- Email: [email protected]
The impact of co-morbid Borderline Personality Disorder and Substance Use Disorder on HPA axis reactivity to social stressors
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CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
Use of telemedicine to treat hepatitis C at a medication-assisted opioid treatment program Lawrence S. Brown 1,∗ , Andrew Talal 2 , Marija Zeremski 3 , Roberto Zavala 1 , Bryce Smith 4 , Anthony Martinez 2 , Melissa Lin 1 , Rositsa Dimova 2 , Jon Zibbell 4 , Steven Kritz 1 1 START Treatment & Recovery Centers, Brooklyn, NY, United States 2 SUNY Buffalo School of Medical and Biological Sciences, Buffalo, NY, United States 3 Weill Cornell Medical College, New York, NY, United States 4 Centers for Disease Control and Prevention, Atlanta, GA, United States
Aims: START Treatment & Recovery Centers is an outpatient medication-assisted opioid treatment program that also provides primary medical care. Half of our 3000 largely minority patients are infected with hepatitis C virus (HCV). To date, very few have received HCV treatment. Based on studies showing that co-location of substance abuse treatment with other co-occurring conditions results in improved outcomes for both conditions, we developed a protocol to treat HCV utilizing telemedicine. Methods: We initially had to determine patient interest in on-site treatment. We surveyed 320 patients to determine HCV knowledge level and receptivity to attending educational sessions as a prelude to treatment. The response was overwhelmingly positive, providing impetus to move forward. Currently, we have provided HCV education to all treatment staff and 114 patients. Fifty patients are HCV infected; of which 23 have had on-site linkage to specialized medical services and evaluation for treatment. Compliance with referral to medical specialists in conventional health care settings is poor. Reasons include fears or doubts, lack of knowledge or interest, and physical limitations. Telemedicine is a simple, costeffective way to assure timely HCV care, i.e., the hepatologist comes to our clinics (via telemedicine); instead of patients being referred offsite. Conclusions: The process of implementing the infrastructure to provide the educational training and telemedicine capabilities presented a number of challenges involving patients, providers, technology, and reimbursement that we have successfully navigated to create a viable model for telemedicine-based delivery of HCV services in a substance use facility. Financial support: CDC Foundation, Gilead Sciences, Vertex Pharmaceuticals, Abbvie & Abbott Molecular. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.999 Pregnancy, tobacco use, and access to health care Qiana Brown 1,∗ , Katherine Keyes 1 , Deborah S. Hasin 1 , Orson Ravenell 2 , David S. Fink 1 , Silvia S. Martins 1 1
Epidemiology, Columbia University, New York, NY, United States 2 Kraemer Women’s Care, Columbia, SC, United States Aims: Access to health insurance may reduce tobacco use among pregnant women via prenatal visits, which represent opportunities to engage in smoking cessation programs and other anti-smoking resources covered by health insurance. This study assessed (1) if pregnant women with health insurance were less likely to use
tobacco in the past month (e.g. cigarettes, cigars) and (2) if type of insurance matters. Methods: Pregnant women (n = 2505) were sampled from three years (2010–2012) of the National Survey of Drug Use and Health. Logistic regressions were used to test the hypothesis that insurance coverage (i.e., any insurance, Medicaid/CHIP, military/VA insurance, private insurance) is inversely associated with past month tobacco use controlling for demographic (e.g., age, race) and other substance use variables. Results: About 17% of pregnant women in the US used tobacco in the past month. Most pregnant women were insured (90%), 37% had Medicaid/CHIP, 50% private insurance, and 4% had VA or military insurance. Any insurance versus no insurance (adjusted odds ratio [aOR] = 1.97; 95% confidence interval [CI] = 1.15, 3.36) and Medicaid/CHIP versus any insurance or no insurance (aOR = 2.21; 95% CI = 1.43, 3.40) were associated with increased odds of past month tobacco use, while military/VA (aOR = 1.91, 95% CI = 0.62, 5.91) and private insurance (aOR = 0.64, 95% CI = 0.34, 1.21) were not associated with past month tobacco use controlling for past year alcohol, marijuana, other drug use, education, income and other demographics. Conclusions: Insurance type is differentially associated with tobacco use among pregnant women. Further research is needed to understand why tobacco use is pervasive among pregnant women, especially women receiving Medicaid/CHIP. Failure to engage pregnant women in smoking cessation programs would be an opportunity missed, especially given insurance coverage. Financial support: NIDA grant T32DA031099 (P.I. Hasin). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1000 The impact of co-morbid Borderline Personality Disorder and Substance Use Disorder on HPA axis reactivity to social stressors Rasheda Browne 1,∗ , Eric Fertuck 1,2 , Barbara Stanley 2 1 The City College of New York (CUNY), Jamaica, NY, United States 2 New York State Psychiatric Institute, New York, NY, United States
