National Substance Abuse Epidemiology Initiatives in the United States:

Data concerning the epidemiology of drug abuse in the United States are presented in this paper. The paper includes an integrating approach from various data sources: national, state, and local level; surveillance systems; and outbreak investigations. An analysis of trends and patterns of drug abuse are discussed, both from the perspective of historical development and the current situation. Analyses focus on changes in levels of use for different drugs as well as changes in user characteristics and consequences of use. Current studies concerning epidemiology of drug abuse in special populations and findings from recent field investigations are presented. Future research directions in the field of epidemiology from a national perspective are outlined.     

Three Complementary Approaches to Characterize Buprenorphine Misuse

Background: In France, buprenorphine has been available for opioid maintenance therapy since 1996 and since then its misuse has been continuously evaluated by the French health authorities. Objectives: To characterize buprenorphine misuse in Languedoc-Roussillon (LR) region, using three different approaches. Methods: Three different data sources were analyzed : (i) spontaneous reports (NotS) of buprenorphine misuse or dependence, (ii) a specific periodic survey from specialized care centers (OPPIDUM) over 11 years (2002–2012) and (iii) a drug reimbursement database (DRB). Results: A total of 209 spontaneous reports were collected. The main type of buprenorphine misuse was use by an unintended route of administration. The main complications notified were directly related to the injection of buprenorphine. NotS enabled the collection of data about severe clinical complications or new diversion phenomenon. The OPPIDUM LR survey revealed a decrease in the buprenorphine misuse indicator through the study period. The DRB analysis identified one subgroup of patients with a buprenorphine deviant behavior, characterized by a significantly greater number of dispensing episodes, pharmacies, prescribers, daily dose and switch between buprenorphine forms (princeps and generic). The DRB analysis provides data on buprenorphine diversion in the context of outpatients care. Conclusion: The three complementary approaches allowed us to characterize buprenorphine misuse in LR area. The three approaches are complementary because each data source provides different types of information.     

Homelessness and High-Dosage Buprenorphine Misuse

Aim.?To determine whether intravenous drug users (IDUs) are more likely to misuse high dosage buprenorphine (HDB) if they are homeless. Design.?We carried out a cross-sectional study using data collected from HDB users between 1998 and 1999. Data were collected by use of a structured questionnaire with questions about demographic characteristics, and use of HDB and other substances. IDUs were considered to be homeless if they did not live on their own or with their parents or friends. Setting.?IDUs were recruited from three centers for the treatment of drug users, three health care networks, one prison, one sleep-in, and two centers that provide psychosocial support for IDUs. Participants.?Of the 788 eligible patients, 779 answered the questionnaire (response rate: 98.9%). Results.?Homeless IDUs were more likely to have injected HDB than those who were not homeless (67% vs. 47%; p<0.001), and their injection behaviors were more likely to be unsafe. The first HDB injection was more likely to result in medical complications in the homeless group than in the nonhomeless group (58% vs. 38%; p = 0.001). Homeless IDUs were less likely to receive medical followed-up and were less well informed about the correct way of using HDB than nonhomeless IDUs. Conclusion.?Homeless IDUs are more likely to misuse HDB. Thus, HDB maintenance therapy may not be the most appropriate maintenance therapy for this group.     

Selecting Communication Channels for Substance Misuse Prevention With At-Risk African-American Emerging Adults Living in the Southern United States

ABSTRACT

Natural health information sources used by African-American emerging adults were investigated to identify sources associated with high and low substance-related risk. Participants (110 males, 234 females; M age = 18.9 years) were recruited using respondent-driven sampling, and structured interviews assessed substance use, sources of health information, and preferences for help. Friends and social network sites were associated with higher risk, whereas teachers/schools were associated with lower risk (ps < .025). Despite risks associated with friends, more participants preferred receiving help from friends than the other sources. The findings inform targeted prevention messages that are sensitive to contextual and audience characteristics.     

Rohypnol Misuse in the United States

Rohypnol, a potent sedative-hypnotic drug prescribed extensively throughout the world, is illicit in the United States. Recently, this drug has gained popularity among United States youths as a cheap means of intoxication and subsequently has become the focus of numerous criminal investigations. College men are alleged to slip Rohypnol tablets into unsuspecting women's drinks and then sexually abuse their sedated victims. Although law enforcement agencies and drug policy groups consider Rohypnol to be an “imminent problem,” little is actually known about patterns of misuse. Presented here is a brief overview of Rohypnol's contemporary appearance in the United States.     

