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Driving impairment of CNS prescription and non-prescription drugs
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Nonmedical and illicit drug use: Associations with PTSD severity & symptom clusters among a sample of U.S. army reserve/national guard soldiers D. Lynn Homish 1,∗ , Sarah Cercone Heavey 1 , Julia Devonish 1 , Jack Cornelius 2 , Gregory G. Homish 1 1 Community Health & Health Behavior, State University of New York at Buffalo, Buffalo, NY, United States 2 Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
Aims: PTSD is a long term mental health issue facing our military. Many with PTSD struggle to deal with their symptoms and may use substances to cope. The objective of this work was to examine the association between substance use (non-medical use of prescription drugs [NMUPD] and illicit drug use) and PTSD symptoms in US Army Reserve/National Guard Soldiers and partners. Methods: Data are from the baseline assessment of Operation:SAFETY (Soldiers and Families Excelling Through the Years), an ongoing, longitudinal study of Reserve Soldiers and partners (N = 373). PTSD total symptom score and symptom severity cluster (Re-experiencing, Avoidance, Negative Thoughts & Hyperarousal) scores were assessed with the PCL-5. Current drug use (i.e., past 3 month frequency of use) was assessed with the NIDA Modified ASSIST and dichotomized to any/no current use. Logistic regression models examined the relation between drug use and PTSD symptoms while controlling for frequent heavy drinking, military status, and age. Results: Among men, there were significantly greater odds of current NMUPD for all four PTSD clusters and overall PTSD severity score (p’s < .05). Men had significantly greater odds of current illicit drug use with overall PTSD score and all clusters except Hyperarousal (p’s < .05). Among women, there were significantly greater odds of current NMUPD for overall PTSD severity score as well as with Negative Thoughts and Hyperarousal clusters (p’s < .05). Greater odds of illicit drug use among women was only associated with the Hyperarousal cluster. Conclusions: Findings indicate that men and women who are experiencing symptoms of PTSD are reporting current NMUPD and illicit drug use, which suggests that individuals may be selfmedicating in an attempt to control the symptoms they are experiencing. Future work needs to examine barriers to treatment seeking. Financial support: Supported by R01-DA034072 (GGH). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.255 Driving impairment of CNS prescription and non-prescription drugs Talar Hopyan 2,∗ , Robert Mann 1,3 , Christine Wickens 1,3 1
Center for Addiction & Mental Health, Toronto, ON, Canada 2 INC Research, Toronto, ON, Canada 3 University of Toronto, Toronto, ON, Canada Aims: The objectives of this poster are to: (1) discuss the impact of driving impairment due to use of prescription and nonprescription drugs; (2) provide a critical review of the FDA guidance and highlight the impact on CNS drug trials; and (3) outline the type of CNS drugs that will be required to perform cognitive and driving
e91
assessments and summarize the type of studies, patient populations and CNS function assessments that are relevant for evaluating drug effects on driving; and (4) discuss driving simulator studies for investigating prescription and non-prescription drug effects on operating a motor vehicle. Conclusions: Motor vehicle accidents are a major public safety concern, particularly in the context of prescription as well as non-prescription drugs. Driving consists of a complex array of psychomotor and perceptual skills, and higher cognition. Drug developers of CNS drugs are now faced with a new set of criteria to evaluate the potential risk of driving impairment in light of the new FDA draft guidance (January, 2015) regarding the investigation of drug effects on CNS functions necessary for the ability to operate a motor vehicle. Until recently, these types of evaluations were typically reserved for sedating drugs. However, the FDA draft guidance recommends evaluating all psychoactive drugs given the significance of the use of prescription drugs in the context operating a motor vehicle. In addition to psychoactive drugs, the guidance also addresses the evaluation of non-psychoactive drugs for potential secondary or unanticipated effects that may impair driving, which are guided by specific drug effects. Financial support: Not applicable. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.256 Mother and child: Improving the health of opiate-dependent mothers and their babies using a community-based peer counselor Terry L. Horton ∗ , Lisa Bechler, Beverly L. WIlson, Mark Lanyon, claudine Jurkovitz, Yukiko Washio Christiana Care Health System, Newark, DE, United States Aims: Pregnant mothers who are dependent on opiates as a result of either active drug abuse or agonist therapy with either methadone or buprenorphine have been identified as at risk for poor compliance to antenatal and postnatal care resulting in suboptimal maternal and perinatal outcomes including premature births, low birthweights, neonatal abstinence syndrome (NAS) and increased healthcare utilization. Recent local data in the Northern Delaware state indicates that over 200 opiate dependent women a year will deliver babies suffering from NAS. Despite longstanding efforts to screen and support opiate dependent mothers, clinical teams express concern and frustration with being able to adequately engage these mothers into established care pathways. We integrate a Community-based Engagement Specialist (CES) into the clinical care teams of OB, NICU, and the Pediatric services to improve the engagement, adherence, health, and health care utilization outcomes of both opiate dependent mothers and the babies they deliver. Methods: We collaborate with the medical and administrative staff of both Women’s Health and Pediatrics departments at Christiana Care to develop and implement processes for data collection and data management utilizing RedCap data collection tool. Outcomes that we track include process measures to test the feasibility and acceptability of the approach, maternal substance use and mental health outcomes, birth outcomes (NICU admission and length of stay, birth-weight, gestational age), and post-delivery maternal and infant health service utilization. Conclusions: We anticipate that providing support to these respective clinical teams as they struggle to care for this challenging and disordered population will also improve patient experiences and staff morale.
