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Financial incentives for smoking abstinence in patients diagnosed with pulmonary disease
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Financial incentives for smoking abstinence in patients diagnosed with pulmonary disease Stacey C. Sigmon, Mollie E. Patrick, Andrew C. Meyer, C. Teneback, A. Dixon Psychiatry, University of Vermont, Burlington, VT, United States Aims: Chronic obstructive pulmonary disease (COPD) is a serious respiratory illness predominantly caused by cigarette smoking. While smoking cessation is identified as the single most effective intervention to slow the rate of disease progression and reduce COPD-related mortality, abstinence rates following smoking cessation among COPD patients are notoriously poor. We have an ongoing pilot study investigating the initial efficacy of an intensive, incentive-based intervention for promoting smoking abstinence in patients with COPD. Methods: Participants must report smoking > 10 cigs/day, have a clinical diagnosis of COPD and have chronic airflow obstruction (post-bronchodilator FEV1/FVC < 70%). Participants attend the clinic daily for 14 days and provide breath CO and urinary cotinine samples at each visit for monitoring of smoking status. Thus far, seven participants (54 yrs old, 29% male, 15 cigs/day, 53% FEV1/FVC) have been randomized to one of two experimental groups: Contingent participants (n = 4) earn voucher-based incentives ($362.50 max) contingent upon biochemically verified smoking abstinence and Noncontingent participants (n = 3) receive vouchers independent of smoking status. Results: While abstinence is generally high for both groups, preliminary analyses show a trend toward greater biochemically verified smoking abstinence among Contingent vs. Noncontingent participants (68% vs. 50% negative samples, respectively; p = .11). By June 2013 we will have full data from the completed pilot study (n = 20), including primary outcomes of biochemically verified smoking abstinence as well as measures of nicotine withdrawal, craving and pulmonary functioning. Conclusions: Overall, this pilot study is positioned to provide the first demonstration that smokers diagnosed with COPD can successfully quit smoking and inform efforts to develop an effective, longer-term smoking cessation intervention for this challenging and costly population of smokers. Financial support: Supported in part by T32 DA007242. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.578 Desomorphine (crocodile) injection among in-treatment drug users in Tbilisi, Georgia Z. Sikharulidze 1 , N. Kapanadze 1 , David Otiashvili 2 , S. Poole 3 , George E. Woody 3 1 Centre for Medical, Socio-economic and Cultural Issues Uranti, Tbilisi, Georgia 2 Addiction Research Center, Alternative Georgia, Tbilisi, Georgia 3 Department of Psychiatry, School of Medicine, University of Pennsylvania, Treatment Research Institute, Philadelphia, PA, United States
Aims: Since 2010 use of the opiate Dezomorphine (“crocodile”) has increased dramatically in Georgia and neighboring countries. Crocodile is made in home-based laboratories, relatively new on the drug scene, and the risks associated with its use have not been studied. Here we present data on the prevalence and patterns of Crocodile use among a recent cohort of patients admitted for drug treatment in the Uranti clinic in Tbilisi, Republic of Georgia.
Methods: Secondary analysis of medical records and interviews with patients. Results: During the period (2011–2012), 220 patients (average age 32) were admitted to Uranti and among them, 80% (n = 160) reported using crocodile for an average period of 7 months. Crocodile was described as a highly toxic drug prepared from different ingredients including codeine, iodine, gasoline and phosphorus and that causes severe damage to soft tissues and neurological complications when injected. Patients described its effects as short lasting resulting in multiple injections that averaged 3/day (range, 1–10). Group use of crocodile and sharing injection paraphernalia was reportedly widespread, as was combining crocodile with other drugs including methamphetamines (35%), and benzodiazepines and barbiturates (56%). During the study period one case of a crocodile related death caused by pulmonary embolism was recorded as were 3 cases of HIV (1.3%); 85% of patients tested HCV positive on admission to treatment. Conclusions: Crocodile injection and sharing of injection equipment associated with its use is becoming widespread and has significant health risks. Further research is needed to better understand the risks and consequences of crocodile injection and develop effective interventions. Financial support: R21-DA-026754-NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.579 Early onset cannabis use and young adult outcomes: An integrative data analysis of three Australasian cohorts Edmund Silins 1 , C. Olsson 2 , L.J. Horwood 3 , D. Hutchinson 1 , G. Patton 2 , D. Fergusson 3 , J. Toumbourou 4 , E. Spry 2 , R. Mattick 1 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia 2 Centre for Adolescent Health, Royal Childrens Hospital, Melbourne, VIC, Australia 3 Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand 4 School of Psychology, Deakin University, Melbourne, VIC, Australia
Aims: Investigation of the extent to which heavy early onset cannabis use is associated with later adverse outcomes is limited by sample size in existing cohort studies. Integrative data analyses may overcome this limitation. The study aimed to obtain more robust estimates of the effect of heavy adolescent cannabis use on particular life-course outcomes by age 25 years by developing integrative analyses across three large and long-running Australasian cohort studies (Australian Temperament Project, n = 2443; Christchurch Health and Development Study, n = 1265; Victorian Adolescent Health Cohort Study, n = 2032). Methods: A consistent metric for the measures of interest was identified across studies. Regression analyses were applied to integrated data to obtain pooled effect sizes adjusted for study effects and potential confounding factors. Results: Results (OR, 95%CI) provide more robust estimates of the association between daily adolescent cannabis use and young adult outcomes including reduced educational attainment (0.3, 0.2–0.4) and increased depression (1.6, 1.1–2.4), self harm (3.8, 2.0–7.4), welfare dependence (1.7, 1.1–2.9), other illicit drug use (10.9, 7.7–15.6) and cannabis dependence (57.4, 37.7–87.6).