Aims: Substance Use Disorder (SUD) is a detrimental cooccurring condition in individuals with Borderline Personality Disorder (BPD), their co-morbidity is associated with worsened treatment outcomes and suicidal behavior. Both BPD and SUD are associated with hypersensitivity to social stressors, often attributed to a dysregulated hypothalamic pituitary adrenal axis. The similar symptoms between these two disorders like emotional instability, impulsivity and interpersonal difficulties suggest their co-occurrence can impact an individual’s ability to regulate social stress. We hypothesize individuals with BPD and SUD will have a faster rate of cortisol increase from baseline as well as a more elevated and longer lasting cortisol response to social stressors compared to BPD without SUD. Methods: We compared two groups of Borderline Personality Disorder patients without a history of substance abuse (N = 41) and were current users or in full remission (N = 37). Each participant underwent a modified version of the Trier Social Stress Test where participants gave a five minute speech followed by a five minute speeded mental arithmetic task. Salivary cortisol levels were measured throughout the procedure: once at baseline and four times following the stressor at 0, 15, 20, 30 and 40 min. Results: There was a main effect of time on cortisol response in both groups (ANOVA; F = 10.16, df = 1, p < 0.01). BPD patients
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
without an SUD showed an expected linear rise in cortisol response to stressor. However, BPD patients with SUD showed a decrease, then rapid increase and leveling off in cortisol response to stressor, indicating a different trajectory of cortisol response in participants in BPD and SUD (ANOVA; F = 3.95, df = 1, p = 0.05). Conclusions: Unlike those with BPD alone, individuals with BPD and SUD had a rapid and nonlinear cortisol response to social stressors. These findings show that the dual diagnosis of SUD and BPD changes responsiveness to social stress and can improve the understanding and treatment of this co-morbidity. Financial support: NIH R21 grant. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1001 The epidemic that never happened: Zohydro ER and the impact of media coverage Simon H. Budman ∗ , E.C. McNaughton, T.A. Cassidy, Stephen F. Butler Inflexxion, Inc., Newton, MA, United States Aims: The launch of an extended-release hydrocodone (Zohydro ER) in February, 2014 was publically criticized by members of Congress, state attorneys general, and other experts. Governors of two states sought to ban or restrict its use. Extensive media coverage often described Zohydro as “Super Potent” and more powerful than any other opioid. We examined actual reports of abuse cases and discussion of Zohydro in online drug abuse forums during the 6 months following Zohydro’s release in the context of media coverage at the time. Methods: From February through September, 2014, we examined self-reports of past 30-day abuse of Zohydro ER and comparators in the ASI-MV® , a computerized, clinical interview for adults in substance abuse treatment. Data were also collected from online drug-abuse discussion forums to capture the level of interest expressed by this high-risk sentinel population. Media coverage of Zohydro was assessed using Google Trends news search. Correlations among data sources were conducted. Results: During the timeframe examined, 48,386 ASI-MV assessments yielded only 20 reports of Zohydro abuse, compared with 1594 cases for any abuse deterrent formulation (ADF), 5867 used any ER opioid, and 6279 used any IR opioid. A Google Trends search yielded 252 Zohydro news references. 182 unique online posts discussed Zohydro. Spearman correlations revealed high correlations between monthly Google searches and cases reported in the ASI-MV (rsp = .82). Monthly counts of Internet posts were also related to Google Trends data (rsp = .94). Content of posts by some suggested interest in abusing Zohydro, while many questioned the media coverage since other products are stronger and more easily obtained/abused. Conclusions: Excessive media coverage peaked at the launch of a single product and subsequently declined; a pattern that was mirrored in measures of abuse and abuse-interest in the product. Although news coverage of Zohydro was high, actual levels of abuse of Zohydro remained very low and went to almost zero when the news subsided. Financial support: Inflexxion, Inc. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1002
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No place to call home: What homelessness means for people who use drugs Lucy Burns 2,∗ , Elizabeth Whittaker 1 1
