Medical Supplies – Medical Products

Background Opioid overdose is a major source of morbidity and mortality in injection drug users in the United States and many other countries. Case description A case is described in which buprenorphine/naloxone (Suboxone((R))) was administered sublingually to reverse a heroin overdose. Conclusions Sublingually administered buprenorphine/naloxone might be used as a means to reverse opioid overdose.

Welsh,C　Sherman,SG　Tobin,KE
Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, Baltimore, MD, USA.

2008,103,1-7

Aim Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.

Wong,FL　Rotheram-Borus,MJ　Lightfoot,M　Pequegnat,W　Comulada,WS　Cumberland,W　Weinhardt,LS　Remien,RH　Chesney,M　Johnson,M
University of California, Los Angeles, CA, USA.

Aim Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment. Design Data were analyzed from a subset of participants in a combined data set of three published randomized controlled trials of CM treatments. Setting A community-based methadone maintenance clinic. Participants One-hundred and sixty-five cocaine-abusing methadone maintenance patients. Intervention Participants received either standard methadone treatment or standard methadone treatment with CM for 3 months. Measurements The HIV Risk Behavior Scale (HRBS) was administered prior to randomization to a study condition and 3 months after the study treatments ended. The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment. Findings Relative to those assigned to standard care, participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors. CM participants also achieved longer durations of consecutive cocaine and opioid abstinence during treatment. Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores. Conclusions These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients.

Hanson,T　Alessi,SM　Petry,NM
University of Connecticut Health Center, Farmington, CT, USA.

Aims The route of drug administration affects risk for dependence and medical harm. This study examines whether routes used by methamphetamine treatment participants were impacted by a major drug suppression policy-federal regulation of the methamphetamine precursor chemicals ephedrine and pseudoephedrine. Design Autoregressive-integrated moving average (ARIMA) intervention time-series analysis. Setting California (1992-2004). Interventions Ephedrine single-ingredient products regulation, implemented August 1995; ephedrine with other active medicinal ingredients regulation, implemented October 1996; pseudoephedrine products regulation, implemented October 1997. Measurements Monthly counts of non-coerced methamphetamine treatment admissions reporting snorting, smoking, swallowing or injecting. Findings After rising sharply, snorting, smoking, swallowing and injecting admissions dropped 50%, 43%, 26% and 26%, respectively, when the 1995 regulation was implemented. Snorting also dropped 38% at the time ofthe 1997 regulation. Snorting, swallowing and injecting remained at lower levels to the end of the study period. Smoking resurged (40%) at the time of the 1996 regulation and continued rising. Conclusions Precursor regulation was associated with changes in the administration of methamphetamine. Injecting, the route with the greatest health risk, entered a long-term reduction. So, too, did snorting and swallowing, two routes with lower risk for dependence. In contrast, smoking, which has a relatively high risk for dependence, dropped, then rebounded and entered a long-term rise. A possible explanation is that injecting, snorting and swallowing were largely linked with US domestic methamphetamine production, which has yet to recover from the regulations. While Mexican production, which was impacted only temporarily by the regulations and has supplanted domestic production, may have helped to diffuse smoking, a route with which it is historically correlated.

Cunningham,JK　Liu,LM　Muramoto,M
Department of Family and Community Medicine, The University of Arizona, Tucson, AZ, USA.

Background This is a supplemental report on tests of the long-term effects of universal preventive interventions conducted during middle school on 17-21-year-olds’ prescription drug misuse. Design/setting/participants Two randomized controlled prevention trials were conducted in public schools in the rural midwestern United States. Study 1 began in 1993, with 667 6th-graders; follow-ups with 12th-graders and 21-year-olds included 457 and 483 participants, respectively. Study 2 began in 1998 with 7th-graders (total sample across waves 2127); follow-ups with 11th- and 12th-graders included 1443 and 1212 participants, respectively. Interventions In study 1, schools were assigned to the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years, or a control condition. In study 2, schools were assigned to the school-based Life Skills Training (LST) plus a revised ISFP, called SFP 10-14 (LST + SFP 10-14), LST-only, or a control condition. Measurements Self reports of lifetime and past-year prescription drug misuse. Findings In study 1, ISFP 12th-graders’ past year narcotic misuse was significantly less than controls, as were ISFP 21-year-olds’ life-time narcotic and barbiturate misuse rates. In study 2, LST + SFP 10-14 showed significant effects on life-time prescription drug misuse at the 11th-grade follow-up, while effects at the 12th-grade follow-up were marginally significant. Conclusions Consistent with intervention effects on other substance use outcomes reported earlier, results suggest that universal interventions have potential for pubic health impact by reducing some types of prescription drug misuse among adolescents and young adults.

