CDC Study Traces Tobacco Trends Among Middle and High School Students, Finding Increased Usage of E-Cigarettes MMWR, Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) released a study tracing tobacco usage trends among middle and high school students. The study found that e-cigarettes were the most commonly used tobacco product among both populations in 2014. From 2011-2014, e-cigarettes and hookah saw statistically significant increases in popularity among students while cigarettes and cigars saw decreases in usage. These changes in usage rates offset each other, resulting in no change in overall tobacco use for this population. The CDC estimates that 4.6 million middle and high school students use tobacco products. The study recommends continued implementation of proven tobacco prevention strategies.
Editor’s Comments William Haning, MD, FASAM, DFAPA Of the 11 pieces provided this week, five relate directly to cannabis. This may reflect how public interest and legislative policy can influence the pursuit of research, but is just as likely to reflect selection bias by the editor and staff at a time when controversy over the legislative status of cannabis use is boiling. It is certainly the case that a higher potency cannabis has altered the impact of usage of the drug. The articles provided yield few surprises in terms of new knowledge, yet are certainly valuable; not all important research is “news”.
Editor-in-Chief: Jeffrey Samet, Boston University School of Medicine
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
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FROM JOURNAL OF ADDICTION MEDICINE
The Stepped Treatment Engagement Protocol for Homeless, Needle Exchange Heroin-Dependent Patients Journal of Addiction Medicine (free ASAM member resource) This letter to the Editor documents a 22-day program employing both buprenorphine and needle exchange. Effectively a case series, it strongly suggests that synthesizing buprenorphine detoxification and nonjudgmental harm reduction reduces treatment-resistant needle exchange patients’ reluctance to enroll in long-term maintenance therapies...
NIDA Releases Online Course on Prescription Opioid Misuse Institute for Research, Education and Training in Addictions The National Institute on Drug Abuse (NIDA) has partnered with the Institute for Research, Education, and Training in Addictions (IRETA) to create a free online course about the prevalence of prescription opioid misuse. Although principally targeted to counselors, physician assistants, and social workers, the course, The Prevalence of Prescription Opioid Misuse: Doctor Shopping, Co-ingestion, and Exposure, aims to familiarize all health care professionals about recent clinically relevant findings from research on opioid misuse and related behaviors. Content includes a discussion of the demographics behind prescription opioid misuse, rates of opioid exposure among teens, and the prevalence of opioid co-ingestion with other substances.
Opioid Substitution Therapy—Time to Replace the Term The Lancet This op-ed by Dr. Jeff Samet asks for corrective action in the language of addiction. As physicians caring for individuals with substance use disorders, our perspective is that use of the term opioid substitution therapy has unintended adverse effects. Inappropriate terms in medicine regarding substance use can cause harm. Opioid substitution therapy, used by WHO and others, oversimplifies the neurobiology of opioid use disorders and the pharmacology of treatment. The term likewise misinforms patients, their families, the public, clinicians, and policy makers, and warrants replacement with “Opioid Agonist Therapy”.
Drug Policy Reform and the Reclassification of Cannabis in England and Wales: A Cautionary Tale The International Journal of Drug Policy A counterintuitive consequence of cannabis decriminalization is described. When the legal classification of cannabis was downgraded in 2004 it represented the most significant liberalization of British drug law in more than 30 years. Paradoxically, however, this apparently progressive reform led to an intensification of police efforts targeting minor possession offences and its failure was confirmed in January 2009 when the decision to downgrade cannabis was reversed.
Simultaneous Versus Concurrent Use of Alcohol and Cannabis in the National Alcohol Survey Alcoholism: Clinical and Experimental Research Cannabis is the most commonly used drug among those who drink, yet no study has directly compared those who use cannabis and alcohol simultaneously, or at the exact same time, versus those who use both separately and on a regular basis. In a retrospective analysis of two data sets of the National Alcohol Survey, 2005 and 2010, the authors were able to demonstrate what many clinicians had long believed: simultaneous users had double the odds of drunk driving, social consequences, and harms to self.
Racial/Ethnic Differences in Trends in Heroin Use and Heroin-Related Risk Behaviors Among Nonmedical Prescription Opioid Users Drug and Alcohol Dependence This is a discriminant analysis of National Survey on Drug Use and Health (NSDUH) data, surveys concluding six years apart (2005 and 2011). Past-year heroin use among individuals with non-medical use of prescription opioids (NMUPO) in 2008-2011 increased with almost twice the odds of heroin use as those in the 2002–2005 period (OR = 1.89, 95%CI: 1.50, 2.39). Higher increases were seen in non-Hispanic (NH) Whites and Hispanics. In summary, the risk of past year heroin use, ever injecting heroin, past-year heroin abuse or dependence, and the perception of availability of heroin increased as the frequency of NMUPO increased across respondents of all race/ethnicities.
Cannabis Use and Mania Symptoms: A Systematic Review and Meta-Analysis Journal of Affective Disorders The authors of a meta-analysis (six articles, 2391 subjects) conclude that there is an association between cannabis use and mania: “These findings whilst tentative, suggest that cannabis use may worsen the occurrence of manic symptoms in those diagnosed with bipolar disorder, and may also act as a causal risk factor in the incidence of manic symptoms. This underscores the importance of discouraging cannabis use among youth and those with bipolar disorder to help prevent chronic psychiatric morbidity. More high quality prospective studies are required to fully elucidate how cannabis use may contribute to the development of mania over time.”
Germany to Stop Pharmaceuticals Offering Doctors ‘Benefits’ for Prescribing Their Drugs Out-Law Pharmaceuticals companies will no longer be able to offer "benefits" to doctors in Germany to encourage them to prescribe their drugs, once an update to the country's criminal code comes into force. This local news item describes a penal code modification that compels a careful examination of conflict-of-interest in dealing with pharmaceutical representatives, by private care physicians.
‘This Is Going To Be Too Hard’: Keeping Kids from Using Pot National Public Radio Colorado has allowed medical marijuana since 2001, but voters amended the state constitution in 2012 to allow private marijuana consumption for adults aged 21 or older. The first-ever stores to sell state-regulated recreational pot opened their doors on Jan. 1, 2014. This series offers three different viewpoints from people who have close contact with kids as they wade through the new world of legalization. Among the contributors to this National Public Radio interview series is a police officer with a sophisticated understanding of the developmental concerns in cannabis exposure.
Cannabis-Related Episodic Memory Deficits and Hippocampal Morphological Differences in Healthy Individuals and Schizophrenia Subjects Hippocampus An MRI-based study of subjects with and without schizophrenia coupled with and without cannabis use disorder yielded significant structural variances. Cannabis use has been associated with episodic memory (EM) impairments and abnormal hippocampus morphology among both healthy individuals and schizophrenia subjects. Considering the hippocampus' role in EM, research is needed to evaluate the relationship between cannabis-related hippocampal morphology and EM among healthy and clinical groups. The authors examined differences in hippocampus morphology between control and schizophrenia subjects with and without a past (not current) cannabis use disorder (CUD).
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