Adverse Childhood Experiences and Child Health in Early Adolescence JAMA Pediatrics Child maltreatment and other adverse childhood experiences (ACEs) have been linked to depressed mood, anxiety, posttraumatic stress disorder symptoms, risk-taking behavior, early pregnancy, eating disorders, weight problems, substance use, sexually transmitted disease treatment, suicide attempts, and mental health treatment in adolescents. While epigenetics is not the focus of this article, those who have been following the rapidly developing literature surrounding sub-cellular consequences of varying types of trauma and adverse exposures will recognize this as important groundwork.
Methadone and Buprenorphine for Opioid Dependence During Pregnancy: A Retrospective Cohort Study Journal of Addiction Medicine (free ASAM member resource) These data suggest pregnancy outcomes with buprenorphine to treat opioid dependence during pregnancy in clinical practice are as good as and often better than outcomes with methadone. These results are consistent with efficacy data from randomized clinical trials and further support the use of buprenorphine for the treatment of opioid dependence during pregnancy. This is an important companion to the MOTHER Study of 2012.
NIH Study Reveals Many Americans at Risk for Alcohol-Medication Interactions National Institutes of Health Nearly 42 percent of US adults who drink also report using medications known to interact with alcohol, based on a study from the National Institutes of Health released recently. Among those over 65 years of age who drink alcohol, nearly 78 percent report using alcohol-interactive medications.
Prenatal Drug Use and Newborn Health: Federal Efforts Need Better Planning and Coordination US Government Accountability Office The proposed action outcome of this GAO study is identification of a single coordinator for studies and initiatives relating to opioid-dependency in pregnancy. The driver for it appears to have been more concern for prevention and management of Neonatal Abstinence Syndrome (NAS) and its impact on U.S. newborn health, and less on the longer-term treatment needs of the mothers. However, a blended population is served by the recommendations developed. With regard to research, the most commonly cited gaps were inadequate research on treatment of prenatal opioid use and the long-term effects of prenatal opioid exposure on children. Reasons cited for these research gaps included difficulties in conducting research, such as identifying and retaining pregnant women with substance use disorders for studies, and prenatal opioid use
and NAS not being as high a priority as other research areas.
Alcoholism: Developing Drugs for Treatment; Draft Guidance for Industry; Availability Federal Register FDA is announcing the availability of a draft guidance for industry entitled “Alcoholism: Developing Drugs for Treatment.” There is a need for additional pharmacologic treatments for alcoholism. Traditionally, alcoholism treatments have been assessed based on the number of patients who refrain from drinking altogether. Patients who attain and sustain complete abstinence from alcohol may be assumed to accrue clinical benefit. However, other patterns of drinking also may be valid surrogates for clinical benefit. This guidance provides supporting information for endpoints based on patterns of drinking that may be considered appropriate measures of clinical benefit. Included is a link for submission of commentary.
Opioid Prescription Claims Among Women of Reproductive Age CDC Morbidity and Mortality Weekly Report CDC used Truven Health's MarketScan Commercial Claims and Encounters and Medicaid data to estimate the number of opioid prescriptions dispensed by outpatient pharmacies to women aged 15–44 years. During 2008–2012, annual opioid prescription claims were consistently higher among Medicaid-enrolled women when compared with privately insured women (across the 5 years, 39.4% compared with 27.7%, p<0.001). Thus, the over-all likelihood of receiving a prescription for an opioid in any year approached 30%, in this sample of approximately 6 million American women of child-bearing age. The most frequently prescribed opioids among women in both groups were hydrocodone, codeine, and oxycodone. Efforts are needed to promote interventions to reduce opioid prescriptions among this population when safer alternative treatments
are available.
Proportion of Patients in South London with First-Episode Psychosis Attributable to Use of High Potency Cannabis: A Case-Control Study The Lancet Between May 1, 2005, and May 31, 2011, the authors obtained data from 410 patients with first-episode psychosis and 370 population controls. The risk of individuals having a psychotic disorder showed a roughly three-times increase in users of skunk-like
cannabis (high-potency, unpleasantly-aromatic) compared with those who never used cannabis (adjusted odds ratio [OR] 2•92, 95% CI 1•52–3•45, p=0•001). Use of skunk-like cannabis every day conferred the highest risk of psychotic disorders compared with no use of cannabis (adjusted OR 5•4, 95% CI 2•81–11•31, p=0•002). The population attributable fraction of first episode psychosis for skunk use for the authors' geographical area was 24% (95% CI 17–31), possibly because of the high prevalence of use of high-potency cannabis (218 [53%] of 410 patients) in this study. The Discussion section considers the likely respective roles of higher-concentration THC and lower-concentration cannabidiol, in psychotogenesis.
Lawmakers Pass Bill to Curb West Virginia Drug Overdoses West Virginia Gazette The House of Delegates unanimously passed a bill February 11 that aims to curb West Virginia’s drug overdose death rate — now the highest in the nation. The legislation allows doctors to prescribe naloxone to drug users and their family members, caregivers and friends. The same people also will be allowed to legally administer the medication for the first time.
A Q&A on Achieving Mental Health Parity in Medicaid Managed Care Kaiser Health News This interview on drug use disorder treatment parity is well-reasoned, is at points appropriately acerbic, and gives valuable background to discussions with patients of treatment availability. Emily Feinstein, the director of health law and policy at substance abuse and addiction center CASAColumbia, has been tracking the parity law’s implementation
and works with states on improving mental health and substance abuse care. If mental health and addiction services are not covered at the same level as medical, she says, there is the potential for more emergency room visits and acute care services that might not happen if people with Medicaid managed care plans had access to a weekly counseling and other mental health services.
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