Spoth,R　Trudeau,L　Shin,C　Redmond,C
Partnerships in Prevention Science Institute, Iowa State University, Ames, IA, USA.

Aims This study describes alcohol consumption among adult survivors of pediatric cancer compared to sibling controls and a national sample of healthy peers. Risk factors for heavy drinking among survivors are described. Design, setting and participants Cross-sectional data were utilized from the Childhood Cancer Survivor Study including adult survivors of pediatric cancer (n = 10 398) and a sibling cohort (n = 3034). Comparison data were drawn from the National Alcohol Survey (n = 4774). Measurement Alcohol consumption, demographic, cancer diagnosis, treatment and psychosocial factors were measured. Findings Compared to peers, survivors were slightly less likely to be risky [adjusted odds ratio (OR(adj)) = 0.9; confidence interval (CI) 0.8-1.0] and heavy drinkers (OR(adj) = 0.8; CI 0.7-0.9) and more likely to be current drinkers. Compared to siblings, survivors were less likely to be current, risky and heavy drinkers. Risk factors for survivors’ heavy drinking included being age 18-21 years (OR(adj) = 2.0; 95% CI 1.5-2.6), male (OR(adj) = 2.1; 95% CI 1.8-2.6), having high school education or less (OR(adj) = 3.4; 95% CI 2.7-4.4) and drinking initiation before age 14 (OR(adj) = 6.9; 95% CI 4.4-10.8). Among survivors, symptoms of depression, anxiety or somatization, fair or poor self-assessed health, activity limitations and anxiety about cancer were associated with heavy drinking. Cognitively compromising treatment, brain tumors and older age at diagnosis were protective. Conclusions Adult survivors of childhood cancer show only a modest reduction in alcohol consumption compared to peers despite their more vulnerable health status. Distress and poorer health are associated with survivor heavy drinking. Screening for alcohol consumption should be instituted in long-term follow-up care and interventions among survivors and siblings should be established to reduce risk for early drinking.

Lown,EA　Goldsby,R　Mertens,AC　Greenfield,T　Bond,J　Whitton,J　Korcha,R　Robison,LL　Zeltzer,LK
Alcohol Research Group, Emeryville, CA, USA.

Aims Epidemiological evidence indicates a positive relationship between income and the prevalence of alcohol abuse in the general population, but an inverse relationship between income and alcohol dependence. Among those with a diagnosis of alcohol abuse, the most prevalent criterion is hazardous use, which commonly requires sufficient resources to own or access a car. The present study investigated whether the association between income and the prevalence of current alcohol abuse is accounted for by the hazardous use criterion; specifically, the drinking and driving symptoms of the hazardous use criterion. Design Face-to-face survey conducted in the 2001-02 National Epidemiologic Survey on Alcohol and Related Conditions, interviewed with the Alcohol Use Disorders and Associated Disabilities Interview 4th edition (AUDADIS-IV). Setting The United States and District of Columbia, including Alaska and Hawaii. Participants Household and group-quarters residents aged >18 years. Life-time dependence cases were excluded (n = 4781). Measurements Income was defined as past-year personal income. Outcomes were specific alcohol abuse criteria and symptom questions. Logistic regressions were performed controlling for demographics. The relationship between alcohol abuse severity indicators and income was modeled using polytomous regression. Findings Among the alcohol abuse criteria, hazardous use is the most prevalent and the only criterion to have a significant positive relationship with income (F = 20.3, df = 3, P < 0.0001). Among the hazardous use symptoms, driving after drinking (F = 13.0, df = 3, P < 0.0001) and driving while drinking (F = 9.2, df = 3, P < 0.0001) were related positively to income. Conclusions Because hazardous use is the most commonly endorsed criterion of alcohol abuse, the link with income raises questions about whether the current alcohol abuse diagnosis can capture the full range of alcohol abusers in every socio-economic class. While many psychiatric disorders exhibit an inverse relationship with socio-economic status, a selection bias may cause the alcohol abuse diagnosis to have an artificially positive relationship with income due to the necessity for access to a vehicle to be diagnosed.

Keyes,KM　Hasin,DS
New York State Psychiatric Institute, New York, NY, USA.