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Numerators and denominators to quantify the abuse of prescription opioids: A review of data sources and metrics
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
cate high impulsivity scores compared to normal controls across all domains, especially in cognitive and nonplanning impulsiveness. Impulsivity was also directly related to aggression and self harm and inversely to age of onset. Results indicate that impulsivity remains stable throughout the period of substance use and treatment. Limits of questionnaire results and key differences to behavioral assessments will be discussed. Conclusions: Impulsivity is significantly higher in substance dependents than controls. Motor impulsivity and non-planning impulsivity are key domains, which result in higher impulsivity scores. Treatment implications are discussed. Financial support: Supported by funding from PHSA (Province of British Columbia, Canada). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.556 Numerators and denominators to quantify the abuse of prescription opioids: A review of data sources and metrics Alex M. Secora, C. Dormitzer, J. Staffa Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, United States Aims: The recent increase in therapeutic use of prescription opioids for pain management has been associated with increased diversion and nonmedical use of these products, an emergent public health concern particularly in the U.S. There are no universally adopted standardized metrics for measuring the estimated prevalence of abuse, or abuse relative to drug utilization, i.e. an “abuse ratio.” Methods: This methodological review will address the relative strengths and limitations of the various numerators and denominators that can make up an abuse ratio, the utility of the ratio itself, and data sources available for the ascertainment of these metrics. Conclusions: Crude numbers (numerators) associated with outcomes of substance abuse (i.e. hospitalizations, emergency room visits, detox or inpatient treatment admissions, overdoses) cannot be properly understood without context. A denominator is critically important in providing that context by accounting for opioid exposure availability or populations at risk of exposure. The impetus for selecting appropriate numerators and denominators is the construction of a prescription opioid abuse ratio to estimate the prevalence and incidence of abuse among those directly exposed, to estimate abuse relative to drug dispensed, and to compare abuse for various opioid drugs. Interpretation of this ratio is dependent on the denominator selected to define exposure availability. Abuse ratios in the literature are observably disparate in the inclusion of specific metrics, and there is no consensus in the field regarding which numerators and denominators allow for the most appropriate approximation and comparison of the extent of prescription opioid abuse. Although certain metrics are preferable for a given abuse ratio, each comes with caveats that must be explained upfront. Financial support: Authorship of this abstract was funded in part by the Oak Ridge Institute for Science and Education (ORISE), managed by Oak Ridge Associated Universities. The principle author (AMS) has an ORISE supported fellowship at the Food and Drug Administration. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.557
Using tincture of opium for treatment of opiate abusers in Iran Leila Seiri 1 , A. Mokri 2 , H. Dezhakam 3 , A. Noroozi 2 1
Aftab Clinic, Tehran, Islamic Republic of Iran Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran 3 Congress 60, Tehran, Islamic Republic of Iran 2
Aims: Iran has implemented nationwide opiate substitution programs delivered through a network of more than 3000 private and governmental treatment centers. Since 2011, tincture of opium (TO) has been introduced to the network as well. Domestic research had shown the safety and effectiveness of such agonist in special group of clients (e.g. opium smokers and the elderly). In the current research effectiveness of TO substitution and very gradual tapering in a private setting for a group of opiate abusers is studied. Methods: A total of 226 male opiate dependent clients (mean age 37.1 ± 11 years) referring to a private treatment service in Tehran, entered the study. The majority of patients (72.6%, n = 164) were opium abusers. The clients were initially stabilized on an equivalent dose of TO and in case of consent, their doses were tapered by 10% every 21 days. In addition to TO all individuals participated in self-help programs including peer counseling and recreational activities initiated by Congress 60, an NGO for opium abusers. Results: After 12 months of follow up, 37 (16.4%) of cases had dropped off treatment and had relapsed to illicit drug use. Twentytwo (9.8%) had voluntarily tapered their TO and abstained from any licit or illicit opiate use, as confirmed through urine analysis. After a year, 167 clients (74%) continued to receive TO on a daily basis. No important side effect was met in the sample. Conclusions: TO substitution seems a viable alternative to MMT and BMT in a selected group of individuals. In the Iranian classical medicine, substitution on opium and its gradual tapering has been endorsed for more than 4 centuries as a cure for opium addictions and public opinion strongly favors such an initiation. Currently many NGOs and public figures support such an approach and TO treatment might turn to an acceptable method for the large number of opiate abusers in Iran as well as users in neighboring countries especially Afghanistan who share common cultural beliefs and practices. Financial support: No financial support received. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.558 Handling and vehicle injections impact corticosterone but not adrenocorticotropic hormone levels in Sprague-Dawley but not Lewis rats K. Seip-Cammack, Michele Buonora, M. Deutsch-Feldman, A. Brownstein, R. Picetti, M.J. Kreek The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States Aims: The hypothalamic–pituitary–adrenal (HPA) axis is a key factor in the addiction trajectory. HPA hormones levels change in response to standard experimental procedures, yet few studies have compared such changes in Lewis and Sprague-Dawley (SD) rats, two strains commonly used in rodent models of addiction. In this study, HPA activity in these two strains was compared after dif-
