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Screening for substance use problems in private US health plans
Abstracts / Drug and Alcohol Dependence 140 (2014) e2–e85
Dopamine D3 receptors underlie cocaine-induced conditioned place preference in mice Eliot L. Gardner 1 , H.Y. Zhang 1 , X.Q. Peng 1 , R.B. Su 2 , R.F. Yang 2 , J. Li 2 , Z.X. Xi 1 , R. Song 1,2 1 Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, United States 2 Beijing Institute of Pharmacology and Toxicology, Beijing, China
Aims: The dopamine D3 receptor (D3R) has received attention as a target for anti-addiction medication development, using selective D3R antagonists in animal models of addiction. The present work was undertaken to determine whether D3R gene deletion (KO) affects cocaine-induced conditioned place preference (CPP). Another aim was to study the effect of the novel D3R antagonist YQA14 on cocaine-induced CPP in wild-type (WT) mice. Methods: Male WT and D3 KO mice and a standard mouse CPP apparatus were used. On days 1–3 mice had free access to both CPP chambers. On days 4–13 mice received saline or cocaine and confined to a treatment-specific CPP chamber. On day 14, mice were allowed free access to both chambers. Experiment 1 tested cocaineinduced CPP in WT mice. Experiment 2 compared cocaine-induced CPP between WT and D3 KO mice. Experiment 3 tested the effect of YQA14 on acquisition of cocaine-induced CPP. Experiment 4 tested the effect of YQA14 on expression of cocaine-induced CPP. Data were analyzed using paired t-tests or one way analyses of variance. Results: WT mice showed a dose-orderly cocaine-induced CPP. D3 KO mice showed an attenuated cocaine-induced CPP compared to WT mice. YQA14 pre-treatment (10 days) inhibited acquisition of cocaine-induced CPP in WT, but not in D3 KO mice. Acute YQA14 pretreatment (20 min before test) inhibited expression of cocaineinduced CPP in WT, but not in D3 KO mice. Conclusions: Functional D3Rs are important for acquisition and expression of cocaine-induced CPP. The anti-addiction profile shown by YQA14 is extremely similar to that of SB277011A and NGB2904. The D3R remains an exceptionally attractive pharmacological target for the development of anti-addiction medications. YQA14 should be further studied to determine its anti-addiction potential. Financial support: Supported by the Intramural Research Program of the U.S. National Institute on Drug Abuse, the National Basic Research Program of China (Grant 2009CB522008), and the National Science Foundation of China (Grant 81102425). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.201 Screening for substance use problems in private US health plans Deborah W. Garnick, Constance M. Horgan, M. Stewart, S. Reif, E. Merrick, D. Hodgkin, A. Quinn Institute for Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States Aims: Despite availability of validated screening instruments and national efforts to encourage screening there is still significant need for improved detection of substance use problems. Health plans can promote expanded screening by imposing requirements in primary care, aligning payment policies, or conducting screening independently. Methods: Data are from a nationally representative, telephone survey of US private health plans in 2010 (89% response rate). For each of the three most commonly purchased insurance products, respondents reported on use of specific screening instruments (e.g.,
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DAST) or general tools; screening, brief intervention and treatment (SBIRT) for alcohol problems; billing for screening; and plans’ independent screening activities. Results are weighted to provide national estimates. Results: In 2010, 18% of products required screening for alcohol and drug abuse problems in primary care using general instruments and 15% required specific screening instruments. Among the 96% of products that encouraged SBIRT, 99% did so through provision of guidelines, 41% through provider feedback, 51% by offering financial incentives, 3% by recognition programs, and 6% through training. Primary care providers (PCP) could bill for substance abuse screening and brief intervention in 72% of products. In terms of health plans’ independent screening activities, 92% conducted screening by phone, mail, or web-based surveys. Positive screens triggered notification of the PCP for 25% of products and follow-up with the enrollee for all products. Conclusions: Although screening is an effective way to improve the identification of substance use problems, most health plans do not require screening in primary care. However, they do use a range of approaches to promote screening, including payment, training and guidelines. Research is needed on the effectiveness of these approaches. This survey was focused on health plan activities, thus these results do not reveal the level of screening in primary care. Financial support: National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.202 Open-label 24-month study of injectable extended-release naltrexone (XR-NTX) in healthcare professionals with opioid dependence David Gastfriend 1 , P. Earley 2 , B. Silverman 1 , A. Memisoglu 1 1 2
