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Battini V, Cirnigliaro G, Giacovelli L, Boscacci M, Massara Manzo S, Mosini G, Guarnieri G, Gringeri M, Benatti B, Clementi E, Dell'Osso B, Carnovale C. Psychiatric and non-psychiatric drugs causing false positive amphetamines urine test in psychiatric patients: a pharmacovigilance analysis using FAERS. Expert Rev Clin Pharmacol 2023; 16:453-465. [PMID: 37147189 DOI: 10.1080/17512433.2023.2211261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Immunoassay urine drug screen (UDS) is frequently used in clinical practice for initial screening process, being generally available, fast, and inexpensive. Exposure to widely prescribed drugs might determine false positive UDS amphetamines, leading to diagnostic issues, wrong therapeutic choices, impairment of physician-patient relationship and legal implications. AREAS COVERED To summarize and comment on a comprehensive list of compounds responsible for UDS false positive for amphetamines, we conducted a literature review on PubMed along with a comparison with Real World Data from the Food and Drug Administration Adverse Event Reporting System (FAERS) database analysis between 2010 and 2022. Forty-four articles and 125 Individual Case Safety Reports (ICSR) involving false positive amphetamine UDS in psychiatric patients were retrieved in FAERS. EXPERT OPINION False positive results were described in literature for antidepressants, atomoxetine and methylphenidate, antipsychotics, but also for non-psychiatric drugs of common use, like labetalol, fenofibrate and metformin. Immunoassays method is usually responsible for false positive results and in most cases mass spectrometry (MS) do not eventually confirm the UDS positivity. Physicians should be aware of immunoassays' limitations and when turning to a confirmatory test. Any new cross-reaction should be reported to pharmacovigilance activities.
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Affiliation(s)
- Vera Battini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences L. Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157, Italy
| | - Luca Giacovelli
- Department of Biomedical and Clinical Sciences L. Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157, Italy
| | - Maria Boscacci
- Department of Biomedical and Clinical Sciences L. Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157, Italy
| | - Silvia Massara Manzo
- IRCCS Stella Maris Foundation, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Greta Guarnieri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Michele Gringeri
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences L. Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences L. Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157, Italy
- "Aldo Ravelli" Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- "Centro per lo studio dei meccanismi molecolari alla base delle patologie neuro-psico-geriatriche", University of Milan, Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Italy
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Cook RR, Foot C, Arah OA, Humphreys K, Rudolph KE, Luo SX, Tsui JI, Levander XA, Korthuis PT. Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addict Sci Clin Pract 2023; 18:11. [PMID: 36788634 PMCID: PMC9930351 DOI: 10.1186/s13722-023-00364-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent "real-world" populations who would benefit from treatment. METHODS We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. RESULTS Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30-49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49-0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48-1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51-1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35-1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08-0.69, p = 0.008). CONCLUSIONS Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.
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Affiliation(s)
- R R Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA.
| | - C Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - O A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Division of Physical Sciences, Department of Statistics, UCLA College, Los Angeles, CA, USA
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - K E Rudolph
- Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA
| | - S X Luo
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, USA
| | - J I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - X A Levander
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - P T Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
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Lampron MC, Paré I, Al-Zharani M, Semlali A, Loubaki L. Cannabinoid Mixture Affects the Fate and Functions of B Cells through the Modulation of the Caspase and MAP Kinase Pathways. Cells 2023; 12:588. [PMID: 36831255 PMCID: PMC9954265 DOI: 10.3390/cells12040588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Cannabis use is continuously increasing in Canada, raising concerns about its potential impact on immunity. The current study assessed the impact of a cannabinoid mixture (CM) on B cells and the mechanisms by which the CM exerts its potential anti-inflammatory properties. Peripheral blood mononuclear cells (PBMCs) were treated with different concentrations of the CM to evaluate cytotoxicity. In addition, flow cytometry was used to evaluate oxidative stress, antioxidant levels, mitochondrial membrane potential, apoptosis, caspase activation, and the activation of key signaling pathways (ERK1/2, NF-κB, STAT5, and p38). The number of IgM- and IgG-expressing cells was assessed using FluoroSpot, and the cytokine production profile of the B cells was explored using a cytokine array. Our results reveal that the CM induced B-cell cytotoxicity in a dose-dependent manner, which was mediated by apoptosis. The levels of ROS and those of the activated caspases, mitochondrial membrane potential, and DNA damage increased following exposure to the CM (3 µg/mL). In addition, the activation of MAP Kinase, STATs, and the NF-κB pathway and the number of IgM- and IgG-expressing cells were reduced following exposure to the CM. Furthermore, the exposure to the CM significantly altered the cytokine profile of the B cells. Our results suggest that cannabinoids have a detrimental effect on B cells, inducing caspase-mediated apoptosis.
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Affiliation(s)
- Marie-Claude Lampron
- Héma-Québec, Medical Affairs and Innovation, 1070 Avenue des Sciences-de-la-Vie, Québec, QC G1V 5C3, Canada
| | - Isabelle Paré
- Héma-Québec, Medical Affairs and Innovation, 1070 Avenue des Sciences-de-la-Vie, Québec, QC G1V 5C3, Canada
| | - Mohammed Al-Zharani
- Department of Biology, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia
| | - Abdelhabib Semlali
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC G1V 0A6, Canada
| | - Lionel Loubaki
- Héma-Québec, Medical Affairs and Innovation, 1070 Avenue des Sciences-de-la-Vie, Québec, QC G1V 5C3, Canada
- Department of Biochemistry, Microbiology and Bioinformatics, Laval University, Québec, QC G1V 0A6, Canada
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Bardhi K, Coates S, Watson CJ, Lazarus P. Cannabinoids and drug metabolizing enzymes: potential for drug-drug interactions and implications for drug safety and efficacy. Expert Rev Clin Pharmacol 2022; 15:1443-1460. [DOI: 10.1080/17512433.2022.2148655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Keti Bardhi
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Shelby Coates
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Christy J.W. Watson
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Philip Lazarus
- Department of Pharmaceutical Sciences, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
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Garzinsky AM, Thomas A, Thevis M. Probing for factors influencing exhaled breath drug testing in sports- Pilot studies focusing on the tested individual's tobacco smoking habit and sex. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9262. [PMID: 35094434 DOI: 10.1002/rcm.9262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE Exhaled breath (EB) was found to be a promising matrix in the field of sports drug testing due to the non-invasive and non-intrusive sampling procedure, but significant inter-individual variations regarding detected drug concentrations have been observed in previous studies. To investigate whether the detectability of doping agents in EB is affected by sex or tobacco smoking, two administration studies were conducted with male and female smokers and nonsmokers concerning the elimination of the beta blocker propranolol and the stimulant pseudoephedrine into EB. METHODS Following the administration of 40 mg propranolol or 30 mg pseudoephedrine, a total of 19 participants, including female and male nonsmokers as well as female and male smokers, collected EB and dried blood spot (DBS) samples over a period of 24 h. Respective analyte concentrations were determined using liquid chromatography and high-resolution tandem mass spectrometry, and semi-quantitative assays were characterized with regard to selectivity, limit of detection and identification, precision, linearity, and carryover. RESULTS Both propranolol and pseudoephedrine were identified in post-administration EB samples from female and male nonsmokers as well as female and male smokers, and the maximum detected drug levels ranged from 9 to 2847 pg/cartridge for propranolol and from 26 to 4805 pg/cartridge for pseudoephedrine. The corresponding DBS levels were in a range of 4-30 ng/mL for propranolol and 55-186 ng/mL for pseudoephedrine. CONCLUSIONS Neither the consumption of cigarettes nor the sex appears to represent a decisive criterion as to the detectability of propranolol or pseudoephedrine in EB, but inter-individual variations regarding the detected drug levels were observed among all studied population groups.
