risk of developing alcohol-related problems while they are deployed and afterwards, a new study suggests.

Soldiers who are at the highest risk of developing alcohol-related problems also are at risk of post-traumatic stress syndrome (PTSD) and/or depression while or after they are deployed, Medicalxpress.com reports.

The article notes that while it is known that alcohol-related problems are common in the military, few studies have examined how PTSD and depression affect the risk of alcohol abuse.

Researchers at Columbia University examined data from 963 soldiers in the Ohio Army National Guard who said they had not abused alcohol prior to their active duty. The study found 113 soldiers, or 11.7 percent, reported an alcohol abuse disorder that first occurred while they were deployed or afterwards. Among these soldiers, 31 percent also reported depression, 20 percent reported PTSD, and 13 percent reported both, the researchers write in Drug and Alcohol Dependence.

Among soldiers who developed alcohol abuse problems during and after deployment, 97 percent were male, 74 percent were younger than 35 years old, and 45 percent were single.

“A novel finding of our study is that developing depression or PTSD during or after deployment were strong risk factors for having alcohol problems during the same time period,” researcher Brandon Marshall, PhD said in a news release. He noted that because new cases of alcohol abuse were most common among soldiers who experienced depression and PTSD, it is possible that these soldiers self-medicate with alcohol to cope with negative feelings and the stress of deployment.

“The high prevalence of alcohol abuse during and after deployment observed here suggests that policies that promote improved access to care and confidentiality merit strong consideration,” he added.

UPDATED- Widely distributing the opioid overdose antidote naloxone, and training people in how to use it, could save many lives, suggests a Centers for Disease Control and Prevention (CDC) report.

Naloxone safely reverses the potentially fatal side effects of an opioid overdose, Time reports. It has successfully reversed more than 10,000 drug overdoses since 1996, according to the CDC report. The article notes naloxone is not effective in treating drug overdoses that do not involve opioids.

The medication is available by prescription only under the brand name Narcan (generic version naloxone). Only 15 states* and the District of Columbia have programs to distribute naloxone in the community, the article states. The programs train people to identify signs of an overdose and provide naloxone to people who use drugs and their loved ones.

The CDC survey found that 188 programs** that distributed naloxone found the medication was given to about 53,000 people, who were trained in recognizing and treating an overdose. The programs received reports of 10,171 overdose reversals.

“To address the substantial increases in opioid-related drug overdose deaths, public health agencies could consider comprehensive measures that include teaching laypersons how to respond to overdoses and administer naloxone to those in need,” the researchers wrote.

*The update reflects 15 states, not 17 states.

**The program number of 48 was reported incorrectly and has been updated to 188.

The arrest of four football players on the Texas Christian University (TCU) team this week on suspicion of selling marijuana points to an increasing problem in college athletics, says the Vice President of the National Center for Drug Free Sports. The four TCU students were among the 17 students arrested this week as part of a six-month drug sting.

Andrea Wickerham told the Associated Press the arrests are not an isolated incident. They came one month after the National Collegiate Athletic Association (NCAA) said 22.6 percent of 20,474 student-athletes who participated in an anonymous survey in 2009 admitted to using marijuana in the previous year—an increase from 21.2 percent in 2005.

The 2009 survey found 26.7 percent of football players and 22 percent of men’s basketball players said they used marijuana in the previous year. The survey, which has been conducted every four years since 1985, has always found alcohol to be the number-one substance of choice, with marijuana coming in second. The NCAA tests for marijuana at championship events and football bowl games, but not in its year-round testing program, according to the AP.

In 2009-2010, 1,645 student athletes were tested, and 4.3 percent were found positive for marijuana, up from 1.6 percent the previous year.

“You want to test often enough so athletes truly believe they have a likelihood of being selected,” says Wickerham, whose group administers drug tests for more than 250 colleges as well as the NCAA. “If you’re only doing it once a semester, or if you do it only when you hear about a bad event, that’s not a huge deterrent over time.”

An increase in ectopic pregnancy deaths in Florida appears to be associated with illicit drug use and delays in seeking health care, according to a new report by the Centers for Disease Control and Prevention (CDC).

Deaths from ectopic pregnancies rose fourfold in the past decade in Florida, according to HealthDay. Ectopic pregnancy is a life-threatening condition, which occurs when an egg is fertilized outside of the uterus, generally in the fallopian tube. If it is not detected, the pregnant woman may die from a hemorrhage caused by a rupture of the tube.

Between 1999 and 2008, there were 13 deaths in Florida due to ectopic pregnancies. In 2009-2010, there were 11 such deaths, the researchers reported in the CDC’s Morbidity and Mortality Weekly Report. Women who died in that one year were more likely to have collapsed from a hemorrhage before they saw a health care provider compared with women who died in the previous decade from ectopic pregnancies. Of the eight women who collapsed during 2009-2010, six tested positive for illicit drug use, including four who tested positive for cocaine. It is not possible to compare the rate of illicit drug use in this group with women who died between 1999 and 2008, because testing for illicit drugs was performed much less often during that period.

“The high prevalence of illicit drug use among the women who died highlights the need to raise public awareness about health risks associated with drug exposure during pregnancy,” the researchers wrote.