National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia 2 NDARC, UNSW, Sydney, NSW, Australia Aims: Substance use disorders are consistently the most prevalent mental health diagnosis amongst homeless populations in Western countries. Although research has examined substance use among people experiencing homelessness, very few studies have looked at the nature of homelessness in people who use drugs and whether the state of homelessness infers particular risks to this group. Given this present study examined the prevalence and correlates of homelessness in an Australian national sample of people who inject drugs (PWID). Methods: Cross-sectional face-to-face interviews were conducted in 2014 with 898 Australians who injected drugs at least monthly in the past six months. Results: Three-quarters (74%) of the sample reported a lifetime history of homelessness. Of these, one-in-five were homeless at the time of interview and one-third reported a chronic homelessness history. The study also showed the majority of these participants had experienced a number of different forms of homelessness in their lifetimes, including rough sleeping (81%), couch surfing (77%), and staying in crisis accommodation (68%) or boarding houses/hostels (55%). Approximately one-quarter (27%) of participants reported being victims of violence during their most recent homelessness episode, most commonly in the form of being physically attacked or stood over. Conclusions: Episodes of homelessness among PWID are common and often chronic. Given that participants had experienced multiple forms of homelessness, further research examining the efficacy of supported housing programs for this group is warranted, particularly as a means of breaking the cycle of homelessness by providing stable housing and reducing the harms associated with substance use and homelessness. Further examination of the associations between risk factors and variables of homelessness, including forms and duration, among PWID are warranted. Financial support: Financial support provided by Australian Department of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1003 Acute effects of cannabis on young drivers’ performance of driving-related skills
Jillian Burston 1,2,∗ , Robert Mann 1,2 , Bernard Le Foll 1,2 , Gina Stoduto 1 , Christine Wickens 1,2 , Jie Fei Pan 1,2 , Marilyn A. Huestis 3 , Bruna Brands 1,2,4 1 Centre for Addiction and Mental Health, Toronto, ON, Canada 2 University of Toronto, Toronto, ON, Canada 3 IRP, Chemistry and Drug Metabolism, National Institute on Drug Abuse, Baltimore, MD, United States 4 Health Canada, Ottawa, ON, Canada
Aims: Young drivers are more likely to drive after smoking cannabis than after drinking alcohol. This study examines the impact of an acute dose of cannabis on driving-related skills among young drivers who use cannabis regularly. Methods: Data are based on a double-blind, placebo-controlled mixed-design study. Participation consists of an eligibility screen and four sessions on consecutive days: practice, drug
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
Use of telemedicine to treat hepatitis C at a medication-assisted opioid treatment program Lawrence S. Brown 1,∗ , Andrew Talal 2 , Marija Zeremski 3 , Roberto Zavala 1 , Bryce Smith 4 , Anthony Martinez 2 , Melissa Lin 1 , Rositsa Dimova 2 , Jon Zibbell 4 , Steven Kritz 1 1 START Treatment & Recovery Centers, Brooklyn, NY, United States 2 SUNY Buffalo School of Medical and Biological Sciences, Buffalo, NY, United States 3 Weill Cornell Medical College, New York, NY, United States 4 Centers for Disease Control and Prevention, Atlanta, GA, United States
Aims: START Treatment & Recovery Centers is an outpatient medication-assisted opioid treatment program that also provides primary medical care. Half of our 3000 largely minority patients are infected with hepatitis C virus (HCV). To date, very few have received HCV treatment. Based on studies showing that co-location of substance abuse treatment with other co-occurring conditions results in improved outcomes for both conditions, we developed a protocol to treat HCV utilizing telemedicine. Methods: We initially had to determine patient interest in on-site treatment. We surveyed 320 patients to determine HCV knowledge level and receptivity to attending educational sessions as a prelude to treatment. The response was overwhelmingly positive, providing impetus to move forward. Currently, we have provided HCV education to all treatment staff and 114 patients. Fifty patients are HCV infected; of which 23 have had on-site linkage to specialized medical services and evaluation for treatment. Compliance with referral to medical specialists in conventional health care settings is poor. Reasons include fears or doubts, lack of knowledge or interest, and physical limitations. Telemedicine is a simple, costeffective way to assure timely HCV care, i.e., the hepatologist comes to our clinics (via telemedicine); instead of patients being referred offsite. Conclusions: The process of implementing the infrastructure to provide the educational training and telemedicine capabilities presented a number of challenges involving patients, providers, technology, and reimbursement that we have successfully navigated to create a viable model for telemedicine-based delivery of HCV services in a substance use facility. Financial support: CDC Foundation, Gilead Sciences, Vertex Pharmaceuticals, Abbvie & Abbott Molecular. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.999 Pregnancy, tobacco use, and access to health care Qiana Brown 1,∗ , Katherine Keyes 1 , Deborah S. Hasin 1 , Orson Ravenell 2 , David S. Fink 1 , Silvia S. Martins 1 1
