- Email: [email protected]
MALMO treatment referral and intervention study: Effective referral from syringe exchange to treatment for heroin dependence
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Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284
significantly associated with a lower likelihood of participation in 12-step meetings over time [B = −0.02, S.E. = 0.005, p < 0.01]. Conclusions: Being European-American, and engaging in sex work and religious activities predicted more 12-step attendance. Also, as substance use increased, 12-step attendance decreased. The twelve-step program may be a viable and potentially underutilized intervention for sex workers. However, more research identifying the barriers to 12-step participation among women of color and those not active in religious activities is needed. Financial support: This study was supported by a NIDA grant R01DA023062 to the 4th author. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.086 Exploratory interviews with e-cigarette and snus users Sarah Bowman, E.C. McNaughton, K. McHugh, M. Behling, Stephen F. Butler, Simon H. Budman Inflexxion, Inc, Newton, MA, United States Aims: To conduct exploratory interviews with e-cigarette and snus users. Emerging themes and constructs will inform qualitative coding for a proof-of-concept study designed to evaluate the feasibility of using Internet forums to understand perceptions, behaviors, and use patterns associated with new tobacco products (NTPs). Methods: Semi-structured phone interviews were conducted with e-cigarette and snus users to address use of these NTPs (e.g., use history, current use, cessation attempts); perceptions regarding health risks of NTPs versus cigarettes, NRTs, and smoking cessation; and use of social media to discuss tobacco products. Recruitment occurred via Craig’s List in states with varying levels of tobacco use including: KY (high), VA (mid), and California (low). Eligibility criteria included: 21+, English speaking and reported past 30-day snus or e-cigarette use. Interviews were recorded, transcribed and thematically coded. Results: Four e-cigarette users, three snus users, and one e-cigarette/snus user were interviewed. Themes that emerged included perceptions of health and social impacts, as well as the experiential aspects of each product both on its own and in comparison to traditional cigarettes and other tobacco/nicotine products. Conclusions: The interviewees represented a range of ecigarette and snus use patterns, reported varied experiences with these products, and expressed perceptions that were informed by health beliefs and social norms. Respondents reported a low knowledge of evidence-based information about health impacts associated with both snus and e-cigarettes. These exploratory interviews provided an opportunity to learn more about the interviewee’s own frameworks and the language used to describe use of e-cigarettes and snus. Reflecting overarching themes and considerations, findings were used to inform qualitative coding of content from Internet forums as part of the development of a post-market surveillance program. Financial support: Inflexxion, Inc., Altria Client Services Inc. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.087
A prospective study of youth’s nonmedical use of opioids, anxiolytics and sedatives Carol J. Boyd 1,2 , Elizabeth A. Meier 2 , Philip T. Veliz 2 , Quyen Epstein-Ngo 2 , Sean E. McCabe 2 1
School of Nursing, University of Michigan, Ann Arbor, MI, United States 2 Institute for Research on Women & Gender, University of Michigan, Ann Arbor, MI, United States Aims: To determine whether adolescents’ recent medical use of opioid analgesics, anxiolytics or sleeping medications is associated with an increased incidence of nonmedical use one year later. Compared to Group A, Group B respondents will demonstrate a higher incidence of nonmedical use opioids, anxiolytics and sedatives at Time 2, and will endorse both sensation-seeking and self-treating motivations. Methods: A longitudinal study using annual web-based surveys was conducted in five secondary schools between 2009 and 2012. At Time 1 respondents self-selected into mutually exclusive groups: Group A was the no exposure group (n = 1287), never having used opioid analgesics, anxiolytics or sedatives. Group B (n = 314) was exposed medically to opioids, anxiolytics or sedatives within the past 12 months, and had possessed their own legal prescriptions for the medications. The sample was comprised of 1601 adolescents with an average age of 14.8 years (SD = 1.9). Sixty-five percent (65.4%) were White/Caucasian, 28% were African-American, and the rest were from other ethnic groups (Asian, Hispanic, and American Indian/Alaskan Native). The sample was evenly distributed by sex and grade. Results: At Time 1, most in Group B had been given a prescription for opioid analgesics (89.9% received opioids, 12.5% anxiolytics and 10.3% sedatives). At Time 2, Group B had a significantly increased incidence of nonmedical use of opioids, anxiolytics or sedatives when compared to Group A (AOR, 3.32 [95% CI 2.04–5.38] p < 0.001), with increased odds of engaging in sensation seeking (AOR, 5.62 [1.94–16.23] p < 0.001) as well as self-treatment motivations (AOR, 2.96 [1.77–4.93] p < 0.001) with the nonmedical use. Conclusions: A legal prescription for a controlled medication at Time 1 increases an adolescent’s risk of nonmedical use one year later, both for sensation-seeking and self-treating motivations. Financial support: This research was supported by research grants R01DA024678, R01DA031160, T32DA007267 from the National Institute on Drug Abuse, National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.088 MALMO treatment referral and intervention study: Effective referral from syringe exchange to treatment for heroin dependence Martin Bråbäck 2,1 , Pernilla Isendahl 2,1 , Suzan Nilsson 2,1 , Anders Håkansson 2,1 1
Psychiatry, Lund University, Lund, Sweden Addiction Center Malmö, Psychiatry Skane, Malmö, Sweden 2
Aims: Syringe exchange has been suggested as a potential conduit to treatment for drug addiction, but this never has been documented in Europe. The results from a few US trials have been varying between 16 and 70% successful referrals even with motivational and financial incentive. The present study aims to assess effectiveness of a syringe exchange programme for referral of heroin addicts to evidence-based treatment, and to assess, in an RCT design, the contribution of a case management intervention.
Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284
Methods: Heroin addicts attending the syringe exchange of Malmö, Sweden, who are willing to participate, are referred to maintenance treatment and randomized to either a strength-based case management intervention in order to facilitate referral, or to referral-only. If eligible for treatment, patients are initiated on the maintenance treatment after 11 days. Study outcome is successful transfer from syringe exchange to treatment initiation. Results: After applying exclusion criteria, 79 heroin users at the syringe exchange programme were addressed and offered to participate in the study. 75 patients turned up for baseline interview and randomization and of those 74 that is 99% of included subjects showed up for medical assessment. Out of the total of 74 that showed up for medical assessment 71 (96%) successfully started treatment. After 6 months 63 patients remained in treatment (89%). Conclusions: Our data indicate that syringe exchange in a Swedish setting can be efficient for transferring heroin-dependent patients to evidence-based treatment. Strength-based case management intervention did not predict referral to treatment initiation. We also showed high retention rates at 6 months. Financial support: Skane region Swedish research council for health, working life and welfare. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.089 Real-time functional MRI feedback attenuates cue-induced craving in non-treatment-seeking nicotine-dependent smokers Kathleen T. Brady 1,2 , Colleen A. Hanlon 1 , Karen Hartwell 1,2 , Jeffrey Borckardt 1 , James Prisciandaro 1 , Melanie Canterberry 1 , Xingbao Li 1 , Todd LeMatty 1 , Max Owens 1 , Michael E. Saladin 1 , Megan Moran-Santa Maria 1 , Mark George 1,2 1 Psychiatry, Medical University of South Carolina, Charleston, SC, United States 2 Ralph H. Johnson VAMC, Charleston, SC, United States
Aims: The prefrontal cortex (PFC) plays an important role in cueinduced craving. Realtime functional Magnetic Resonance Imaging (rtfMRI) provides an individual with feedback about their neural activity during a task. We hypothesized that compared with no feedback, “real” feedback from a region of interest (ROI) in the PFC would significantly attenuate cue reactivity in nicotine-dependent smoker. Methods: In a single-blind controlled trial, nicotine-dependent smokers (N = 49) were randomized to either a real (R) or no (N) feedback group. Participants completed three rtfMRI sessions, and two follow-up visits. An ROI was established through a “crave” run in which the participants were instructed to crave when viewing smoking cues. A thermometer bar depicting activity in the ROI (anterior cingulate or medial PFC) was ‘fed-back’ during three “reduce” craving scans while participants viewed smoking and neutral cues. Participants were asked to reduce craving and the activity in the ROI. In a human laboratory cue reactivity session conducted after each scanning visit, psychophysiologic and self-report response to nicotine cues were measured. Results: There was a significant effect of group for heart rate (F = 14.13, p < 0.001) and skin conductance (F = 9.67, p < 0.01), with the R group exhibiting lower responses to the cues than the N group. There were significant group differences in urge to smoke (F = 4.52, p < 0.05) and craving (F = 4.00, p = 0.05), with the R group reporting a lower urge to smoke and lower peak craving than the N group. There was a significant group effect on the percent BOLD signal change in
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the ROI, with the R group exhibiting a lower BOLD response in the ROI than the N group. Conclusions: These data suggest that rtfMRI feedback from a patient-tailored ROI can attenuate craving and regional brain activity in nicotine-dependent smokers. Future work is needed to translate these findings to clinical practice. Financial support: Supported by 5R33DA026085. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.090 Risk factors of psychosis among amphetamine users: A prospective study of clients in the Swedish criminal justice system Jørgen G. Bramness 1 , Eline B. Rognli 1 , Jonas Berge 2 , Anders C. Håkansson 2 1 Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway 2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