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Affiliation(s)
- Ann-Marie Garzinsky
- Center for Preventive Doping Research/Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Andreas Thomas
- Center for Preventive Doping Research/Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
| | - Mario Thevis
- Center for Preventive Doping Research/Institute of Biochemistry, German Sport University Cologne, Cologne, Germany
- European Monitoring Center for Emerging Doping Agents, Cologne/Bonn, Germany
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Mahmoudinoodezh H, Telukutla SR, Bhangu SK, Bachari A, Cavalieri F, Mantri N. The Transdermal Delivery of Therapeutic Cannabinoids. Pharmaceutics 2022; 14:pharmaceutics14020438. [PMID: 35214170 PMCID: PMC8876728 DOI: 10.3390/pharmaceutics14020438] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023] Open
Abstract
Recently, several studies have indicated an increased interest in the scientific community regarding the application of Cannabis sativa plants, and their extracts, for medicinal purposes. This plant of enormous medicinal potential has been legalised in an increasing number of countries globally. Due to the recent changes in therapeutic and recreational legislation, cannabis and cannabinoids are now frequently permitted for use in clinical settings. However, with their highly lipophilic features and very low aqueous solubility, cannabinoids are prone to degradation, specifically in solution, as they are light-, temperature-, and auto-oxidation-sensitive. Thus, plant-derived cannabinoids have been developed for oral, nasal-inhalation, intranasal, mucosal (sublingual and buccal), transcutaneous (transdermal), local (topical), and parenteral deliveries. Among these administrations routes, topical and transdermal products usually have a higher bioavailability rate with a prolonged steady-state plasma concentration. Additionally, these administrations have the potential to eliminate the psychotropic impacts of the drug by its diffusion into a nonreactive, dead stratum corneum. This modality avoids oral administration and, thus, the first-pass metabolism, leading to constant cannabinoid plasma levels. This review article investigates the practicality of delivering therapeutic cannabinoids via skin in accordance with existing literature.
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Affiliation(s)
- Haleh Mahmoudinoodezh
- The Pangenomics Lab, School of Science, RMIT University, Bundoora, VIC 3083, Australia; (H.M.); (S.R.T.); (A.B.)
| | - Srinivasa Reddy Telukutla
- The Pangenomics Lab, School of Science, RMIT University, Bundoora, VIC 3083, Australia; (H.M.); (S.R.T.); (A.B.)
| | | | - Ava Bachari
- The Pangenomics Lab, School of Science, RMIT University, Bundoora, VIC 3083, Australia; (H.M.); (S.R.T.); (A.B.)
| | - Francesca Cavalieri
- Applied Chemistry and Environmental Science, RMIT University, Melbourne, VIC 3000, Australia;
| | - Nitin Mantri
- The Pangenomics Lab, School of Science, RMIT University, Bundoora, VIC 3083, Australia; (H.M.); (S.R.T.); (A.B.)
- The UWA Institute of Agriculture, The University of Western Australia, Perth, WA 6009, Australia
- Correspondence:
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Gallagher JP, Twohig PA, Crnic A, Rochling FA. Illicit Drug Use and Endoscopy: When Do We Say No? Dig Dis Sci 2022; 67:5371-5381. [PMID: 35867192 PMCID: PMC9306238 DOI: 10.1007/s10620-022-07619-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/11/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Illicit drug use (IDU) is often encountered in patients undergoing elective ambulatory surgical procedures such as endoscopy. Given the variety of systemic effects of these drugs, sedation and anesthetics are believed to increase the risk of cardiopulmonary complications during procedures. Procedural cancelations are common, regardless of the drug type, recency of use, and total dosage consumed. There is a lack of institutional and society recommendations regarding the optimal approach to performing outpatient endoscopy on patients with IDU. AIM To review the literature for current recommendations regarding the optimal management of outpatient elective endoscopic procedures in patients with IDU. Secondary aim is to provide guidance for clinicians who encounter IDU in endoscopic practice. METHODS Systematic review of PubMed, CINAHL, Embase, and Google Scholar for articles presenting data on outcomes of elective procedures in patients using illicit drugs. RESULTS There are no clinically relevant differences in periprocedural complications or mortality in cannabis users compared to non-users. Endoscopy in patients with remote cocaine use was also found to have similar outcomes to recent use. CONCLUSIONS Canceling endoscopic procedures in patients with recent IDU without consideration of the type of drug, dosage, and chronicity may lead to unnecessary delays in care and increased patient morbidity. Healthcare systems would benefit from additional guidelines for evaluating the patient with recent illicit drug use for acute intoxication and consider proceeding with procedures in the non-toxic population.
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Affiliation(s)
- John P. Gallagher
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Patrick A. Twohig
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Fedja A. Rochling
- Division of Gastroenterology & Hepatology, University of Nebraska Medical Center, 982000 Medical Center Drive, Omaha, NE 68198 USA
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Smid MC, Metz TD, McMillin GA, Mele L, Casey BM, Reddy UM, Wapner RJ, Thorp JM, Saade GR, Tita ATN, Miller ES, Rouse DJ, Sibai B, Costantine MM, Mercer BM, Caritis SN. Prenatal Nicotine or Cannabis Exposure and Offspring Neurobehavioral Outcomes. Obstet Gynecol 2022; 139:21-30. [PMID: 34856574 PMCID: PMC8715943 DOI: 10.1097/aog.0000000000004632] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To study the association between nicotine or cannabis metabolite presence in maternal urine and child neurodevelopmental outcomes. METHODS We conducted a secondary analysis of two parallel multicenter randomized controlled trials of treatment for hypothyroxinemia or subclinical hypothyroidism among pregnant individuals enrolled at 8-20 weeks of gestation. All maternal-child dyads with a maternal urine sample at enrollment and child neurodevelopmental testing were included (N=1,197). Exposure was urine samples positive for nicotine (cotinine) or cannabis 11-nor-9-carboxy-delta-9-tetrahydrocannabinol [THC-COOH]) or both metabolites. Primary outcome was child IQ at 60 months. Secondary outcomes included cognitive, motor and language, attention, behavioral and social competency, and differential skills assessments at 12, 24, 36, and 48 months. Quantile regression analysis was performed with confounder adjustment. RESULTS Of 1,197 pregnant individuals, 99 (8.3%) had positive cotinine samples and 47 (3.9%) had positive THC-COOH samples; 33 (2.8%) were positive for both. Groups differed in self-reported race and ethnicity, education, marital status, insurance, and thyroid status. Median IQ was similar between cotinine-exposed and -unexposed children (90 vs 95, adjusted difference in medians -2.47, 95% CI -6.22 to 1.29) and THC-COOH-exposed and -unexposed children (89 vs 95, adjusted difference in medians -1.35, 95% CI -7.76 to 5.05). In secondary outcome analysis, children with THC-COOH exposure compared with those unexposed had higher attention scores at 48 months of age (57 vs 49, adjusted difference in medians 6.0, 95% CI 1.11-10.89). CONCLUSIONS Neither prenatal nicotine nor cannabis exposure was associated with a difference in IQ. Cannabis exposure was associated with worse attention scores in early childhood. Longitudinal studies assessing associations between child neurodevelopmental outcomes and prenatal nicotine and cannabis exposure with a focus on timing and quantity of exposure are needed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00388297.
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Affiliation(s)
- Marcela C Smid
- Departments of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, University of Texas-Southwestern, Dallas, Texas, Columbia University, New York, New York, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Texas Medical Branch at Galveston, Galveston, Texas, University of Alabama at Birmingham, Birmingham, Alabama, Northwestern University, Chicago, Illinois, Brown University, Providence, Rhode Island, University of Texas-Houston, Houston, Texas, The Ohio State University, Columbus, Ohio, Case Western Reserve University, Cleveland, Ohio, and University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Pathology, University of Utah Health and ARUP Laboratories, Salt Lake City, Utah; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Mapping the Chemistry of Hair Strands by Mass Spectrometry Imaging-A Review. Molecules 2021; 26:molecules26247522. [PMID: 34946604 PMCID: PMC8706971 DOI: 10.3390/molecules26247522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Hair can record chemical information reflecting our living conditions, and, therefore, strands of hair have become a potent analytical target within the biological and forensic sciences. While early efforts focused on analyzing complete hair strands in bulk, high spatial resolution mass spectrometry imaging (MSI) has recently come to the forefront of chemical hair-strand analysis. MSI techniques offer a localized analysis, requiring fewer de-contamination procedures per default and making it possible to map the distribution of analytes on and within individual hair strands. Applying the techniques to hair samples has proven particularly useful in investigations quantifying the exposure to, and uptake of, toxins or drugs. Overall, MSI, combined with optimized sample preparation protocols, has improved precision and accuracy for identifying several elemental and molecular species in single strands of hair. Here, we review different sample preparation protocols and use cases with a view to make the methodology more accessible to researchers outside of the field of forensic science. We conclude that—although some challenges remain, including contamination issues and matrix effects—MSI offers unique opportunities for obtaining highly resolved spatial information of several compounds simultaneously across hair surfaces.
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Kelly LM, Crane CA, Zajac K, Easton CJ. The Impact of Depressive Symptoms on Response to Integrated Cognitive Behavioral Therapy for Substance Use Disorders and Intimate Partner Violence. ADVANCES IN DUAL DIAGNOSIS 2021; 14:85-98. [PMID: 34733357 DOI: 10.1108/add-09-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. We hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. Design/methodology/approach A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n=29) to those in DC (n=34). Findings Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (e.g., family, strangers) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. Originality Although integrated CBT's efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated. Practical Implications Integrated CBT buffered depressive symptoms' impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. Research Limitations/Implications This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.