A Marked Increase in Cocaine-Related Deaths in the State of Florida

Abstract

The history of cocaine misuse includes a destructive epidemic during the 1980s. While recent surveys suggest cocaine use is stable or decreasing, we have observed increasing trends of cocaine-related death through analysis of medical examiner data collected by the Florida Department of Law Enforcement (FDLE). Florida's per capita cocaine-related death rates nearly doubled from 2001 to 2005. Electronic collection of data such as that collected by the FDLE nationally and in real-time would greatly advance understanding of drug-use patterns and consequences. For example, results from Florida suggest that high school and college students, and members of higher socioeconomic status, appear to be at increased risk of cocaine abuse. Public health interventions are necessary to prevent another full-fledged epidemic.     

Preference for brand-name buprenorphine is related to severity of addiction among outpatients in opioid maintenance treatment

As a form of opioid maintenance treatment, high-dose buprenorphine is increasingly being used in the United States. On the French market since 1996, it is the most commonly prescribed and frequently employed opioid maintenance treatment. For unknown reasons, the brand-name form is used far more often than the generic form (76–24%). The objective was to show that the patients' levels of addiction were differentiated according to the form of buprenorphine currently being used and to their previous experience of a different form. An observational study in 9 sites throughout France used self-assessment questionnaires filled out in retail pharmacies by all patients to whom their prescribed buprenorphine treatment was being delivered. The 151 canvassed pharmacies solicited 879 patients, of whom 724 completed the questionnaires. Participants were statistically similar to non-participants. The patients using the brand-name form subsequent to experience with the generic form exhibited a more elevated addiction severity index and a higher dosage than brand-name form users with no experience of a different form. Compared to generic users, their doses were higher, their was addiction more severe, and their alcohol consumption was more excessive; they were also more likely to make daily use of psychotropic substances. However, the level of misuse or illicit consumption was similar between these groups. Preferring the brand-name buprenorphine form to the generic form is associated with a higher level of severe addiction, a more frequent need for daily psychotropics, and excessive drinking; but the study was unable to show a causal link.     

Examination of Veteran Fathers' Parenting and Their Adolescent Children's Substance Use in the United States

Background: Adolescent children of U.S. military veterans may be at increased risk for engaging in substance use; however, this has yet to be examined using nationally representative data. Parental involvement and communication are potential protective factors to target with prevention efforts, but veterans' parenting has not been studied in general, nonclinical populations. Objectives: This study presents data on parenting characteristics among fathers who are veterans of the U.S. military and the substance use behaviors of their adolescent children. Methods: Data were analyzed from approximately 2,200 veteran fathers, 13,100 nonveteran fathers, and their children aged 12 to 17 who participated in the National Survey on Drug Use and Health from 2004 to 2013. Parenting characteristics and adolescent substance use were compared by fathers' veteran status. Results: Compared with nonveteran fathers, veteran fathers were less likely to have talked with their children about the dangers of substance use, were more likely to believe that their children used substances, and were just as likely to be parentally involved. Higher percentages of adolescent children of veterans than those of nonveterans engaged in tobacco use and nonmedical use of psychotherapeutic drugs. Parental involvement and father-child communication about the dangers of substance use did not explain differences in substance use among adolescents with veteran versus nonveteran fathers. Conclusions/Importance: Adolescent children of veterans appear to be a group in particular need of substance use prevention services. Parental involvement and father-child communication may be appropriate protective factors to address in prevention efforts.     

Inquiries About and Initiation of Buprenorphine Treatment in an Inner-City Clinic

ABSTRACT

Despite increases in opioid dependence, availability of buprenorphine treatment remains limited. Reasons may include health center concerns about becoming overwhelmed or attracting patients who differ from the local community. This study documents inquiries about and initiation of buprenorphine treatment in an inner-city health center. From 2006–2008, we collected demographic information and subsequent treatment data for everyone who inquired about treatment. Of the 324 people who inquired, 55.6% initiated treatment. The number of inquiries increased gradually over time, and most came from local community residents (80.4%). These results may allay health center concerns, and can help planning for buprenorphine treatment.     