Aims: The aim of this prospective study was to investigate which risk factors mediate the risk of hospitalization due to psychosis in a cohort of amphetamine users in the Swedish criminal justice system. Methods: Amphetamine-using prison inmates or clients of other correctional facilities in Sweden were identified using the Addiction Severity Index (ASI) interview. Between 2001 and 2006, a total of 1709 individuals were identified. A follow-up of the subjects, using national registry data, was conducted in 2010. The outcome measure was hospitalization for primary or substanceinduced psychotic episodes during the follow-up period. Data were analyzed in a multivariate logistic regression model. Results: Age of onset of amphetamine use, number of years used, and use in the month prior to baseline interview were all unrelated to risk of future hospitalization due to psychosis. Prior psychiatric hospitalization and experience of hallucinations not related to drug use, as well as being born outside of a Nordic country or being homeless, were all positively linked to hospitalization due to psychosis. Conclusions: This study demonstrates that, in a cohort of amphetamine users within the criminal justice system, prior psychiatric morbidity and demographic risk factors are more important than baseline patterns of amphetamine use in predicting future risk of hospitalization due to psychosis. These findings suggest the need for a more integrated understanding of amphetamine use and psychosis. Financial support: Financed by internal funding from University of Oslo. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.091 Heroin and prescription opioid users: Characterization in a Canadian federal context Bruna Brands 1,2,3 , T. Thornton 1 , M. Ternes 4 , M. Cheverie 4 , K. Thibault 4 , A. Moser 4 1
Health Canada, Ottawa, ON, Canada Centre for Addiction and Mental Health, Toronto, ON, Canada 3 University of Toronto, Toronto, ON, Canada 4 Correctional Services Canada, Ottawa, ON, Canada 2
Aims: While the literature suggests that prescription opioid (PO) abuse is a growing public health issue in the general
Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284
significantly associated with a lower likelihood of participation in 12-step meetings over time [B = −0.02, S.E. = 0.005, p < 0.01]. Conclusions: Being European-American, and engaging in sex work and religious activities predicted more 12-step attendance. Also, as substance use increased, 12-step attendance decreased. The twelve-step program may be a viable and potentially underutilized intervention for sex workers. However, more research identifying the barriers to 12-step participation among women of color and those not active in religious activities is needed. Financial support: This study was supported by a NIDA grant R01DA023062 to the 4th author. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.086 Exploratory interviews with e-cigarette and snus users Sarah Bowman, E.C. McNaughton, K. McHugh, M. Behling, Stephen F. Butler, Simon H. Budman Inflexxion, Inc, Newton, MA, United States Aims: To conduct exploratory interviews with e-cigarette and snus users. Emerging themes and constructs will inform qualitative coding for a proof-of-concept study designed to evaluate the feasibility of using Internet forums to understand perceptions, behaviors, and use patterns associated with new tobacco products (NTPs). Methods: Semi-structured phone interviews were conducted with e-cigarette and snus users to address use of these NTPs (e.g., use history, current use, cessation attempts); perceptions regarding health risks of NTPs versus cigarettes, NRTs, and smoking cessation; and use of social media to discuss tobacco products. Recruitment occurred via Craig’s List in states with varying levels of tobacco use including: KY (high), VA (mid), and California (low). Eligibility criteria included: 21+, English speaking and reported past 30-day snus or e-cigarette use. Interviews were recorded, transcribed and thematically coded. Results: Four e-cigarette users, three snus users, and one e-cigarette/snus user were interviewed. Themes that emerged included perceptions of health and social impacts, as well as the experiential