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Affiliation(s)
- Lourah M Kelly
- Rochester Institute of Technology, College of Health Sciences and Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623.,University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030
| | - Cory A Crane
- Rochester Institute of Technology, College of Health Sciences and Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623
| | - Kristyn Zajac
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030
| | - Caroline J Easton
- Rochester Institute of Technology, College of Health Sciences and Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623.,University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030
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Mumford SL, Flannagan KS, Radoc JG, Sjaarda LA, Zolton JR, Metz TD, Plowden TC, Perkins NJ, DeVilbiss EA, Andriessen VC, A C PS, Kim K, Yisahak SF, Freeman JR, Alkhalaf Z, Silver RM, Schisterman EF. Cannabis use while trying to conceive: a prospective cohort study evaluating associations with fecundability, live birth and pregnancy loss. Hum Reprod 2021; 36:1405-1415. [PMID: 33421071 DOI: 10.1093/humrep/deaa355] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 11/19/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is cannabis use assessed via urinary metabolites and self-report during preconception associated with fecundability, live birth and pregnancy loss? SUMMARY ANSWER Preconception cannabis use was associated with reduced fecundability among women with a history of pregnancy loss attempting pregnancy despite an increased frequency of intercourse. WHAT IS KNOWN ALREADY Cannabis use continues to rise despite limited evidence of safety during critical windows of pregnancy establishment. While existing studies suggest that self-reported cannabis use is not associated with fecundability, self-report may not be reliable. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out including 1228 women followed for up to six cycles while attempting pregnancy (2006 to 2012), and throughout pregnancy if they conceived. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged 18-40 years with a history of pregnancy loss (n = 1228) were recruited from four clinical centers. Women self-reported preconception cannabis use at baseline and urinary tetrahydrocannabinol metabolites were measured throughout preconception and early pregnancy (up to four times during the study: at baseline, after 6 months of follow-up or at the beginning of the conception cycle, and weeks 4 and 8 of pregnancy). Time to hCG-detected pregnancy, and incidence of live birth and pregnancy loss were prospectively assessed. Fecundability odds ratios (FOR) and 95% CI were estimated using discrete time Cox proportional hazards models, and risk ratios (RRs) and 95% CI using log-binomial regression adjusting for age, race, BMI, education level, baseline urine cotinine, alcohol use and antidepressant use. MAIN RESULTS AND THE ROLE OF CHANCE Preconception cannabis use was 5% (62/1228), based on combined urinary metabolite measurements and self-report, and 1.3% (11/789) used cannabis during the first 8 weeks of gestation based on urinary metabolites only. Women with preconception cannabis use had reduced fecundability (FOR 0.59; 95% CI 0.38, 0.92). Preconception cannabis use was also associated with increased frequency of intercourse per cycle (9.4 ± 7 versus 7.5 ± 7 days; P = 0.02) and higher LH (percentage change 64%, 95% CI 3, 161) and higher LH:FSH ratio (percentage change 39%, 95% CI 7, 81). There were also suggestive, though imprecise, associations with anovulation (RR 1.92, 95% CI 0.88, 4.18), and live birth (42% (19/45) cannabis users versus 55% (578/1043) nonusers; RR 0.80, 95% CI 0.57, 1.12). No associations were observed between preconception cannabis use and pregnancy loss (RR 0.81, 95% CI 0.46, 1.42). Similar results were observed after additional adjustment for parity, income, employment status and stress. We were unable to estimate associations between cannabis use during early pregnancy and pregnancy loss due to limited sample size. LIMITATIONS, REASONS FOR CAUTION Owing to the relatively few cannabis users in our study, we had limited ability to make conclusions regarding live birth and pregnancy loss, and were unable to account for male partner use. While results were similar after excluding smokers, alcohol use and any drug use in the past year, some residual confounding may persist due to these potential co-exposures. WIDER IMPLICATIONS OF THE FINDINGS These findings highlight potential risks on fecundability among women attempting pregnancy with a history of pregnancy loss and the need for expanded evidence regarding the reproductive health effects of cannabis use in the current climate of increasing legalization. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland (Contract numbers: HHSN267200603423, HHSN267200603424, HHSN267200603426, HHSN275201300023I). Jeannie G. Radoc has been funded by the National Institutes of Health Medical Research Scholars Program, a public-private partnership supported jointly by the National Institutes of Health and generous contributions to the Foundation for the National Institutes of Health from the Doris Duke Charitable Foundation (DDCF Grant # 2014194), Genentech, Elsevier, and other private donors. The authors report no conflict of interest in this work and have nothing to disclose. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT00467363.
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Affiliation(s)
- S L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - K S Flannagan
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - J G Radoc
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - L A Sjaarda
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - J R Zolton
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - T D Metz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - T C Plowden
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - N J Perkins
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - E A DeVilbiss
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - V C Andriessen
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - Purdue-Smithe A C
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - K Kim
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - S F Yisahak
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - J R Freeman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - Z Alkhalaf
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
| | - R M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | - E F Schisterman
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA
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12
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Boyles GP, Costantine MM. Septic arthritis of the pubic symphysis in pregnancy. BMJ Case Rep 2020; 13:13/11/e236470. [PMID: 33139358 DOI: 10.1136/bcr-2020-236470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Septic arthritis of the pubic symphysis is a rare but serious entity which can be difficult to distinguish from common pregnancy-related problems. The following highlights the risk factors and clinical features of this uncommon condition and describes its diagnosis and management. The patient is a 26-year-old gravida 2 para 1 (second pregnancy that lasted >20 weeks and one prior term delivery) who presented to the labour and delivery triage unit of a tertiary care centre at 23 weeks' gestation with pelvis and hip pain. The patient had elevated inflammatory markers and Staphylococcal bacteraemia. MRI demonstrated pubic symphyseal septic arthritis and osteomyelitis. The patient underwent two fluoroscopy-guided joint aspirations; synovial fluid contained abundant neutrophils and grew colonies of methicillin-susceptible Staphylococcus aureus She then completed 6 weeks of intravenous antibiotic therapy. Repeat MRI of the pelvis at 31 weeks' gestation was favourable. The patient underwent caesarean delivery at 39 weeks' gestation without complication. Pelvic pain is common in pregnancy. However, abnormal musculoskeletal exam findings, historical elements and elevated inflammatory markers may suggest septic arthritis or osteomyelitis of the pubic symphysis. Accurate microbial identification, aggressive source control and multidisciplinary treatment are essential to optimal maternal and pregnancy outcomes.
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Affiliation(s)
- Glenn Patrick Boyles
- Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maged M Costantine
- Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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13
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Mirzaei H, O'Brien A, Tasnim N, Ravishankara A, Tahmooressi H, Hoorfar M. Topical review on monitoring tetrahydrocannabinol in breath. J Breath Res 2020; 14:034002. [PMID: 31842004 DOI: 10.1088/1752-7163/ab6229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Legalization of cannabis for recreational use has compelled governments to seek new tools to accurately monitor Δ9-tetrahydrocannabinol (Δ9-THC) and understand its effect on impairment. Various methods have been employed to measure Δ9-THC, and its respective metabolites, in different biological matrices. Recently, breath analysis has gained interest as a non-invasive method for the detection of chemicals that are either produced as part of biological processes or are absorbed from the environment. Existing breath analyzers function by analyzing previously collected samples or by direct real-time analysis. Portable hand-held devices are of particular interest for law enforcement and personal use. This paper reviews and compares both commercially available and prototype devices that proclaim Δ9-THC detection in exhaled breath using methods such as Field Asymmetric Ion Mobility Spectrometry, Semiconductor-Enriched Single-Walled Carbon Nanotube chemiresistors, Liquid Chromatography Tandem-mass Spectrometry, microfluidic-based artificial olfaction, and optical-based gas sensing.