Epidemiology, Columbia University, New York, NY, United States 2 Kraemer Women’s Care, Columbia, SC, United States Aims: Access to health insurance may reduce tobacco use among pregnant women via prenatal visits, which represent opportunities to engage in smoking cessation programs and other anti-smoking resources covered by health insurance. This study assessed (1) if pregnant women with health insurance were less likely to use
tobacco in the past month (e.g. cigarettes, cigars) and (2) if type of insurance matters. Methods: Pregnant women (n = 2505) were sampled from three years (2010–2012) of the National Survey of Drug Use and Health. Logistic regressions were used to test the hypothesis that insurance coverage (i.e., any insurance, Medicaid/CHIP, military/VA insurance, private insurance) is inversely associated with past month tobacco use controlling for demographic (e.g., age, race) and other substance use variables. Results: About 17% of pregnant women in the US used tobacco in the past month. Most pregnant women were insured (90%), 37% had Medicaid/CHIP, 50% private insurance, and 4% had VA or military insurance. Any insurance versus no insurance (adjusted odds ratio [aOR] = 1.97; 95% confidence interval [CI] = 1.15, 3.36) and Medicaid/CHIP versus any insurance or no insurance (aOR = 2.21; 95% CI = 1.43, 3.40) were associated with increased odds of past month tobacco use, while military/VA (aOR = 1.91, 95% CI = 0.62, 5.91) and private insurance (aOR = 0.64, 95% CI = 0.34, 1.21) were not associated with past month tobacco use controlling for past year alcohol, marijuana, other drug use, education, income and other demographics. Conclusions: Insurance type is differentially associated with tobacco use among pregnant women. Further research is needed to understand why tobacco use is pervasive among pregnant women, especially women receiving Medicaid/CHIP. Failure to engage pregnant women in smoking cessation programs would be an opportunity missed, especially given insurance coverage. Financial support: NIDA grant T32DA031099 (P.I. Hasin). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1000 The impact of co-morbid Borderline Personality Disorder and Substance Use Disorder on HPA axis reactivity to social stressors Rasheda Browne 1,∗ , Eric Fertuck 1,2 , Barbara Stanley 2 1 The City College of New York (CUNY), Jamaica, NY, United States 2 New York State Psychiatric Institute, New York, NY, United States
Aims: Substance Use Disorder (SUD) is a detrimental cooccurring condition in individuals with Borderline Personality Disorder (BPD), their co-morbidity is associated with worsened treatment outcomes and suicidal behavior. Both BPD and SUD are associated with hypersensitivity to social stressors, often attributed to a dysregulated hypothalamic pituitary adrenal axis. The similar symptoms between these two disorders like emotional instability, impulsivity and interpersonal difficulties suggest their co-occurrence can impact an individual’s ability to regulate social stress. We hypothesize individuals with BPD and SUD will have a faster rate of cortisol increase from baseline as well as a more elevated and longer lasting cortisol response to social stressors compared to BPD without SUD. Methods: We compared two groups of Borderline Personality Disorder patients without a history of substance abuse (N = 41) and were current users or in full remission (N = 37). Each participant underwent a modified version of the Trier Social Stress Test where participants gave a five minute speech followed by a five minute speeded mental arithmetic task. Salivary cortisol levels were measured throughout the procedure: once at baseline and four times following the stressor at 0, 15, 20, 30 and 40 min. Results: There was a main effect of time on cortisol response in both groups (ANOVA; F = 10.16, df = 1, p < 0.01). BPD patients
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
without an SUD showed an expected linear rise in cortisol response to stressor. However, BPD patients with SUD showed a decrease, then rapid increase and leveling off in cortisol response to stressor, indicating a different trajectory of cortisol response in participants in BPD and SUD (ANOVA; F = 3.95, df = 1, p = 0.05). Conclusions: Unlike those with BPD alone, individuals with BPD and SUD had a rapid and nonlinear cortisol response to social stressors. These findings show that the dual diagnosis of SUD and BPD changes responsiveness to social stress and can improve the understanding and treatment of this co-morbidity. Financial support: NIH R21 grant. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1001 The epidemic that never happened: Zohydro ER and the impact of media coverage Simon H. Budman ∗ , E.C. McNaughton, T.A. Cassidy, Stephen F. Butler Inflexxion, Inc., Newton, MA, United States Aims: The launch of an extended-release hydrocodone (Zohydro ER) in February, 2014 was publically criticized by members of Congress, state attorneys general, and other experts. Governors of two states sought to ban or restrict its use. Extensive media coverage often described Zohydro as “Super Potent” and more powerful than any other opioid. We examined actual reports of abuse cases and discussion of Zohydro in online drug abuse forums during the 6 months following Zohydro’s release in the context of media coverage at the time. Methods: From February through September, 2014, we examined self-reports of past 30-day abuse of Zohydro ER and comparators in the ASI-MV® , a computerized, clinical interview for adults in substance abuse treatment. Data were also collected from online drug-abuse discussion forums to capture the level of interest expressed by this high-risk sentinel population. Media coverage of Zohydro was assessed using Google Trends news search. Correlations among data sources were conducted. Results: During the timeframe examined, 48,386 ASI-MV assessments yielded only 20 reports of Zohydro abuse, compared with 1594 cases for any abuse deterrent formulation (ADF), 5867 used any ER opioid, and 6279 used any IR opioid. A Google Trends search yielded 252 Zohydro news references. 182 unique online posts discussed Zohydro. Spearman correlations revealed high correlations between monthly Google searches and cases reported in the ASI-MV (rsp = .82). Monthly counts of Internet posts were also related to Google Trends data (rsp = .94). Content of posts by some suggested interest in abusing Zohydro, while many questioned the media coverage since other products are stronger and more easily obtained/abused. Conclusions: Excessive media coverage peaked at the launch of a single product and subsequently declined; a pattern that was mirrored in measures of abuse and abuse-interest in the product. Although news coverage of Zohydro was high, actual levels of abuse of Zohydro remained very low and went to almost zero when the news subsided. Financial support: Inflexxion, Inc. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1002
e31
No place to call home: What homelessness means for people who use drugs Lucy Burns 2,∗ , Elizabeth Whittaker 1 1
National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia 2 NDARC, UNSW, Sydney, NSW, Australia Aims: Substance use disorders are consistently the most prevalent mental health diagnosis amongst homeless populations in Western countries. Although research has examined substance use among people experiencing homelessness, very few studies have looked at the nature of homelessness in people who use drugs and whether the state of homelessness infers particular risks to this group. Given this present study examined the prevalence and correlates of homelessness in an Australian national sample of people who inject drugs (PWID). Methods: Cross-sectional face-to-face interviews were conducted in 2014 with 898 Australians who injected drugs at least monthly in the past six months. Results: Three-quarters (74%) of the sample reported a lifetime history of homelessness. Of these, one-in-five were homeless at the time of interview and one-third reported a chronic homelessness history. The study also showed the majority of these participants had experienced a number of different forms of homelessness in their lifetimes, including rough sleeping (81%), couch surfing (77%), and staying in crisis accommodation (68%) or boarding houses/hostels (55%). Approximately one-quarter (27%) of participants reported being victims of violence during their most recent homelessness episode, most commonly in the form of being physically attacked or stood over. Conclusions: Episodes of homelessness among PWID are common and often chronic. Given that participants had experienced multiple forms of homelessness, further research examining the efficacy of supported housing programs for this group is warranted, particularly as a means of breaking the cycle of homelessness by providing stable housing and reducing the harms associated with substance use and homelessness. Further examination of the associations between risk factors and variables of homelessness, including forms and duration, among PWID are warranted. Financial support: Financial support provided by Australian Department of Health. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.1003 Acute effects of cannabis on young drivers’ performance of driving-related skills
Jillian Burston 1,2,∗ , Robert Mann 1,2 , Bernard Le Foll 1,2 , Gina Stoduto 1 , Christine Wickens 1,2 , Jie Fei Pan 1,2 , Marilyn A. Huestis 3 , Bruna Brands 1,2,4 1 Centre for Addiction and Mental Health, Toronto, ON, Canada 2 University of Toronto, Toronto, ON, Canada 3 IRP, Chemistry and Drug Metabolism, National Institute on Drug Abuse, Baltimore, MD, United States 4 Health Canada, Ottawa, ON, Canada
Aims: Young drivers are more likely to drive after smoking cannabis than after drinking alcohol. This study examines the impact of an acute dose of cannabis on driving-related skills among young drivers who use cannabis regularly. Methods: Data are based on a double-blind, placebo-controlled mixed-design study. Participation consists of an eligibility screen and four sessions on consecutive days: practice, drug