aspects of each product both on its own and in comparison to traditional cigarettes and other tobacco/nicotine products. Conclusions: The interviewees represented a range of ecigarette and snus use patterns, reported varied experiences with these products, and expressed perceptions that were informed by health beliefs and social norms. Respondents reported a low knowledge of evidence-based information about health impacts associated with both snus and e-cigarettes. These exploratory interviews provided an opportunity to learn more about the interviewee’s own frameworks and the language used to describe use of e-cigarettes and snus. Reflecting overarching themes and considerations, findings were used to inform qualitative coding of content from Internet forums as part of the development of a post-market surveillance program. Financial support: Inflexxion, Inc., Altria Client Services Inc. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.087
A prospective study of youth’s nonmedical use of opioids, anxiolytics and sedatives Carol J. Boyd 1,2 , Elizabeth A. Meier 2 , Philip T. Veliz 2 , Quyen Epstein-Ngo 2 , Sean E. McCabe 2 1
School of Nursing, University of Michigan, Ann Arbor, MI, United States 2 Institute for Research on Women & Gender, University of Michigan, Ann Arbor, MI, United States Aims: To determine whether adolescents’ recent medical use of opioid analgesics, anxiolytics or sleeping medications is associated with an increased incidence of nonmedical use one year later. Compared to Group A, Group B respondents will demonstrate a higher incidence of nonmedical use opioids, anxiolytics and sedatives at Time 2, and will endorse both sensation-seeking and self-treating motivations. Methods: A longitudinal study using annual web-based surveys was conducted in five secondary schools between 2009 and 2012. At Time 1 respondents self-selected into mutually exclusive groups: Group A was the no exposure group (n = 1287), never having used opioid analgesics, anxiolytics or sedatives. Group B (n = 314) was exposed medically to opioids, anxiolytics or sedatives within the past 12 months, and had possessed their own legal prescriptions for the medications. The sample was comprised of 1601 adolescents with an average age of 14.8 years (SD = 1.9). Sixty-five percent (65.4%) were White/Caucasian, 28% were African-American, and the rest were from other ethnic groups (Asian, Hispanic, and American Indian/Alaskan Native). The sample was evenly distributed by sex and grade. Results: At Time 1, most in Group B had been given a prescription for opioid analgesics (89.9% received opioids, 12.5% anxiolytics and 10.3% sedatives). At Time 2, Group B had a significantly increased incidence of nonmedical use of opioids, anxiolytics or sedatives when compared to Group A (AOR, 3.32 [95% CI 2.04–5.38] p < 0.001), with increased odds of engaging in sensation seeking (AOR, 5.62 [1.94–16.23] p < 0.001) as well as self-treatment motivations (AOR, 2.96 [1.77–4.93] p < 0.001) with the nonmedical use. Conclusions: A legal prescription for a controlled medication at Time 1 increases an adolescent’s risk of nonmedical use one year later, both for sensation-seeking and self-treating motivations. Financial support: This research was supported by research grants R01DA024678, R01DA031160, T32DA007267 from the National Institute on Drug Abuse, National Institutes of Health. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.088 MALMO treatment referral and intervention study: Effective referral from syringe exchange to treatment for heroin dependence Martin Bråbäck 2,1 , Pernilla Isendahl 2,1 , Suzan Nilsson 2,1 , Anders Håkansson 2,1 1
Psychiatry, Lund University, Lund, Sweden Addiction Center Malmö, Psychiatry Skane, Malmö, Sweden 2
Aims: Syringe exchange has been suggested as a potential conduit to treatment for drug addiction, but this never has been documented in Europe. The results from a few US trials have been varying between 16 and 70% successful referrals even with motivational and financial incentive. The present study aims to assess effectiveness of a syringe exchange programme for referral of heroin addicts to evidence-based treatment, and to assess, in an RCT design, the contribution of a case management intervention.