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14
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Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B. Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl. J Med Toxicol 2020; 16:41-48. [PMID: 31471760 PMCID: PMC6942078 DOI: 10.1007/s13181-019-00735-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/01/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Illicitly manufactured fentanyl (IMF) is responsible for a growing number of deaths. Some case series have suggested that IMF overdoses require significantly higher naloxone doses than heroin overdoses. Our objective was to determine if the naloxone dose required to treat an opioid overdose is associated with the finding of fentanyl, opiates, or both on urine drug screen (UDS). METHODS A retrospective chart review was conducted at a single emergency department and its affiliated emergency medical services (EMS) agency. The charts of all patients who received naloxone through this EMS from 1/1/2017 to 6/15/2018 were reviewed. The study included patients diagnosed with a non-suicidal opioid overdose whose UDS was positive for opiates, fentanyl, or both. Data collected included demographics, vital signs, initial GCS, EMS and ED naloxone administrations, response to treatment, laboratory findings, and ED disposition. The fentanyl-only and fentanyl + opiate groups were compared to the opiate-only group using the stratified (by ED provider) variant of the Mann-Whitney U test. RESULTS Eight hundred and thirty-seven charts were reviewed, and 121 subjects were included in the final analysis. The median age of included subjects was 38 years and 75% were male. In the naloxone dose analysis, neither the fentanyl-only (median 0.8 mg, IQR 0.4-1.6; p = 0.68) nor the fentanyl + opiate (median 0.8 mg, IQR 0.4-1.2; p = 0.56) groups differed from the opiate-only group (median 0.58 mg, IQR 0.4-1.6). CONCLUSION Our findings refute the notion that high potency synthetic opioids like illicitly manufactured fentanyl require increased doses of naloxone to successfully treat an overdose. There were no significant differences in the dose of naloxone required to treat opioid overdose patients with UDS evidence of exposure to fentanyl, opiates, or both. Further evaluation of naloxone stocking and dosing protocols is needed.
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Affiliation(s)
- Joseph Carpenter
- Georgia Poison Center, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA.
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Sukhshant Atti
- Georgia Poison Center, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA
| | - Tim P Moran
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Arthur Yancey
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Brent Morgan
- Georgia Poison Center, 50 Hurt Plaza SE, Suite 600, Atlanta, GA, 30303, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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15
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Ma J, He Y, Zeng K, Liu X. Positive Urine Morphine Test in a Chinese Patient Receiving Methadone Maintenance Treatment After Eating Hot Pot: A Case Report. Front Psychiatry 2020; 11:637. [PMID: 32719626 PMCID: PMC7348055 DOI: 10.3389/fpsyt.2020.00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Poppy shells contain opioids. It is a popular, but illegal spice in China. If these shells are added to food, urine morphine test of the patients involved in methadone maintenance treatment (MMT) can turn out positive. A 44-year-old male patient, who had been receiving MMT for 12 years with an extremely good treatment adherence, presented with positive urine morphine test in routine clinical compliance monitoring. However, the patient denied the use of any opioids recently. Coincidently, all of his four family members (none with a history of heroin abuse) showed positive results in urine morphine test. Considering that all these people ate a hot pot together a day before the test added to the speculation that the positive result could be due to the addition of poppy shell to the hot pot. Based on our results, we propose that this unusual phenomenon is worthy of clinical attention when managing patients at MMT clinics.
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Affiliation(s)
- Jun Ma
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yafei He
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Kuan Zeng
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Xuebing Liu
- Affiliated Wuhan Mental Health Center, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
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16
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Archie SR, Cucullo L. Harmful Effects of Smoking Cannabis: A Cerebrovascular and Neurological Perspective. Front Pharmacol 2019; 10:1481. [PMID: 31920665 PMCID: PMC6915047 DOI: 10.3389/fphar.2019.01481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022] Open
Abstract
Apart from being used as a medicine, cannabis or marijuana is the most widely abused recreational drug all over the world. The legalization and decriminalization of cannabis in Canada and various states of USA may be the underlying reason of the widespread popularity of it among young population. Various studies have reported about the relationship between cannabis use and different detrimental effects like cardiovascular, cerebrovascular, and neurological complications among different age groups. Specifically, the young population is getting adversely affected by this, harmful yet, readily accessible recreational drug. Although the mechanism behind cannabis mediated neurological and cerebrovascular complications has not been elucidated yet, the results of these studies have confirmed the association of these diseases with cannabis. Given the lack of comprehensive study relating these harmful complications with cannabis use, the aim of this narrative literature review article is to evaluate and summarize current studies on cannabis consumption and cerebrovascular/neurological diseases along with the leading toxicological mechanisms.
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Affiliation(s)
- Sabrina Rahman Archie
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States
| | - Luca Cucullo
- Department of Pharmaceutical Sciences, Texas Tech University Health Sciences Center, Amarillo, TX, United States.,Center for Blood Brain Barrier Research, Texas Tech University Health Sciences Center, Amarillo, TX, United States
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17
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Liang P, Li F, Laramee B, Musselman B. Effect of reducing sample volume on the detection of drugs in urine by transmission mode direct analysis in real time mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2019; 35 Suppl 2:e8688. [PMID: 31794630 DOI: 10.1002/rcm.8688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
RATIONALE Matrix interference attributed to urea and other nitrogenous substances in unprocessed urine is significant. In this study desorption ionization of sub-microliter volume samples is performed in an effort to improve the detection of drugs in unprocessed urine using transmission mode-direct analysis in real time mass spectrometry (TM-DART-MS). METHODS Urine samples were spiked with analytical standards of two drugs of abuse, codeine and methadone. Various sub-microliter volumes of unprocessed urine were deposited onto wire mesh screen consumables and analyzed using TM-DART for desorption ionization and a high-resolution mass spectrometer operated in full scan mode for mass analysis. A 22 factorial design of experiment (DOE) was employed to examine the effects of sample volume and sample introduction speed to the DART source. RESULTS Results from analysis of one microliter and sub-microliter sample volumes were compared by measuring the signal produced by TM-DART-MS. Based on an α of 0.05, the lower-volume samples yielded spectra where the abundance of urea and creatinine ions was reduced, thus significantly improving the TM-DART-MS signal for drugs of abuse. Using slower sample introduction speeds increased the time during which the sample was exposed to the heated ionization gas, resulting in a significant increase in the TM-DART-MS signal. CONCLUSIONS Reducing the sample volume to sub-microliter levels improved the detection of drugs of abuse present as either individual or multiple components of the untreated urine. The improved signal demonstrates the potential for using sub-microliter volumes for screening drugs in urine without the need for chromatography or sample pretreatment.
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Affiliation(s)
- Paul Liang
- IonSense, Inc., 999 Broadway, Saugus, MA, 01906, USA
| | - Frederick Li
- IonSense, Inc., 999 Broadway, Saugus, MA, 01906, USA
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18
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Ondersma SJ, Chang G, Blake-Lamb T, Gilstad-Hayden K, Orav J, Beatty JR, Goyert GL, Yonkers KA. Accuracy of five self-report screening instruments for substance use in pregnancy. Addiction 2019; 114:1683-1693. [PMID: 31216102 PMCID: PMC8407406 DOI: 10.1111/add.14651] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The accuracy of current screening instruments for identification of substance use in pregnancy is unclear, particularly given methodological shortcomings in existing research. This diagnostic accuracy study compared five existing instruments for ability to identify illicit drug, opioid and alcohol use, under privacy expectations consistent with applied practice and using a gold standard incorporating toxicological analysis. DESIGN Prospective cross-sectional screening accuracy study. SETTING Three sites encompassing four prenatal care clinics in the United States. PARTICIPANTS Convenience sample of 1220 racially, ethnically and socio-economically diverse pregnant women aged 18 years and over. MEASUREMENTS In Phase I, participants completed the five screening instruments in counterbalanced order. Instruments included the Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT (acronym for five-item screener with items related to car, relax, alone, forget, friends and trouble), 5Ps (parents, peers, partner, pregnancy, past), Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (NIDA) Quick Screen. In Phase II, participants provided a urine sample and completed a calendar recall-based interview regarding substance use. These screeners were tested, using receiver operating characteristic (ROC) analysis and accuracy statistics, against a reference standard consisting of substance use in three classes (illicit drugs, opioids and alcohol), considered positive if use was evident via 30-day calendar recall or urine analysis. FINDINGS Three hundred and fifteen of 1220 participants (26.3%) met reference standard criteria for positivity. The single-item screening questions from the NIDA Quick Screen showed high specificity (0.99) for all substances, but very poor sensitivity (0.10-0.27). The 5Ps showed high sensitivity (0.80-0.88) but low specificity (0.35-0.37). The CRAFFT, SURP-P and 5Ps had the highest area under the curve (AUC) for alcohol (0.67, 0.66 and 0.62, respectively), and the WIDUS had the highest AUC for illicit drugs and opioids (0.70 and 0.69, respectively). Performance of all instruments varied significantly with race, site and economic status. CONCLUSIONS Of five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile-Pregnancy (SURP-P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.