Buprenorphine dosing regime in the management of out-patient heroin withdrawal

This study aimed to establish a buprenorphine regime suitable for the short-term management of out-patient heroin withdrawal using an open-label, single-group case series. Eighteen dependent injecting heroin users underwent an 8-day withdrawal episode with supervised dosing of sublingual Subutex tablets. Buprenorphine doses were titrated daily over a 5-day period. Fifteen subjects (83%) completed the 5-day regime, and 14 (78%) completed the 8-day withdrawal episode. The mean doses ((SD) were 6.1 (1.2) mg on day 1; 9.6 (1.7) mg on day 2; 10.1 (1.9) mg on day 3; 8.9 (2.0) mg on day 4; 4.1 (1.5) mg on day 5; and a total regime dose of 38.9 (5.8) mg. Withdrawal severity was mild, with minimal rebound upon the cessation of dosing. Five subjects reported no heroin use, and five subjects reported using on only one occasion during the 8 days. An out-patient buprenorphine regime is recommended.     

Integrating Buprenorphine Treatment into a Public Healthcare System: The San Francisco Department of Public Health's Office-Based Buprenorphine Pilot Program

Abstract

Despite well-documented efficacy, US physicians have been relatively slow to embrace the use of buprenorphine for the treatment of opioid dependence. In order to introduce and support the use of buprenorphine across the San Francisco Department of Public Health system of care, the Buprenorphine Pilot Program was initiated in 2003. Program treatment sites included a centralized buprenorphine induction clinic and program pharmacy, and three community-based treatment sites; two primary care clinics and a private dual diagnosis group practice. The target patient population consisted of opioid-dependent patients typically seen in an urban, public health setting, including individuals experiencing extreme poverty, homelessness/unstable housing, unemployment, polysubstance abuse/dependence, coexisting mental health disorders, and/or little psychosocial support. This program evaluation reviews patient characteristics, treatment retention, substance use over time, patient impressions, and provider practices for the 57 patients admitted between 9/1/03 and 8/31/05. At baseline, over 80% of patients were injecting heroin, over 40% were homeless, and over one-third were using cocaine. Outcomes included an overall one-year retention rate of 61%, a rapid and dramatic decline in opioid use, very positive patient impressions of the program and of buprenorphine, and significant shifts in provider practices over time.     

Buprenorphine versus methadone in the treatment of opioid-dependent cocaine users

This study compared the efficacy of buprenorphine to methadone for decreasing cocaine use in patients with combined opioid and cocaine use. Participants (n=51) were enrolled in a 26-week treatment program and randomly assigned to either buprenorphine or methadone. Dosing was double-blind and double-dummy. Patients were stabilized on either 8 mg sublingual buprenorphine or 50 mg oral methadone, with dose increases given in response to continued illicit cocaine use or opioid use through week 16 of treatment. Maximum doses possible were 16 mg buprenorphine and 90 mg methadone. Average doses achieved were 11.2 mg buprenorphine and 66.6 mg methadone; 49% of the patients received the maximum doses possible. Urine samples were collected three times per week, and there was no significant difference in the rate of cocaine positive urines for the intent-to-treat sample (69% for buprenorphine versus 63% for methadone). For patients who remained in treatment through the flexible dosing period (n=28), there were significant decreases in cocaine positive urines over time (P<0.01), but no significant differences between groups or group × time effects. Buprenorphine and methadone were equally effective on measures of treatment retention, urine results for opioids, and compliance with attendance and counseling. These results demonstrate no selective efficacy of either buprenorphine or methadone in attenuating cocaine use in this population, but do provide further support for the equivalent efficacy of buprenorphine and methadone in the treatment of opioid dependence.Presented at the 55th Annual Scientific Meeting, The College on Problems of Drug Dependence, Toronto, Canada (Mune 17, 1993)     

Examining Pharmacy Workforce Issues in the United States and the United Kingdom

Objective. To examine available data and actions surrounding current pharmacy workforce issues in the United States and United Kingdom.Methods. Published pharmacy workforce data from the United States and United Kingdom were gathered from various sources, including PUBMED, Internet search engines, and pharmacy organization websites. Data was collated from additional sources including scientific literature, internal documents, news releases, and policy positions.Results. The number of colleges and schools of pharmacy has expanded by approximately 50% in both the United States and United Kingdom over the previous decade. In the United States, continued demand for the pharmacy workforce has been forecasted, but this need is based on outdated supply figures and assumptions for economic recovery. In the United Kingdom, workforce modeling has predicted a significant future oversupply of pharmacists, and action within the profession has attempted to address the situation through educational planning and regulation.Conclusion. Workforce planning is an essential task for sustaining a healthy profession. Recent workforce planning mechanisms in the United Kingdom may provide guidance for renewed efforts within the profession in the United States.