Alkermes, Inc., Waltham, MA, United States Earley Consultancy LLP, Smyrna, GA, United States
Aims: This pilot study evaluated the long-term safety, tolerability and efficacy of injectable, once-monthly, intramuscular XR-NTX in opioid dependent healthcare professionals. Methods: After detoxification, intramuscular XR-NTX was offered for up to 24 months. Results: Of 49 patients screened, 38 (77.6%) began XR-NTX. The majority (N = 31; 81.6%) were female nurses. Fifteen (39.5%) remained in treatment for 24 months. While receiving XR-NTX, four patients had opioid positive urine drug tests: 2 were in month 1; 3 patients discontinued and 1 patient continued in the study with negative opioids on all subsequent urine tests. There was a 37.8% reduction from baseline to month 24 in the mean opioid craving score. On the SF-36, (norm = 50), mean SF-36 Physical Component Scores remained stable: BL = 52.2, 24-mo = 53.4; however, Mental Component Scores began ∼1.5 standard deviations below normal, BL = 36.3, and rose at 24 months to 47.6, for a mean change of 11.3 (>1 standard deviation). Mean Global Treatment Satisfaction Score was 93.2 (max = 100) at 24 months. Common adverse events included nausea (42.1%), injection site pain (36.8%), anxiety (28.9%), and headache (26.3%); 18.4% discontinued due to adverse events and 18.4% were lost to follow-up. No patient experienced a drug-related serious adverse event and none died, overdosed or discontinued due to serious adverse events. Limitations include small sample size, open design and the unique population. Conclusions: These results, in at-risk health professionals, indicate good long-term persistence on XR-NTX, high rates of opioid
Dopamine D3 receptors underlie cocaine-induced conditioned place preference in mice Eliot L. Gardner 1 , H.Y. Zhang 1 , X.Q. Peng 1 , R.B. Su 2 , R.F. Yang 2 , J. Li 2 , Z.X. Xi 1 , R. Song 1,2 1 Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, United States 2 Beijing Institute of Pharmacology and Toxicology, Beijing, China
Aims: The dopamine D3 receptor (D3R) has received attention as a target for anti-addiction medication development, using selective D3R antagonists in animal models of addiction. The present work was undertaken to determine whether D3R gene deletion (KO) affects cocaine-induced conditioned place preference (CPP). Another aim was to study the effect of the novel D3R antagonist YQA14 on cocaine-induced CPP in wild-type (WT) mice. Methods: Male WT and D3 KO mice and a standard mouse CPP apparatus were used. On days 1–3 mice had free access to both CPP chambers. On days 4–13 mice received saline or cocaine and confined to a treatment-specific CPP chamber. On day 14, mice were allowed free access to both chambers. Experiment 1 tested cocaineinduced CPP in WT mice. Experiment 2 compared cocaine-induced CPP between WT and D3 KO mice. Experiment 3 tested the effect of YQA14 on acquisition of cocaine-induced CPP. Experiment 4 tested the effect of YQA14 on expression of cocaine-induced CPP. Data were analyzed using paired t-tests or one way analyses of variance. Results: WT mice showed a dose-orderly cocaine-induced CPP. D3 KO mice showed an attenuated cocaine-induced CPP compared to WT mice. YQA14 pre-treatment (10 days) inhibited acquisition of cocaine-induced CPP in WT, but not in D3 KO mice. Acute YQA14 pretreatment (20 min before test) inhibited expression of cocaineinduced CPP in WT, but not in D3 KO mice. Conclusions: Functional D3Rs are important for acquisition and expression of cocaine-induced CPP. The anti-addiction profile shown by YQA14 is extremely similar to that of SB277011A and NGB2904. The D3R remains an exceptionally attractive pharmacological target for the development of anti-addiction medications. YQA14 should be further studied to determine its anti-addiction potential. Financial support: Supported by the Intramural Research Program of the U.S. National Institute on Drug Abuse, the National Basic Research Program of China (Grant 2009CB522008), and the National Science Foundation of China (Grant 81102425). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.201 Screening for substance use problems in private US health plans Deborah W. Garnick, Constance M. Horgan, M. Stewart, S. Reif, E. Merrick, D. Hodgkin, A. Quinn Institute for Behavioral Health, Heller School, Brandeis University, Waltham, MA, United States Aims: Despite availability of validated screening instruments and national efforts to encourage screening there is still significant need for improved detection of substance use problems. Health plans can promote expanded screening by imposing requirements in primary care, aligning payment policies, or conducting screening independently. Methods: Data are from a nationally representative, telephone survey of US private health plans in 2010 (89% response rate). For each of the three most commonly purchased insurance products, respondents reported on use of specific screening instruments (e.g.,
e67
DAST) or general tools; screening, brief intervention and treatment (SBIRT) for alcohol problems; billing for screening; and plans’ independent screening activities. Results are weighted to provide national estimates. Results: In 2010, 18% of products required screening for alcohol and drug abuse problems in primary care using general instruments and 15% required specific screening instruments. Among the 96% of products that encouraged SBIRT, 99% did so through provision of guidelines, 41% through provider feedback, 51% by offering financial incentives, 3% by recognition programs, and 6% through training. Primary care providers (PCP) could bill for substance abuse screening and brief intervention in 72% of products. In terms of health plans’ independent screening activities, 92% conducted screening by phone, mail, or web-based surveys. Positive screens triggered notification of the PCP for 25% of products and follow-up with the enrollee for all products. Conclusions: Although screening is an effective way to improve the identification of substance use problems, most health plans do not require screening in primary care. However, they do use a range of approaches to promote screening, including payment, training and guidelines. Research is needed on the effectiveness of these approaches. This survey was focused on health plan activities, thus these results do not reveal the level of screening in primary care. Financial support: National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.202 Open-label 24-month study of injectable extended-release naltrexone (XR-NTX) in healthcare professionals with opioid dependence David Gastfriend 1 , P. Earley 2 , B. Silverman 1 , A. Memisoglu 1 1 2
Alkermes, Inc., Waltham, MA, United States Earley Consultancy LLP, Smyrna, GA, United States
Aims: This pilot study evaluated the long-term safety, tolerability and efficacy of injectable, once-monthly, intramuscular XR-NTX in opioid dependent healthcare professionals. Methods: After detoxification, intramuscular XR-NTX was offered for up to 24 months. Results: Of 49 patients screened, 38 (77.6%) began XR-NTX. The majority (N = 31; 81.6%) were female nurses. Fifteen (39.5%) remained in treatment for 24 months. While receiving XR-NTX, four patients had opioid positive urine drug tests: 2 were in month 1; 3 patients discontinued and 1 patient continued in the study with negative opioids on all subsequent urine tests. There was a 37.8% reduction from baseline to month 24 in the mean opioid craving score. On the SF-36, (norm = 50), mean SF-36 Physical Component Scores remained stable: BL = 52.2, 24-mo = 53.4; however, Mental Component Scores began ∼1.5 standard deviations below normal, BL = 36.3, and rose at 24 months to 47.6, for a mean change of 11.3 (>1 standard deviation). Mean Global Treatment Satisfaction Score was 93.2 (max = 100) at 24 months. Common adverse events included nausea (42.1%), injection site pain (36.8%), anxiety (28.9%), and headache (26.3%); 18.4% discontinued due to adverse events and 18.4% were lost to follow-up. No patient experienced a drug-related serious adverse event and none died, overdosed or discontinued due to serious adverse events. Limitations include small sample size, open design and the unique population. Conclusions: These results, in at-risk health professionals, indicate good long-term persistence on XR-NTX, high rates of opioid