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Affiliation(s)
- Steven J. Ondersma
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Grace Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Tiffany Blake-Lamb
- Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - John Orav
- Department of Medicine (Biostatistics) and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica R. Beatty
- Merrill Palmer Skillman Institute and Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Gregory L. Goyert
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Kimberly A. Yonkers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
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19
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Grigoriadis CE, Cork DP, Dembitsky W, Jaski BE. Recurrent Cardiogenic Shock Associated with Cannabis Use: Report of a Case and Review of the Literature. J Emerg Med 2019; 56:319-322. [DOI: 10.1016/j.jemermed.2018.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/01/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
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20
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Gargya A, Trehan G, McCaughan S. List of Addictive Drugs and Their Metabolites in Urine. Pain 2019. [DOI: 10.1007/978-3-319-99124-5_250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Zinka B, Epple S, Schick S, Skopp G, Graw M, Musshoff F. Can a threshold for 11-nor-9-carboxy-Δ9
-tetrahydrocannabinol in hair be derived when its respective concentration in blood serum indicates regular use? Drug Test Anal 2018; 11:325-330. [DOI: 10.1002/dta.2496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Bettina Zinka
- Institute of Forensic Medicine; Nußbaumstr. 26 80336 Munich Germany
| | - Sabine Epple
- Institute of Forensic Medicine; Nußbaumstr. 26 80336 Munich Germany
| | - Sylvia Schick
- Institute of Forensic Medicine; Nußbaumstr. 26 80336 Munich Germany
| | - Gisela Skopp
- Forensic Toxicological Centre GmbH; Bayerstr. 53 80335 Munich Germany
| | - Matthias Graw
- Institute of Forensic Medicine; Nußbaumstr. 26 80336 Munich Germany
| | - Frank Musshoff
- Forensic Toxicological Centre GmbH; Bayerstr. 53 80335 Munich Germany
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22
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Zhou F, Zimmermann K, Xin F, Scheele D, Dau W, Banger M, Weber B, Hurlemann R, Kendrick KM, Becker B. Shifted balance of dorsal versus ventral striatal communication with frontal reward and regulatory regions in cannabis-dependent males. Hum Brain Mapp 2018; 39:5062-5073. [PMID: 30277629 DOI: 10.1002/hbm.24345] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/15/2018] [Accepted: 07/26/2018] [Indexed: 12/15/2022] Open
Abstract
The transition from voluntary to addictive behavior is characterized by a loss of regulatory control in favor of reward driven behavior. Animal models indicate that this process is neurally underpinned by a shift in ventral-dorsal striatal control of behavior; however, this shift has not been directly examined in humans. The present resting state functional magnetic resonance imaging (fMRI) study employed a two-step approach to: (a) precisely map striatal alterations using a novel, data-driven network classification strategy combining intrinsic connectivity contrast with multivoxel pattern analysis and, (b) to determine whether a ventral to dorsal striatal shift in connectivity with reward and regulatory control regions can be observed in abstinent (28 days) male cannabis-dependent individuals (n = 24) relative to matched controls (n = 28). Network classification revealed that the groups can be reliably discriminated by global connectivity profiles of two striatal regions that mapped onto the ventral (nucleus accumbens) and dorsal striatum (caudate). Subsequent functional connectivity analysis demonstrated a relative shift between ventral and dorsal striatal communication with fronto-limbic regions that have been consistently involved in reward processing (rostral anterior cingulate cortex [ACC]) and executive/regulatory functions (dorsomedial prefrontal cortex [PFC]). Specifically, in the cannabis-dependent subjects, connectivity between the ventral striatum with the rostral ACC increased, whereas both striatal regions were uncoupled from the regulatory dorsomedial PFC. Together, these findings suggest a shift in the balance between dorsal and ventral striatal control in cannabis dependence. Similar changes have been observed in animal models and may promote the loss of control central to addictive behavior.
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Affiliation(s)
- Feng Zhou
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Kaeli Zimmermann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - Fei Xin
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Dirk Scheele
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - Wolfgang Dau
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, Bonn, Germany
| | - Markus Banger
- Department of Addiction and Psychotherapy, LVR-Clinic Bonn, Bonn, Germany
| | - Bernd Weber
- Center for Economics and Neuroscience, Department of Epileptology, University of Bonn, Bonn, Germany.,Department of Neurocognition, Life & Brain Center, Bonn, Germany
| | - René Hurlemann
- Department of Psychiatry and Division of Medical Psychology, University of Bonn, Bonn, Germany
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
| | - Benjamin Becker
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Marsden J, Goetz C, Meynen T, Mitcheson L, Stillwell G, Eastwood B, Strang J, Grey N. Memory-focused cognitive therapy for cocaine use disorder: Rationale, design and protocol for an external pilot randomised controlled trial. Contemp Clin Trials Commun 2017; 8:264-273. [PMID: 29696218 PMCID: PMC5898541 DOI: 10.1016/j.conctc.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/18/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cocaine use disorder (CUD) is a debilitating condition characterised by maladaptive cocaine-related memories and impaired cognitive and behavioural control. There are no evidence-supported pharmacotherapies and only weakly effective psychological interventions specific for CUD. Our novel Memory-focused Cognitive Therapy (MFCT) aims to modify cocaine-related memories to reduce craving and drug use. METHODS This is a single-centre (outpatient), 15-week, two-arm, pilot randomised controlled trial (RCT) to address feasibility, safety, quality and preliminary efficacy. Thirty participants (adults ≥18 years; current CUD) will receive ongoing standard care (treatment-as-usual [TAU]) during the study and will be randomised (1:1) to a control or intervention group. The control group will receive 3 × 90min CUD cognitive case conceptualisation assessments and 2 × 30min cocaine-related cue-induction procedures (in vivo presentation of images and objects). Experimental group participants will receive 3 × 90min CUD cognitive case conceptualisation assessments; 2 × 30min cue-induction procedures; and individual MFCT (5 × 120min; daily for 1 week; with 3 relapse prevention follow-ups over 3-months). All study participants will complete research follow-ups at 1-week, 1-month and 3-months. The experimental and control groups will be compared on the mean score on the frequency version of the Craving Experience Questionnaire at 1-month (primary outcome measure). Secondary outcomes include: percentage of days abstinent and longest period of continuous abstinence from cocaine (past 28-days at 1-month follow-up); urine drug screen and CUD diagnosis (DSM-5). CONCLUSIONS We will conduct a full external pilot RCT of a novel, MFCT for CUD. The findings will inform the case, and necessary modifications, for a substantive study.
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Affiliation(s)
- John Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Camille Goetz
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Tim Meynen
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Luke Mitcheson
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Garry Stillwell
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Brian Eastwood
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - John Strang
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
- South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, United Kingdom
- Department of Psychology, University of Sussex, United Kingdom
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Meier SI, Koelzer SC, Schubert-Zsilavecz M, Toennes SW. Analysis of drugs of abuse in Cerumen - correlation of postmortem analysis results with those for blood, urine and hair. Drug Test Anal 2017; 9:1572-1585. [DOI: 10.1002/dta.2177] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Sylvia I. Meier
- Institute of Legal Medicine; Goethe-University Frankfurt; Kennedyallee 104 D-60596 Frankfurt/Main Germany
| | - Sarah C. Koelzer
- Institute of Legal Medicine; Goethe-University Frankfurt; Kennedyallee 104 D-60596 Frankfurt/Main Germany
| | - Manfred Schubert-Zsilavecz
- Institute for Pharmaceutical Chemistry; Goethe-University Frankfurt; Max-von-Laue-Str. 9 D-60438 Frankfurt/Main Germany
| | - Stefan W. Toennes
- Institute of Legal Medicine; Goethe-University Frankfurt; Kennedyallee 104 D-60596 Frankfurt/Main Germany
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Utility of Point-of-care Urine Drug Tests in the Treatment of Primary Care Patients With Drug Use Disorders. J Addict Med 2017; 10:196-201. [PMID: 27159345 DOI: 10.1097/adm.0000000000000220] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine if urine drug tests (UDTs) can detect under-reporting of drug use (ie, negative self-report, but positive UDT) and identify patient characteristics associated with underreporting when treating substance use disorders in primary care. METHODS Self-reported use (last 30 d) and UDTs were gathered at baseline, 3, 6, 9, and 12 months from 829 primary care patients participating in a drug use intervention study. Rates of under-reporting were calculated for all drugs, cannabis, stimulants, opioids, and sedatives. Logistic regressions were used to identify characteristics associated with under-reporting. RESULTS Among the participants, 40% (n = 331) denied drug use in the prior 30 days despite a corresponding positive UDT during at least 1 assessment. Levels of under-reporting during 1 or more assessments were 3% (n = 22) for cannabis, 20% (n = 167) for stimulants, 27% (n = 226) for opioids, and 13% (n = 106) for sedatives. Older (odds ratio [OR] 1.04), female (OR 1.66), or disabled (OR 1.42) individuals were more likely to under-report any drug use. Under-reporting of stimulant use was also more likely in individuals with lower levels of educational attainment, previous arrests, and family and social problems. Under-reporting of opioid use was more likely in those with other drug problems, but less likely in those with better physical health, more severe alcohol and psychiatric comorbidities, and African-Americans. CONCLUSIONS With the exception of cannabis, UDTs are important assessment tools when treating drug use disorders in primary care. UDTs might be particularly helpful when treating patients who are older, female, disabled, have legal and social problems, and have more severe drug problems.