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Financial incentives for smoking abstinence in patients diagnosed with pulmonary disease Stacey C. Sigmon, Mollie E. Patrick, Andrew C. Meyer, C. Teneback, A. Dixon Psychiatry, University of Vermont, Burlington, VT, United States Aims: Chronic obstructive pulmonary disease (COPD) is a serious respiratory illness predominantly caused by cigarette smoking. While smoking cessation is identified as the single most effective intervention to slow the rate of disease progression and reduce COPD-related mortality, abstinence rates following smoking cessation among COPD patients are notoriously poor. We have an ongoing pilot study investigating the initial efficacy of an intensive, incentive-based intervention for promoting smoking abstinence in patients with COPD. Methods: Participants must report smoking > 10 cigs/day, have a clinical diagnosis of COPD and have chronic airflow obstruction (post-bronchodilator FEV1/FVC < 70%). Participants attend the clinic daily for 14 days and provide breath CO and urinary cotinine samples at each visit for monitoring of smoking status. Thus far, seven participants (54 yrs old, 29% male, 15 cigs/day, 53% FEV1/FVC) have been randomized to one of two experimental groups: Contingent participants (n = 4) earn voucher-based incentives ($362.50 max) contingent upon biochemically verified smoking abstinence and Noncontingent participants (n = 3) receive vouchers independent of smoking status. Results: While abstinence is generally high for both groups, preliminary analyses show a trend toward greater biochemically verified smoking abstinence among Contingent vs. Noncontingent participants (68% vs. 50% negative samples, respectively; p = .11). By June 2013 we will have full data from the completed pilot study (n = 20), including primary outcomes of biochemically verified smoking abstinence as well as measures of nicotine withdrawal, craving and pulmonary functioning. Conclusions: Overall, this pilot study is positioned to provide the first demonstration that smokers diagnosed with COPD can successfully quit smoking and inform efforts to develop an effective, longer-term smoking cessation intervention for this challenging and costly population of smokers. Financial support: Supported in part by T32 DA007242. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.578 Desomorphine (crocodile) injection among in-treatment drug users in Tbilisi, Georgia Z. Sikharulidze 1 , N. Kapanadze 1 , David Otiashvili 2 , S. Poole 3 , George E. Woody 3 1 Centre for Medical, Socio-economic and Cultural Issues Uranti, Tbilisi, Georgia 2 Addiction Research Center, Alternative Georgia, Tbilisi, Georgia 3 Department of Psychiatry, School of Medicine, University of Pennsylvania, Treatment Research Institute, Philadelphia, PA, United States
Aims: Since 2010 use of the opiate Dezomorphine (“crocodile”) has increased dramatically in Georgia and neighboring countries. Crocodile is made in home-based laboratories, relatively new on the drug scene, and the risks associated with its use have not been studied. Here we present data on the prevalence and patterns of Crocodile use among a recent cohort of patients admitted for drug treatment in the Uranti clinic in Tbilisi, Republic of Georgia.
Methods: Secondary analysis of medical records and interviews with patients. Results: During the period (2011–2012), 220 patients (average age 32) were admitted to Uranti and among them, 80% (n = 160) reported using crocodile for an average period of 7 months. Crocodile was described as a highly toxic drug prepared from different ingredients including codeine, iodine, gasoline and phosphorus and that causes severe damage to soft tissues and neurological complications when injected. Patients described its effects as short lasting resulting in multiple injections that averaged 3/day (range, 1–10). Group use of crocodile and sharing injection paraphernalia was reportedly widespread, as was combining crocodile with other drugs including methamphetamines (35%), and benzodiazepines and barbiturates (56%). During the study period one case of a crocodile related death caused by pulmonary embolism was recorded as were 3 cases of HIV (1.3%); 85% of patients tested HCV positive on admission to treatment. Conclusions: Crocodile injection and sharing of injection equipment associated with its use is becoming widespread and has significant health risks. Further research is needed to better understand the risks and consequences of crocodile injection and develop effective interventions. Financial support: R21-DA-026754-NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.579 Early onset cannabis use and young adult outcomes: An integrative data analysis of three Australasian cohorts Edmund Silins 1 , C. Olsson 2 , L.J. Horwood 3 , D. Hutchinson 1 , G. Patton 2 , D. Fergusson 3 , J. Toumbourou 4 , E. Spry 2 , R. Mattick 1 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia 2 Centre for Adolescent Health, Royal Childrens Hospital, Melbourne, VIC, Australia 3 Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand 4 School of Psychology, Deakin University, Melbourne, VIC, Australia
Aims: Investigation of the extent to which heavy early onset cannabis use is associated with later adverse outcomes is limited by sample size in existing cohort studies. Integrative data analyses may overcome this limitation. The study aimed to obtain more robust estimates of the effect of heavy adolescent cannabis use on particular life-course outcomes by age 25 years by developing integrative analyses across three large and long-running Australasian cohort studies (Australian Temperament Project, n = 2443; Christchurch Health and Development Study, n = 1265; Victorian Adolescent Health Cohort Study, n = 2032). Methods: A consistent metric for the measures of interest was identified across studies. Regression analyses were applied to integrated data to obtain pooled effect sizes adjusted for study effects and potential confounding factors. Results: Results (OR, 95%CI) provide more robust estimates of the association between daily adolescent cannabis use and young adult outcomes including reduced educational attainment (0.3, 0.2–0.4) and increased depression (1.6, 1.1–2.4), self harm (3.8, 2.0–7.4), welfare dependence (1.7, 1.1–2.9), other illicit drug use (10.9, 7.7–15.6) and cannabis dependence (57.4, 37.7–87.6).