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Reducing subject burden: Identifying critical measures in human abuse potential studies using factor analysis
Abstracts / Drug and Alcohol Dependence 140 (2014) e86–e168
lower levels of past month ARV medication adherence (7.1 days missed vs. 12.7 days missed; p = .002). Conclusions: This is the first study that documents the diversion of ARV medications by HIV positive, substance using women. Our results suggest that sex traders are especially vulnerable to substance dependence and mental health issues, participate in ARV diversion more often, and have less access to HIV treatment and care. Due to the significant health consequences resulting from ARV non-adherence and diversion, these findings have important public health implications. Financial support: This research was supported by Grant Number R01DA023157 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.344 Using prescription drug monitoring data to predict prescription opioid misuse Deysia L. Levin 1,2 , D. Paone 2 , E. Tuazon 2 , E. Goldmann 2 , G. Li 1 , S. Martins 1 1 Epidemiology, Columbia University, New York, NY, United States 2 Bureau of Alcohol and Drug Use, Prevention, Care and Treatment, NYC Department of Health and Mental Hygiene, Long Island City, NY, United States
Aims: To identify possible predictors of elevated risk for “doctor shopping” – the practice of obtaining controlled substances from multiple health care practitioners without the prescribers’ knowledge of the other prescriptions – a proxy for opioid analgesic misuse. Methods: The data used for this analysis is a subset of the New York State Prescription Drug Monitoring Program, and includes opioid prescriptions filled by 881,558 NYC residents in 2010. A case–control study design was utilized to identify those who met the criteria for doctor shopping, defined as visits to three or more practitioners and three or more pharmacies within a 3-month period. We randomly sampled controls who did not meet the criteria for doctor shopping. Controls were matched to cases on age category, gender, and borough in a 1:1 ratio, yielding a final analytic sample of 1118 patients. A series of binomial logistic regressions were used to predict the odds ratio (OR) of doctor shopping for prescription-related variables, including type of opioid-analgesic, co-prescribing of certain opioid analgesics, and morphine equivalent dose. After exploratory analyses, a series of multivariate logistic models were constructed. Results: Univariate analyses showed that cases were 2.2 times more likely than controls to have prescriptions for Schedule II drugs (95% CI: 1.54–3.188), and that the greatest association with doctor shopping was receiving prescriptions for both oxycodone and hydrocodone (OR = 4.3; 95% CI: 2.83–6.66). Multivariate analyses yielded similar results, indicating that prescriptions for oxycodone and hydrocodone, and prescriptions for Schedule II drugs could be factors that increase the probability of doctor shopping (p < .0001). Conclusions: Using PDMP data, we identified possible predictors for opioid mis-use. Patients with prescriptions for oxycodone or hydrocodone, and Patients with prescriptions for schedule II drugs are more likely to be a ‘doctor shopper’. Financial support: Primm-Singleton Minority Travel Awards Program. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.345
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Reducing subject burden: Identifying critical measures in human abuse potential studies using factor analysis Naama Levy-Cooperman, C. Mills, M.J. Shram, Kerri A. Schoedel Clinical Pharmacology, INC Research, Toronto, ON, Canada Aims: To assess various subjective effects of abused substances, human abuse potential (HAP) studies include multiple measures to assess positive, negative and overall drug effects. Factor analysis is often used to assess the construct validity of a behavioral scale. In this exploratory analysis, we characterized the relationships among subjective measures using factor analysis in order to identify a reduced battery of core measures. Methods: To determine the overall factor structure of common abuse potential measures, data from 10 scales (eg, 100-pt bipolar Drug Liking, Overall Drug Liking; unipolar High, Good Effects visual analog scale [VAS]) were combined from 19 double-blind, randomized, crossover HAP studies in recreational drug users (N = 532). An initial analysis was conducted using Peak Effect of all doses combined (Emaxd) for all VAS across treatments; a second analysis was conducted using Emax by dose. An orthogonal rotation (i.e., varimax) was selected to check the possible overlap and uniqueness of the measurements. Results: Factor analysis for Emaxd identified 3 factors. Factor 1 included the ‘global effect’ scales such as Drug Liking, Subjective Drug Value, Take Drug Again, and Overall Drug Liking, with the latter 2 scales loading most highly (>0.85). Factor 2 included primarily unipolar scales with the exception of ARCI-LSD, the only variable to load on Factor 3 (0.96). Good Effects and High VAS cross-loaded on to both Factor 1 and Factor 2 (>0.45 for both factors). Similar findings were observed when variables included Emax for all doses, with the exception that ARCI-LSD loaded on to Factor 2 (0.51). Conclusions: Factor analysis of Emaxd or Emax of subjective drug effect measures showed similar results, with 2 obvious factors emerging. Strong correlations between positive effects measures suggest potential redundancy; therefore, measures selected for use in HAP studies can be reduced. Additional research is required to identify differences between recreational user sub-groups or specific drug class effects (eg, stimulant and sedative users). Financial support: Supported by INC Research. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.346 Agmatine modifies some behavioral effects of methamphetamine in rats Jun-Xu Li, D.A. Thorn Pharmacology and Toxicology, University at Buffalo, Buffalo, NY, United States Aims: The polyamine agmatine modulates various abuserelated effects of opioids. In addition, our recent data show that agmatine also attenuates the rewarding effects of the psychostimulant methamphetamine (MA) in rats. However, it is unclear whether agmatine also modulates other behavioral effects of MA. Methods: MA-induced rectal temperature increase (hyperthermia), food-induced conditioned place preference (CPP), and MA-induced hyperactivity were used to examine the effects of agmatine on these behavioral actions of MA in separate groups of rats. Results: MA (10 mg/kg, i.p.) elicited a robust hyperthermia in rats and agmatine (10–56 mg/kg, i.p.) dose-dependently and almost completely prevented MA-induced hyperthermia. Palat-
lower levels of past month ARV medication adherence (7.1 days missed vs. 12.7 days missed; p = .002). Conclusions: This is the first study that documents the diversion of ARV medications by HIV positive, substance using women. Our results suggest that sex traders are especially vulnerable to substance dependence and mental health issues, participate in ARV diversion more often, and have less access to HIV treatment and care. Due to the significant health consequences resulting from ARV non-adherence and diversion, these findings have important public health implications. Financial support: This research was supported by Grant Number R01DA023157 from the National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.344 Using prescription drug monitoring data to predict prescription opioid misuse Deysia L. Levin 1,2 , D. Paone 2 , E. Tuazon 2 , E. Goldmann 2 , G. Li 1 , S. Martins 1 1 Epidemiology, Columbia University, New York, NY, United States 2 Bureau of Alcohol and Drug Use, Prevention, Care and Treatment, NYC Department of Health and Mental Hygiene, Long Island City, NY, United States
Aims: To identify possible predictors of elevated risk for “doctor shopping” – the practice of obtaining controlled substances from multiple health care practitioners without the prescribers’ knowledge of the other prescriptions – a proxy for opioid analgesic misuse. Methods: The data used for this analysis is a subset of the New York State Prescription Drug Monitoring Program, and includes opioid prescriptions filled by 881,558 NYC residents in 2010. A case–control study design was utilized to identify those who met the criteria for doctor shopping, defined as visits to three or more practitioners and three or more pharmacies within a 3-month period. We randomly sampled controls who did not meet the criteria for doctor shopping. Controls were matched to cases on age category, gender, and borough in a 1:1 ratio, yielding a final analytic sample of 1118 patients. A series of binomial logistic regressions were used to predict the odds ratio (OR) of doctor shopping for