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Nyamathi AM, Salem BE, Farabee D, Zhang S. Differential reporting of drug use among gay, bisexual and transgender stimulant-using homeless adults post intervention. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1179805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Cannabis sativa is the most commonly used recreational drug, Δ(9)-tetrahydrocannabinol (Δ(9)-THC) being the main addictive compound. Biotransformation of cannabinoids is an important field of xenobiochemistry and toxicology and the study of the metabolism can lead to the discovery of new compounds, unknown metabolites with unique structures and new therapeutic effects. The pharmacokinetics of Δ(9)-THC is dependent on multiple factors such as physical/chemical form, route of administration, genetics, and concurrent consumption of alcohol. This review aims to discuss metabolomics of Δ(9)-THC, namely by presenting all known metabolites of Δ(9)-THC described both in vitro and in vivo, and their roles in the Δ(9)-THC-mediated toxic effects. Since medicinal use is increasing, metabolomics of Δ(9)-THC will also be discussed in order to uncover potential active metabolites that can be made available for this purpose.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- a IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, CRL , Gandra , Portugal .,b UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto , Porto , Portugal , and.,c Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto , Porto , Portugal
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The Influence of Drug Testing and Benefit-Based Distribution of Opioid Substitution Therapy on Drug Abstinence. J Addict Nurs 2015; 26:208-12. [PMID: 26669228 DOI: 10.1097/jan.0000000000000098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The objective of our research was to discover whether the new approach to urine drug testing has a positive effect on users' abstinence, users' treatment, and their cooperation, while remaining user-friendly, and whether this approach is more cost-effective. The centers are focused on providing high-quality treatment within a cost-efficient program. In this study, we focus on the influence of drug testing and benefit-based distribution of opioid substitution therapy (BBDOST) on drug abstinence. The purpose of this study was to find any possible positive effect of modified distribution of the therapy and illicit drug testing on the number of users who are abstinent from illicit drugs and users who are not abstinent from illicit drugs as well as the users' opinion on BBDOST and testing. We are also interested in a difference in abstinence rates between those on BBDOST and those not receiving BBDOST. In 2010, the method of drug testing at the center was changed (less frequent and random drug testing) to enable its users faster access to BBDOST (take-home therapy). It was found that the number of drug-abstinent program participants has increased from initial 44.5% (2010) to 54.1% (2014). According to the program participants, the new method allows them to achieve and maintain abstinence from drugs more easily. In addition, they are also satisfied with the modified way of drug testing. This opinion does not change with age, gender, and acquired benefits.
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Pharmacokinetic interaction of enrofloxacin/trimethoprim combination following single-dose intraperitoneal and oral administration in rats. Eur J Drug Metab Pharmacokinet 2013; 39:11-6. [DOI: 10.1007/s13318-013-0142-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 05/24/2013] [Indexed: 10/26/2022]
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Humbert L, Richeval C. Analyse toxicologique avec mesure par « masse exacte ». Caractérisation de métabolites urinaires par couplage UPLC/QTOF : apports et intérêts dans le cadre de la soumission chimique. ACTA ACUST UNITED AC 2012. [DOI: 10.1051/ata/2012008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Congress passed the Drug-Free Workplace Act in April 1988, which resulted in the Mandatory Guidelines for Federal Workplace Drug Testing Programs. The intent was to establish a substance-free work environment for all federal workers by requiring that all federal employees pass a urine drug test before employment. These guidelines specifically, and exclusively, focus on testing urine specimens for metabolites of marijuana, cocaine, phencyclidine, opiates (focusing on heroin metabolites), and amphetamines (including Ecstasy). Since then, there have been many scientific, technical, and legal challenges to the validity of urine drug testing. In response, the Substance Abuse and Mental Health Services Administration, a division operating under the executive branch of the United States Department of Health and Human Services, put forth, through many revisions, strict procedural guidelines and specimen validity-testing criteria to manage suspicious or adulterated samples during and after urine collection. This review focuses on the legal ramifications, the procedural process, and the sensitivity and specificity of the two urine drug tests used for workplace drug testing: immunoassay and gas chromatography-mass spectrometry. Moreover, we dissect the problematic issue of cross-sensitivity between illicit and prescription drugs, and how this affects the validity of future urine drug testing.
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Affiliation(s)
- Hieu M Phan
- College of Pharmacy, Touro University-California, Vallejo, CA 94592, USA.
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Significantly increased detection rate of drugs of abuse in urine following the introduction of new German driving licence re-granting guidelines. Forensic Sci Int 2012; 215:32-7. [DOI: 10.1016/j.forsciint.2011.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 10/04/2011] [Accepted: 10/11/2011] [Indexed: 11/20/2022]
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Li G, Baker SP, Zhao Q, Brady JE, Lang BH, Rebok GW, DiMaggio C. Drug violations and aviation accidents: findings from the US mandatory drug testing programs. Addiction 2011; 106:1287-92. [PMID: 21306594 PMCID: PMC3391734 DOI: 10.1111/j.1360-0443.2011.03388.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To assess the role of drug violations in aviation accidents. DESIGN Case-control analysis. SETTING Commercial aviation in the United States. PARTICIPANTS Aviation employees who were tested for drugs during 1995-2005 under the post-accident testing program (cases, n = 4977) or under the random testing program (controls, n = 1 129 922). MEASUREMENTS Point prevalence of drug violations, odds ratio of accident involvement and attributable risk in the population. A drug violation was defined as a confirmed positive test for marijuana (≥50 ng/ml), cocaine (≥300 ng/ml), amphetamines (≥1000 ng/ml), opiates (≥2000 ng/ml) or phencyclidine (≥25 ng/ml). FINDINGS The prevalence of drug violations was 0.64% [95% confidence interval (CI): 0.62-0.65%] in random drug tests and 1.82% (95% CI: 1.47-2.24%) in post-accident tests. The odds of accident involvement for employees who tested positive for drugs was almost three times the odds for those who tested negative (odds ratio 2.90, 95% CI: 2.35-3.57), with an estimated attributable risk of 1.2%. Marijuana accounted for 67.3% of the illicit drugs detected. The proportion of illicit drugs represented by amphetamines increased progressively during the study period, from 3.4% in 1995 to 10.3% in 2005 (P < 0.0001). CONCLUSIONS Use of illicit drugs by aviation employees is associated with a significantly increased risk of accident involvement. Due to the very low prevalence, drug violations contribute to only a small fraction of aviation accidents.
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Affiliation(s)
- Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| | - Susan P. Baker
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205, USA
| | - Qi Zhao
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 St., R1030, New York, New York, 10032, USA
| | - Joanne E. Brady
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168 St., PH5-505, New York, New York 10032, USA
,Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 St., R1030, New York, New York, 10032, USA
| | - Barbara H. Lang
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168 St., PH5-505, New York, New York 10032, USA
| | - George W. Rebok
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland 21205, USA
| | - Charles DiMaggio
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168 St., PH5-505, New York, New York 10032, USA
,Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168 St., R1030, New York, New York, 10032, USA
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Meyer MR, Maurer HH. Absorption, distribution, metabolism and excretion pharmacogenomics of drugs of abuse. Pharmacogenomics 2011; 12:215-33. [DOI: 10.2217/pgs.10.171] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pharmacologic and toxic effects of xenobiotics, such as drugs of abuse, depend on the genotype and phenotype of an individual, and conversely on the isoenzymes involved in their metabolism and transport. The current knowledge of such isoenzymes of frequently abused therapeutics such as opioids (oxycodone, hydrocodone, methadone, fentanyl, buprenorphine, tramadol, heroin, morphine and codeine), anesthetics (γ-hydroxybutyric acid, propofol, ketamine and phencyclidine) and cognitive enhancers (methylphenidate and modafinil), and some important plant-derived hallucinogens (lysergide, salvinorin A, psilocybin and psilocin), as well as of nicotine in humans are summarized in this article. The isoenzymes (e.g., cytochrome P450, glucuronyltransferases, esterases and reductases) involved in the metabolism of drugs and some pharmacokinetic data are discussed. The relevance of such data is discussed for predicting possible interactions with other xenobiotics, understanding pharmacokinetic behavior and pharmacogenomic variations, assessing toxic risks, developing suitable toxicological analysis procedures, and finally for interpretating drug testing results.