[Clinical usability and practicability of Alfaxalone for short-term anaesthesia in the cat after premedication with Buprenorphine].

Tierarztl Prax Ausg K Kleintiere Heimtiere. 2012 Feb 20;40(1):17-25

Authors: Bösing B, Tünsmeyer J, Mischke R, Beyerbach M, Kästner SB

Abstract
Objective of this clinical study was to assess the anaesthetic quality (induction and recovery) and utility of short term alfaxalone anaesthesia in healthy and diseased cats. Cardiopulmonary effects and the influence on haematological and biochemical blood parameters were evaluated. Material and methods: Twenty feline patients (ASA1-4) were anaesthetized with alfaxalone for various short surgical or diagnostic procedures. Heart rate, breathing rate, end-tidal CO2 partial pressure, arterial oxygen saturation, mean arterial blood pressure and the body temperature were measured and recorded every 10 minutes. Before, after and 6hours after anaesthesia venous blood samples were taken and haematologic and blood chemistry parameters were determined. Recovery time and quality were assessed by a numerical rating scale. Results: Anaesthetic induction was rapid and smooth in all cats. Spontaneous respiration was maintained in all cats. Cardiopulmonary parameters mostly remained within a clinically tolerable range. Noticeable was a high heart rate (mean >190 bpm) at the beginning of anaesthesia lasting up to 10 minutes. Statistically significant changes (p<0.05) occurred in some haematologic parameters (RBC, haemoglobin, haematocrit and MCV decreased), electrolytes and venous acid-base-status (bicarbonate, chloride and base excess increased, sodium and potassium decreased) and blood chemistry parameters (alanine aminotransferase, glutamate dehydrogenase and creatinine decreased). None of these changes appeared to have clinical relevance. Recovery was smooth in the majority of cats. Mild signs of hyperexcitability (muscle tremor, short term opisthotonus and hyperacusis) occurred in individual animals. The duration of recovery varied between 21 and 93 minutes. Conclusion and clinical relevance: Alfaxalone by repeated intravenous injection is suitable for short-term diagnostic and surgical procedures in cats. Because of its minor cardiovascular effects and slight respiratory depression, it is also well tolerated by patients with increased anaesthetic risk (ASA 3 and 4).

PMID: 22331325 [PubMed - in process]

Using the mouse grimace scale to reevaluate the efficacy of postoperative analgesics in laboratory mice.

J Am Assoc Lab Anim Sci. 2012;51(1):42-9

Authors: Matsumiya LC, Sorge RE, Sotocinal SG, Tabaka JM, Wieskopf JS, Zaloum A, King OD, Mogil JS

Abstract
Postoperative pain management in animals is complicated greatly by the inability to recognize pain. As a result, the choice of analgesics and their doses has been based on extrapolation from greatly differing pain models or the use of measures with unclear relevance to pain. We recently developed the Mouse Grimace Scale (MGS), a facial-expression-based pain coding system adapted directly from scales used in nonverbal human populations. The MGS has shown to be a reliable, highly accurate measure of spontaneous pain of moderate duration, and therefore is particularly useful in the quantification of postoperative pain. In the present study, we quantified the relative intensity and duration of postoperative pain after a sham ventral ovariectomy (laparotomy) in outbred mice. In addition, we compiled dose-response data for 4 commonly used analgesics: buprenorphine, carprofen, ketoprofen, and acetaminophen. We found that postoperative pain in mice, as defined by facial grimacing, lasts for 36 to 48 h, and appears to show relative exacerbation during the early dark (active) photophase. We find that buprenorphine was highly effective in inhibiting postoperative pain-induced facial grimacing in mice at doses equal to or lower than current recommendations, that carprofen and ketoprofen are effective only at doses markedly higher than those currently recommended, and that acetaminophen was ineffective at any dose used. We suggest the revision of practices for postoperative pain management in mice in light of these findings.

PMID: 22330867 [PubMed - in process]

Use of Operant Performance to Guide and Evaluate Medical Treatment in an Adult Male Cynomolgus Macaque (Macaca fascicularis).

J Am Assoc Lab Anim Sci. 2011;50(6):946-8

Authors: Hamilton LR, Cox DM, Myers TM

Abstract
A 6-y-old male cynomolgus macaque presented with noticeable swelling of the left forearm and signs of discomfort, as indicated by nonuse of the arm even in a behavioral task that he previously had been well-motivated to perform. Examination under anesthesia revealed lacerations to the arm. Radiography of the forearm showed no fractures, indicating that the damage was limited to soft tissue. The daily operant behavioral session assessed the amount of force the monkey emitted when touching the screen with the affected arm and how long each touch was sustained. We then used these parameters (force and duration of touch) as objective measures of putative pain relief and recovery of function to guide the medical treatment. The affected monkey received ketoprofen, buprenorphine, or their combination but continued to perform poorly during daily operant behavioral sessions. Only after treatment with dexamethasone did performance return to preinjury levels, suggesting inflammation near the radial or ulnar nerve. These findings indicate that performance of a trained operant task performance can be useful in guiding medical treatment, evaluating pain relief, and objectively monitoring health in laboratory animals.

PMID: 22330792 [PubMed - in process]