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
cate high impulsivity scores compared to normal controls across all domains, especially in cognitive and nonplanning impulsiveness. Impulsivity was also directly related to aggression and self harm and inversely to age of onset. Results indicate that impulsivity remains stable throughout the period of substance use and treatment. Limits of questionnaire results and key differences to behavioral assessments will be discussed. Conclusions: Impulsivity is significantly higher in substance dependents than controls. Motor impulsivity and non-planning impulsivity are key domains, which result in higher impulsivity scores. Treatment implications are discussed. Financial support: Supported by funding from PHSA (Province of British Columbia, Canada). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.556 Numerators and denominators to quantify the abuse of prescription opioids: A review of data sources and metrics Alex M. Secora, C. Dormitzer, J. Staffa Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, United States Aims: The recent increase in therapeutic use of prescription opioids for pain management has been associated with increased diversion and nonmedical use of these products, an emergent public health concern particularly in the U.S. There are no universally adopted standardized metrics for measuring the estimated prevalence of abuse, or abuse relative to drug utilization, i.e. an “abuse ratio.” Methods: This methodological review will address the relative strengths and limitations of the various numerators and denominators that can make up an abuse ratio, the utility of the ratio itself, and data sources available for the ascertainment of these metrics. Conclusions: Crude numbers (numerators) associated with outcomes of substance abuse (i.e. hospitalizations, emergency room visits, detox or inpatient treatment admissions, overdoses) cannot be properly understood without context. A denominator is critically important in providing that context by accounting for opioid exposure availability or populations at risk of exposure. The impetus for selecting appropriate numerators and denominators is the construction of a prescription opioid abuse ratio to estimate the prevalence and incidence of abuse among those directly exposed, to estimate abuse relative to drug dispensed, and to compare abuse for various opioid drugs. Interpretation of this ratio is dependent on the denominator selected to define exposure availability. Abuse ratios in the literature are observably disparate in the inclusion of specific metrics, and there is no consensus in the field regarding which numerators and denominators allow for the most appropriate approximation and comparison of the extent of prescription opioid abuse. Although certain metrics are preferable for a given abuse ratio, each comes with caveats that must be explained upfront. Financial support: Authorship of this abstract was funded in part by the Oak Ridge Institute for Science and Education (ORISE), managed by Oak Ridge Associated Universities. The principle author (AMS) has an ORISE supported fellowship at the Food and Drug Administration. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.557
Using tincture of opium for treatment of opiate abusers in Iran Leila Seiri 1 , A. Mokri 2 , H. Dezhakam 3 , A. Noroozi 2 1
Aftab Clinic, Tehran, Islamic Republic of Iran Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran 3 Congress 60, Tehran, Islamic Republic of Iran 2
Aims: Iran has implemented nationwide opiate substitution programs delivered through a network of more than 3000 private and governmental treatment centers. Since 2011, tincture of opium (TO) has been introduced to the network as well. Domestic research had shown the safety and effectiveness of such agonist in special group of clients (e.g. opium smokers and the elderly). In the current research effectiveness of TO substitution and very gradual tapering in a private setting for a group of opiate abusers is studied. Methods: A total of 226 male opiate dependent clients (mean age 37.1 ± 11 years) referring to a private treatment service in Tehran, entered the study. The majority of patients (72.6%, n = 164) were opium abusers. The clients were initially stabilized on an equivalent dose of TO and in case of consent, their doses were tapered by 10% every 21 days. In addition to TO all individuals participated in self-help programs including peer counseling and recreational activities initiated by Congress 60, an NGO for opium abusers. Results: After 12 months of follow up, 37 (16.4%) of cases had dropped off treatment and had relapsed to illicit drug use. Twentytwo (9.8%) had voluntarily tapered their TO and abstained from any licit or illicit opiate use, as confirmed through urine analysis. After a year, 167 clients (74%) continued to receive TO on a daily basis. No important side effect was met in the sample. Conclusions: TO substitution seems a viable alternative to MMT and BMT in a selected group of individuals. In the Iranian classical medicine, substitution on opium and its gradual tapering has been endorsed for more than 4 centuries as a cure for opium addictions and public opinion strongly favors such an initiation. Currently many NGOs and public figures support such an approach and TO treatment might turn to an acceptable method for the large number of opiate abusers in Iran as well as users in neighboring countries especially Afghanistan who share common cultural beliefs and practices. Financial support: No financial support received. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.558 Handling and vehicle injections impact corticosterone but not adrenocorticotropic hormone levels in Sprague-Dawley but not Lewis rats K. Seip-Cammack, Michele Buonora, M. Deutsch-Feldman, A. Brownstein, R. Picetti, M.J. Kreek The Laboratory of the Biology of Addictive Diseases, The Rockefeller University, New York, NY, United States Aims: The hypothalamic–pituitary–adrenal (HPA) axis is a key factor in the addiction trajectory. HPA hormones levels change in response to standard experimental procedures, yet few studies have compared such changes in Lewis and Sprague-Dawley (SD) rats, two strains commonly used in rodent models of addiction. In this study, HPA activity in these two strains was compared after dif-