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Affiliation(s)
- Markus R Meyer
- Department of Experimental & Clinical Toxicology, Institute of Experimental & Clinical Pharmacology & Toxicology, Saarland University, D 66421 Homburg (Saar), Germany
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A hybrid liquid chromatography–mass spectrometry strategy in a forensic laboratory for opioid, cocaine and amphetamine classes in human urine using a hybrid linear ion trap-triple quadrupole mass spectrometer. J Chromatogr A 2010; 1217:6857-66. [DOI: 10.1016/j.chroma.2010.08.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 08/03/2010] [Accepted: 08/16/2010] [Indexed: 11/17/2022]
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Shakleya DM, Dams R, Choo RE, Jones H, Huestis MA. Simultaneous liquid chromatography-mass spectrometry quantification of urinary opiates, cocaine, and metabolites in opiate-dependent pregnant women in methadone-maintenance treatment. J Anal Toxicol 2010; 34:17-25. [PMID: 20109298 DOI: 10.1093/jat/34.1.17] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Opiates, cocaine, and metabolites were quantified by liquid chromatography-mass spectrometry (LC-MS) in 284 urine specimens, collected thrice weekly, to monitor possible drug relapse in 15 pregnant heroin-dependent women. Opiates were detected in 149 urine specimens (52%) with limits of quantification (LOQ) of 10-50 microg/L. Morphine, morphine-3-glucuronide, and/or morphine-6-glucuronide were positive in 121 specimens; 6-acetylmorphine, a biomarker of heroin ingestion, was quantifiable in only 7. No heroin, 6-acetylcodeine, papaverine, or noscapine were detected. One hundred and sixty-five urine specimens (58%) from all 15 participants were positive for one or more cocaine analytes (LOQ 10-100 microg/L). Ecgonine methylester (EME) and/or benzoylecgonine were the major cocaine biomarkers in 142. Anhydroecgonine methylester, a biomarker of smoked cocaine, was positive in six; cocaethylene and/or ecgonine ethylester, biomarkers of cocaine and ethanol co-ingestion, were found in 25. At the current Substance Abuse Mental Health Services Administration cutoffs for total morphine (2000 microg/L), codeine (2000 microg/L), 6-acetylmorphine (10 microg/L), and benzoylecgonine (100 microg/L), 16 opiate- and 29 cocaine-positive specimens were identified. Considering 100 microg/L EME as an additional urinary cocaine biomarker would identify 51 more positive cocaine specimens. Of interest is the differential pattern of opiate and cocaine biomarkers observed after LC-MS as compared to gas chromatography-mass spectrometry analysis.
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Affiliation(s)
- Diaa M Shakleya
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, NIH, Baltimore, Maryland 21224, USA
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Kirby KC, Kerwin ME, Carpenedo CM, Rosenwasser BJ, Gardner RS. Interdependent group contingency management for cocaine-dependent methadone maintenance patients. J Appl Behav Anal 2009; 41:579-95. [PMID: 19192861 DOI: 10.1901/jaba.2008.41-579] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. The group CM intervention proved feasible and safe. The MB condition improved group CM meeting attendance relative to the CA condition.
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Affiliation(s)
- Kimberly C Kirby
- Treatment Research Institute, 600 Public Ledger Building, 150 S. Independence Mall West, Philadelphia, Pennsylvania 19106, USA.
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Laker CJ. A literature review to assess the reliability and validity of measures appropriate for use in research to evaluate the efficacy of a brief harm reduction strategy in reducing cannabis use among people with schizophrenia in acute inpatient settings. J Psychiatr Ment Health Nurs 2008; 15:777-83. [PMID: 18844804 DOI: 10.1111/j.1365-2850.2008.01297.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is a growing body of evidence looking at the effects of cannabis use on those with schizophrenia with concerning results. This has led to the development of a number of interventions that are intended to improve outcomes for this client group. However, the methodological quality of some dual diagnosis research has been questioned in reviews for using outcome measures that are not tested as reliable and valid in the population for which they are intended for use. This literature review assesses the self-report measures that have been reliability and validity tested in populations of people with schizophrenia who use cannabis and reports on their appropriateness for use in further research studies. An overview of the most appropriate biochemical tests for cannabis is also given.
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Affiliation(s)
- C J Laker
- Health Services Research, Institute of Psychiatry, King's College, London, UK.
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Cocaine, Myocardial Infarction, and β-Blockers: Time to Rethink the Equation? Ann Emerg Med 2008; 51:130-4. [DOI: 10.1016/j.annemergmed.2007.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2007] [Revised: 08/07/2007] [Accepted: 08/22/2007] [Indexed: 11/15/2022]
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Nakhaee N, Divsalar K, Meimandi MS, Dabiri S. Estimating the prevalence of opiates use by unlinked anonymous urine drug testing: a pilot study in Iran. Subst Use Misuse 2008; 43:513-20. [PMID: 18365947 DOI: 10.1080/10826080701772348] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In order to estimate the prevalence of opiate use and to cross-validate the current program of urine testing as the sole screening and detection method for finding opiate abusers in Iran, urine samples of 1120 men with a mean (+/- SD) age of 46.6 (+/- 16.5) years referring to a large clinical lab for diagnostic and screening purposes in Kerman (the center of the biggest province in Iran) were assayed by anonymous, unlinked testing for opioid metabolites during 2004. The specimens were analyzed by an immunoassay screening test and a thin-layer chromatography (TLC) confirmation test. The initial screening test was positive in 28.8% (95% CI: 26.1-31.5) of cases (322 individuals), half of whom were confirmed by TLC. As a whole, 14.4% (95% CI: 12.4-16.6) of urine samples were positive for opioid metabolites. Although individuals referring to clinical labs do not exactly represent the general population, according to relatively high figures achieved in this study we suggest revising the urine test as the sole screening and detection method for finding Iranians who use opiates for non-medical reasons. Research is needed to further pursue these findings.
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Affiliation(s)
- Nouzar Nakhaee
- Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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Hides L, Dawe S, Young RM, Kavanagh DJ. The reliability and validity of the Severity of Dependence Scale for detecting cannabis dependence in psychosis. Addiction 2007; 102:35-40. [PMID: 17207121 DOI: 10.1111/j.1360-0443.2006.01669.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine the reliability and validity of the Severity of Dependence Scale (SDS) for detecting cannabis dependence in a large sample of in-patients with a schizophrenia spectrum disorder. DESIGN Cross-sectional study. PARTICIPANTS Participants were 153 in-patients with a schizophrenia spectrum disorder in Brisbane, Australia. MEASUREMENTS Participants were administered the SDS for cannabis dependence in the past 12 months. The presence of Diagnostic and Statistical Manual Version-IV (DSM-IV) cannabis dependence in the previous 12 months was assessed using the Comprehensive International Diagnostic Interview (CIDI). FINDINGS The SDS had high levels of internal consistency and strong construct and concurrent validity. Individuals with a score of >or = 2 on the SDS were nearly 30 times more likely to have DSM-IV cannabis dependence. The SDS was the strongest predictor of DSM-IV cannabis dependence after controlling for other predictor variables. CONCLUSIONS The SDS is a brief, valid and reliable screen for cannabis dependence among people with psychosis.
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Affiliation(s)
- L Hides
- School of Applied Psychology, Griffith University, Australia.
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43
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Maurer HH, Sauer C, Theobald DS. Toxicokinetics of drugs of abuse: current knowledge of the isoenzymes involved in the human metabolism of tetrahydrocannabinol, cocaine, heroin, morphine, and codeine. Ther Drug Monit 2006; 28:447-53. [PMID: 16778732 DOI: 10.1097/01.ftd.0000211812.27558.6e] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review summarizes the major metabolic pathways of the drugs of abuse, tetrahydrocannabinol, cocaine, heroin, morphine, and codeine, in humans including the involvement of isoenzymes. This knowledge may be important for predicting their possible interactions with other xenobiotics, understanding pharmaco-/toxicokinetic and pharmacogenetic variations, toxicological risk assessment, developing suitable toxicological analysis procedures, and finally for understanding certain pitfalls in drug testing. The detection times of these drugs and/or their metabolites in biological samples are summarized and the implications of the presented data on the possible interactions of drugs of abuse with other xenobiotics, ie, inhibition or induction of individual polymorphic and nonpolymorphic isoenzymes, discussed.
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Affiliation(s)
- Hans H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, University of Saarland, D-66421 Homburg (Saar), Germany.