prescription-related variables, including type of opioid-analgesic, co-prescribing of certain opioid analgesics, and morphine equivalent dose. After exploratory analyses, a series of multivariate logistic models were constructed. Results: Univariate analyses showed that cases were 2.2 times more likely than controls to have prescriptions for Schedule II drugs (95% CI: 1.54–3.188), and that the greatest association with doctor shopping was receiving prescriptions for both oxycodone and hydrocodone (OR = 4.3; 95% CI: 2.83–6.66). Multivariate analyses yielded similar results, indicating that prescriptions for oxycodone and hydrocodone, and prescriptions for Schedule II drugs could be factors that increase the probability of doctor shopping (p < .0001). Conclusions: Using PDMP data, we identified possible predictors for opioid mis-use. Patients with prescriptions for oxycodone or hydrocodone, and Patients with prescriptions for schedule II drugs are more likely to be a ‘doctor shopper’. Financial support: Primm-Singleton Minority Travel Awards Program. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.345
e121
Reducing subject burden: Identifying critical measures in human abuse potential studies using factor analysis Naama Levy-Cooperman, C. Mills, M.J. Shram, Kerri A. Schoedel Clinical Pharmacology, INC Research, Toronto, ON, Canada Aims: To assess various subjective effects of abused substances, human abuse potential (HAP) studies include multiple measures to assess positive, negative and overall drug effects. Factor analysis is often used to assess the construct validity of a behavioral scale. In this exploratory analysis, we characterized the relationships among subjective measures using factor analysis in order to identify a reduced battery of core measures. Methods: To determine the overall factor structure of common abuse potential measures, data from 10 scales (eg, 100-pt bipolar Drug Liking, Overall Drug Liking; unipolar High, Good Effects visual analog scale [VAS]) were combined from 19 double-blind, randomized, crossover HAP studies in recreational drug users (N = 532). An initial analysis was conducted using Peak Effect of all doses combined (Emaxd) for all VAS across treatments; a second analysis was conducted using Emax by dose. An orthogonal rotation (i.e., varimax) was selected to check the possible overlap and uniqueness of the measurements. Results: Factor analysis for Emaxd identified 3 factors. Factor 1 included the ‘global effect’ scales such as Drug Liking, Subjective Drug Value, Take Drug Again, and Overall Drug Liking, with the latter 2 scales loading most highly (>0.85). Factor 2 included primarily unipolar scales with the exception of ARCI-LSD, the only variable to load on Factor 3 (0.96). Good Effects and High VAS cross-loaded on to both Factor 1 and Factor 2 (>0.45 for both factors). Similar findings were observed when variables included Emax for all doses, with the exception that ARCI-LSD loaded on to Factor 2 (0.51). Conclusions: Factor analysis of Emaxd or Emax of subjective drug effect measures showed similar results, with 2 obvious factors emerging. Strong correlations between positive effects measures suggest potential redundancy; therefore, measures selected for use in HAP studies can be reduced. Additional research is required to identify differences between recreational user sub-groups or specific drug class effects (eg, stimulant and sedative users). Financial support: Supported by INC Research. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.346 Agmatine modifies some behavioral effects of methamphetamine in rats Jun-Xu Li, D.A. Thorn Pharmacology and Toxicology, University at Buffalo, Buffalo, NY, United States Aims: The polyamine agmatine modulates various abuserelated effects of opioids. In addition, our recent data show that agmatine also attenuates the rewarding effects of the psychostimulant methamphetamine (MA) in rats. However, it is unclear whether agmatine also modulates other behavioral effects of MA. Methods: MA-induced rectal temperature increase (hyperthermia), food-induced conditioned place preference (CPP), and MA-induced hyperactivity were used to examine the effects of agmatine on these behavioral actions of MA in separate groups of rats. Results: MA (10 mg/kg, i.p.) elicited a robust hyperthermia in rats and agmatine (10–56 mg/kg, i.p.) dose-dependently and almost completely prevented MA-induced hyperthermia. Palat-