Nonmedical and illicit drug use: Associations with PTSD severity & symptom clusters among a sample of U.S. army reserve/national guard soldiers D. Lynn Homish 1,∗ , Sarah Cercone Heavey 1 , Julia Devonish 1 , Jack Cornelius 2 , Gregory G. Homish 1 1 Community Health & Health Behavior, State University of New York at Buffalo, Buffalo, NY, United States 2 Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
Aims: PTSD is a long term mental health issue facing our military. Many with PTSD struggle to deal with their symptoms and may use substances to cope. The objective of this work was to examine the association between substance use (non-medical use of prescription drugs [NMUPD] and illicit drug use) and PTSD symptoms in US Army Reserve/National Guard Soldiers and partners. Methods: Data are from the baseline assessment of Operation:SAFETY (Soldiers and Families Excelling Through the Years), an ongoing, longitudinal study of Reserve Soldiers and partners (N = 373). PTSD total symptom score and symptom severity cluster (Re-experiencing, Avoidance, Negative Thoughts & Hyperarousal) scores were assessed with the PCL-5. Current drug use (i.e., past 3 month frequency of use) was assessed with the NIDA Modified ASSIST and dichotomized to any/no current use. Logistic regression models examined the relation between drug use and PTSD symptoms while controlling for frequent heavy drinking, military status, and age. Results: Among men, there were significantly greater odds of current NMUPD for all four PTSD clusters and overall PTSD severity score (p’s < .05). Men had significantly greater odds of current illicit drug use with overall PTSD score and all clusters except Hyperarousal (p’s < .05). Among women, there were significantly greater odds of current NMUPD for overall PTSD severity score as well as with Negative Thoughts and Hyperarousal clusters (p’s < .05). Greater odds of illicit drug use among women was only associated with the Hyperarousal cluster. Conclusions: Findings indicate that men and women who are experiencing symptoms of PTSD are reporting current NMUPD and illicit drug use, which suggests that individuals may be selfmedicating in an attempt to control the symptoms they are experiencing. Future work needs to examine barriers to treatment seeking. Financial support: Supported by R01-DA034072 (GGH). http://dx.doi.org/10.1016/j.drugalcdep.2016.08.255 Driving impairment of CNS prescription and non-prescription drugs Talar Hopyan 2,∗ , Robert Mann 1,3 , Christine Wickens 1,3 1
Center for Addiction & Mental Health, Toronto, ON, Canada 2 INC Research, Toronto, ON, Canada 3 University of Toronto, Toronto, ON, Canada Aims: The objectives of this poster are to: (1) discuss the impact of driving impairment due to use of prescription and nonprescription drugs; (2) provide a critical review of the FDA guidance and highlight the impact on CNS drug trials; and (3) outline the type of CNS drugs that will be required to perform cognitive and driving
e91
assessments and summarize the type of studies, patient populations and CNS function assessments that are relevant for evaluating drug effects on driving; and (4) discuss driving simulator studies for investigating prescription and non-prescription drug effects on operating a motor vehicle. Conclusions: Motor vehicle accidents are a major public safety concern, particularly in the context of prescription as well as non-prescription drugs. Driving consists of a complex array of psychomotor and perceptual skills, and higher cognition. Drug developers of CNS drugs are now faced with a new set of criteria to evaluate the potential risk of driving impairment in light of the new FDA draft guidance (January, 2015) regarding the investigation of drug effects on CNS functions necessary for the ability to operate a motor vehicle. Until recently, these types of evaluations were typically reserved for sedating drugs. However, the FDA draft guidance recommends evaluating all psychoactive drugs given the significance of the use of prescription drugs in the context operating a motor vehicle. In addition to psychoactive drugs, the guidance also addresses the evaluation of non-psychoactive drugs for potential secondary or unanticipated effects that may impair driving, which are guided by specific drug effects. Financial support: Not applicable. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.256 Mother and child: Improving the health of opiate-dependent mothers and their babies using a community-based peer counselor Terry L. Horton ∗ , Lisa Bechler, Beverly L. WIlson, Mark Lanyon, claudine Jurkovitz, Yukiko Washio Christiana Care Health System, Newark, DE, United States Aims: Pregnant mothers who are dependent on opiates as a result of either active drug abuse or agonist therapy with either methadone or buprenorphine have been identified as at risk for poor compliance to antenatal and postnatal care resulting in suboptimal maternal and perinatal outcomes including premature births, low birthweights, neonatal abstinence syndrome (NAS) and increased healthcare utilization. Recent local data in the Northern Delaware state indicates that over 200 opiate dependent women a year will deliver babies suffering from NAS. Despite longstanding efforts to screen and support opiate dependent mothers, clinical teams express concern and frustration with being able to adequately engage these mothers into established care pathways. We integrate a Community-based Engagement Specialist (CES) into the clinical care teams of OB, NICU, and the Pediatric services to improve the engagement, adherence, health, and health care utilization outcomes of both opiate dependent mothers and the babies they deliver. Methods: We collaborate with the medical and administrative staff of both Women’s Health and Pediatrics departments at Christiana Care to develop and implement processes for data collection and data management utilizing RedCap data collection tool. Outcomes that we track include process measures to test the feasibility and acceptability of the approach, maternal substance use and mental health outcomes, birth outcomes (NICU admission and length of stay, birth-weight, gestational age), and post-delivery maternal and infant health service utilization. Conclusions: We anticipate that providing support to these respective clinical teams as they struggle to care for this challenging and disordered population will also improve patient experiences and staff morale.