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Hides L, Dawe S, Kavanagh DJ, Young RM. Psychotic symptom and cannabis relapse in recent-onset psychosis. Prospective study. Br J Psychiatry 2006; 189:137-43. [PMID: 16880483 DOI: 10.1192/bjp.bp.105.014308] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cannabis use appears to exacerbate psychotic symptoms and increase risk of psychotic relapse. However, the relative contribution of cannabis use compared with other risk factors is unclear. The influence of psychotic symptoms on cannabis use has received little attention. AIMS To examine the influence of cannabis use on psychotic symptom relapse and the influence of psychotic symptom severity on relapse in cannabis use in the 6 months following hospital admission. METHOD At baseline, 84 participants with recent-onset psychosis were assessed and 81 were followed up weekly for 6 months, using telephone and face-to-face interviews. RESULTS A higher frequency of cannabis use was predictive of psychotic relapse, after controlling for medication adherence, other substance use and duration of untreated psychosis. An increase in psychotic symptoms was predictive of relapse to cannabis use, and medication adherence reduced cannabis relapse risk. CONCLUSIONS The relationship between cannabis use and psychosis may be bidirectional, highlighting the need for early intervention programmes to target cannabis use and psychotic symptom severity in this population.
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Affiliation(s)
- L Hides
- School of Applied Psychology, Griffith University, Melbourne, Victoria, Australia.
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45
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O'Connor AD, Rusyniak DE, Bruno A. Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse. Med Clin North Am 2005; 89:1343-58. [PMID: 16227066 DOI: 10.1016/j.mcna.2005.06.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Alcohol and stimulant abuse represents a major cause of cerebrovascular and cardiovascular disease in young adults. Although mild-to-moderate alcohol consumption has been linked to a decreased risk for stroke and CVD, excessive use is associated with an increased risk for intracranial hemorrhage and cardiomyopathy. Cocaine represents the single largest,cause of medical complications related to illegal drug use. Cocaine has been associated with cerebral infarction, intracranial hemorrhage, myocardial infarction, cardiomyopathy, and cardiac arrhythmias. Abuse of amphetamines is associated with complications similar to those of cocaine. The complications associated with stimulant abuse are thought to be primarily mediated through excess catecholamines, resulting in acute arterial hypertension, vasospasm, thrombosis, and accelerated atherosclerosis. Because many complications of alcohol and stimulant abuse are preventable and reversible, it is important to screen for these in patients with cerebrovascular and cardiovascular disease.
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Affiliation(s)
- Ayrn D O'Connor
- Department of Emergency Medicine, Iniana University School of Medicine, Indianapolis, IN, USA.
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46
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Abstract
Data on the detection times of drugs of abuse are based on studies of controlled administration to volunteers or on the analysis of biologic samples of subjects who are forced to stop their (often chronic) use of drugs of abuse, eg, because of imprisonment or detoxification. The detection times depend mainly on the dose and sensitivity of the method used and also on the preparation and route of administration, the duration of use (acute or chronic), the matrix that is analyzed, the molecule or metabolite that is looked for, the pH and concentration of the matrix (urine, oral fluid), and the interindividual variation in metabolic and renal clearance. In general, the detection time is longest in hair, followed by urine, sweat, oral fluid, and blood. In blood or plasma, most drugs of abuse can be detected at the low nanogram per milliliter level for 1 or 2 days. In urine the detection time of a single dose is 1.5 to 4 days. In chronic users, drugs of abuse can be detected in urine for approximately 1 week after last use, and in extreme cases even longer in cocaine and cannabis users. In oral fluid, drugs of abuse can be detected for 5-48 hours at a low nanogram per milliliter level. The duration of detection of GHB is much shorter. After a single dose of 1 or 2 ng of flunitrazepam, the most sensitive methods can detect 7-aminoflunitrazepam for up to 4 weeks in urine.
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Affiliation(s)
- Alain G Verstraete
- Clinical Biology Laboratory, Ghent University Hospital, B-9000 Ghent, Belgium.
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47
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Abstract
The introduction of novel, powerful and rapid multidimensional separation and characterization methods has produced revolutionary global changes at the genome, proteome and metabolome level, bringing about a radical transition in our views of living systems, at the molecular level. The age of proteomics and metabolomics demands high-resolution multidimensional separation techniques. Multidimensional gas and liquid chromatography techniques, in addition to capillary and microchip electrophoresis methods, offer increased resolution and sensitivity, while also affording adequate throughput and reproducibility to meet the demands of the modern pharmaceutical industry. Coupled with MS, these techniques provide not only separation but also reliable identification of the sample components. The resolving power of these methods has proved to be superior over individual one-dimensional approaches, enabling the comprehensive separation of complex biological mixtures, with excellent resolution and reproducibility. High capacity computer systems that are capable of rigorous qualitative and quantitative analysis of the separation profiles allow the establishment and mining of large databases. Examples of various modern multidimensional separation techniques, and their integration with MS, are reviewed, here, with respect to pharmaceutical analysis.
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Affiliation(s)
- András Guttman
- Diversa Corp, 4955 Directors Pl, San Diego, CA 92121, USA.
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48
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Urbina A, Jones K. Crystal Methamphetamine, Its Analogues, and HIV Infection: Medical and Psychiatric Aspects of a New Epidemic. Clin Infect Dis 2004; 38:890-4. [PMID: 14999636 DOI: 10.1086/381975] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 11/12/2003] [Indexed: 11/03/2022] Open
Abstract
The use of the recreational drug crystal methamphetamine among younger homosexual men is expanding, and with it, unsafe sex behaviors that increase the transmission of human immunodeficiency virus (HIV). This article reviews available literature on the medical and psychiatric morbidities associated with methamphetamine abuse in HIV-infected patients. Medical complications include hypertension, hyperthermia, rhabdoymyolysis, and stroke. One fatal case of ingestion of methamphetamine with HIV medication has been documented. Two fatal cases of ingestion of HIV medication with the amphetamine analogue n-methyl-3,4 methylenedioxymethamphetamine (MDMA, or "ecstasy") have also been reported. Some molecular researchers suggest that dopaminergic systems are vulnerable to the combined neurotoxicity of HIV infection and methamphetamine. Population surveys indicate high rates of HIV infection among methamphetamine abusers and high rates of unprotected anal intercourse during drug intoxication. Intoxication can sometimes produce paranoia, auditory hallucinations, and, occasionally, violent behavior. Amphetamine withdrawal commonly results in symptoms of depression. Methamphetamine is a new challenge related to treatment and prevention of HIV infection.
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49
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Abstract
The use of urine drug testing (UDT) has increased over recent years. UDT results have traditionally been used in legal proceedings under supervision of a medical review officer (MRO). In this context, testing has been required by statute or regulation and so is typically not in the "donor's" interest. Physicians, however, can use UDT to assist in monitoring their patient's treatment plan. By using UDT in a patient-centered fashion, both patient and physician interests are maintained. The MRO-based model of testing in the clinical setting can lead to mistrust and a deterioration of the doctor-patient relationship. Clinical testing can enhance the doctor-patient relationship when the results are used to improve communication. A patient-centered model of UDT should be used to improve quality of care. This article discusses why urine is the biological specimen of choice for drug testing; who, when and why to test; testing methods; and, most importantly, interpretation of results.
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Affiliation(s)
- Howard A Heit
- Department of Medicine, Georgetown University School of Medicine, Washington, D.C., USA
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50
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Maurer HH. Position of chromatographic techniques in screening for detection of drugs or poisons in clinical and forensic toxicology and/or doping control. ACTA ACUST UNITED AC 2004; 42:1310-24. [PMID: 15576292 DOI: 10.1515/cclm.2004.250] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThis paper reviews chromatographic screening procedures for simultaneous detection of several drug classes relevant to clinical and forensic toxicology or doping control in urine or blood using gas chromatography-mass spectrometry (GC-MS), liquid chromatography coupled with a diode-array detector (LC-DAD) or a mass spectrometer (LC-MS). The pros and cons of the different techniques and procedures are discussed leading to the following conclusions and perspectives. GC-MS, especially in the electron ionization full-scan mode, is still the method of choice for comprehensive screening providing best separation power, specificity and universality, although requiring derivatization. LC-DAD is also often used for screening, but its separation power and its specificity are still inferior to those of GC-MS. Finally, LC-MS has shown to be an ideal supplement, especially for the detection of more polar, thermolabile and/or low-dose drugs, especially in blood plasma. It may become the gold standard in clinical and forensic toxicology and doping control if, at a later date, the costs of the apparatus will be markedly reduced, the current disadvantages like irreproducibility of fragmentation, reduction of ionization by matrix, etc. will be overcome, and finally if one of the increasing number of quite different techniques will become the apparatus standard.
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Affiliation(s)
- Hans H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, University of Saarland, Homburg (Saar), Germany.
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