Abstracts / Drug and Alcohol Dependence 146 (2015) e202–e284
Methods: Heroin addicts attending the syringe exchange of Malmö, Sweden, who are willing to participate, are referred to maintenance treatment and randomized to either a strength-based case management intervention in order to facilitate referral, or to referral-only. If eligible for treatment, patients are initiated on the maintenance treatment after 11 days. Study outcome is successful transfer from syringe exchange to treatment initiation. Results: After applying exclusion criteria, 79 heroin users at the syringe exchange programme were addressed and offered to participate in the study. 75 patients turned up for baseline interview and randomization and of those 74 that is 99% of included subjects showed up for medical assessment. Out of the total of 74 that showed up for medical assessment 71 (96%) successfully started treatment. After 6 months 63 patients remained in treatment (89%). Conclusions: Our data indicate that syringe exchange in a Swedish setting can be efficient for transferring heroin-dependent patients to evidence-based treatment. Strength-based case management intervention did not predict referral to treatment initiation. We also showed high retention rates at 6 months. Financial support: Skane region Swedish research council for health, working life and welfare. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.089 Real-time functional MRI feedback attenuates cue-induced craving in non-treatment-seeking nicotine-dependent smokers Kathleen T. Brady 1,2 , Colleen A. Hanlon 1 , Karen Hartwell 1,2 , Jeffrey Borckardt 1 , James Prisciandaro 1 , Melanie Canterberry 1 , Xingbao Li 1 , Todd LeMatty 1 , Max Owens 1 , Michael E. Saladin 1 , Megan Moran-Santa Maria 1 , Mark George 1,2 1 Psychiatry, Medical University of South Carolina, Charleston, SC, United States 2 Ralph H. Johnson VAMC, Charleston, SC, United States
Aims: The prefrontal cortex (PFC) plays an important role in cueinduced craving. Realtime functional Magnetic Resonance Imaging (rtfMRI) provides an individual with feedback about their neural activity during a task. We hypothesized that compared with no feedback, “real” feedback from a region of interest (ROI) in the PFC would significantly attenuate cue reactivity in nicotine-dependent smoker. Methods: In a single-blind controlled trial, nicotine-dependent smokers (N = 49) were randomized to either a real (R) or no (N) feedback group. Participants completed three rtfMRI sessions, and two follow-up visits. An ROI was established through a “crave” run in which the participants were instructed to crave when viewing smoking cues. A thermometer bar depicting activity in the ROI (anterior cingulate or medial PFC) was ‘fed-back’ during three “reduce” craving scans while participants viewed smoking and neutral cues. Participants were asked to reduce craving and the activity in the ROI. In a human laboratory cue reactivity session conducted after each scanning visit, psychophysiologic and self-report response to nicotine cues were measured. Results: There was a significant effect of group for heart rate (F = 14.13, p < 0.001) and skin conductance (F = 9.67, p < 0.01), with the R group exhibiting lower responses to the cues than the N group. There were significant group differences in urge to smoke (F = 4.52, p < 0.05) and craving (F = 4.00, p = 0.05), with the R group reporting a lower urge to smoke and lower peak craving than the N group. There was a significant group effect on the percent BOLD signal change in
e229
the ROI, with the R group exhibiting a lower BOLD response in the ROI than the N group. Conclusions: These data suggest that rtfMRI feedback from a patient-tailored ROI can attenuate craving and regional brain activity in nicotine-dependent smokers. Future work is needed to translate these findings to clinical practice. Financial support: Supported by 5R33DA026085. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.090 Risk factors of psychosis among amphetamine users: A prospective study of clients in the Swedish criminal justice system Jørgen G. Bramness 1 , Eline B. Rognli 1 , Jonas Berge 2 , Anders C. Håkansson 2 1 Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway 2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
Aims: The aim of this prospective study was to investigate which risk factors mediate the risk of hospitalization due to psychosis in a cohort of amphetamine users in the Swedish criminal justice system. Methods: Amphetamine-using prison inmates or clients of other correctional facilities in Sweden were identified using the Addiction Severity Index (ASI) interview. Between 2001 and 2006, a total of 1709 individuals were identified. A follow-up of the subjects, using national registry data, was conducted in 2010. The outcome measure was hospitalization for primary or substanceinduced psychotic episodes during the follow-up period. Data were analyzed in a multivariate logistic regression model. Results: Age of onset of amphetamine use, number of years used, and use in the month prior to baseline interview were all unrelated to risk of future hospitalization due to psychosis. Prior psychiatric hospitalization and experience of hallucinations not related to drug use, as well as being born outside of a Nordic country or being homeless, were all positively linked to hospitalization due to psychosis. Conclusions: This study demonstrates that, in a cohort of amphetamine users within the criminal justice system, prior psychiatric morbidity and demographic risk factors are more important than baseline patterns of amphetamine use in predicting future risk of hospitalization due to psychosis. These findings suggest the need for a more integrated understanding of amphetamine use and psychosis. Financial support: Financed by internal funding from University of Oslo. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.091 Heroin and prescription opioid users: Characterization in a Canadian federal context Bruna Brands 1,2,3 , T. Thornton 1 , M. Ternes 4 , M. Cheverie 4 , K. Thibault 4 , A. Moser 4 1
Health Canada, Ottawa, ON, Canada Centre for Addiction and Mental Health, Toronto, ON, Canada 3 University of Toronto, Toronto, ON, Canada 4 Correctional Services Canada, Ottawa, ON, Canada 2
Aims: While the literature suggests that prescription opioid (PO) abuse is a growing public health issue in the general