Changes in the prevalence and correlates of cocaine use and cocaine use disorder in the United States, 2001–2002 and 2012–2013

To present nationally representative data on changes in the prevalences of 12-month cocaine use, cocaine use disorder (CocUD) and 12-month CocUD among 12-month cocaine users between 2001 and 2002 and 2012–2013. Data were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the 2012–2013 NESARC-III. Between 2001 and 2002 and 2012–2013, prevalences of 12-month cocaine use and DSM-IV CocUD significantly increased and 12-month CocUD among 12-month users significantly decreased. Increases in risk of cocaine use were seen across nearly all sociodemographic subgroups while increases in CocUD were observed among women, those in the oldest age group, Whites, individuals with the lowest incomes and highest education, and those residing in urban areas. Prevalence of CocUD among users significantly declined overall and among men, individuals aged 30–44 years old, the never-married, respondents with incomes between $20,000 and $34,000, and those residing in the Midwest. Increases in coca cultivation in Colombia in recent years together with increases in the purity of cocaine entering the U.S. portend more significant increases in the rates of cocaine use and CocUD in the U.S. along with increases in cocaine-related morbidity and mortality. The results of this study support the continued monitoring of cocaine use and CocUD in the U.S., especially in view of the narrowing of the gender gap and shifts in race-ethnic, age and socioeconomic differentials seen between 2001 and 2002 and 2012–2013.     

Anticoagulant rodenticide exposure and toxicosis in four species of birds of prey in Massachusetts,USA, 2012–2016, in relation to use of rodenticides by pest management professionals

Restrictions on second-generation anticoagulant rodenticides (SGARs) in the United States, which were partially implemented in 2011, prohibit the sale of SGAR products through general consumer outlets to minimize use by non-professional or non-agricultural applicators. This study analyzed liver tissue from four species of birds of prey admitted to a wildlife clinic in Massachusetts, USA, from 2012–2016 for residues of anticoagulant rodenticides (ARs). Ninety-four birds were analyzed; 16 were symptomatic for AR toxicosis, and 78 asymptomatic. Ninety-six percent of all birds tested were positive for SGARs: 100% of those diagnosed with AR toxicosis ante-mortem and/or post-mortem and 95% of subclinically exposed birds. Brodifacoum was found in 95% of all birds. Sixty-six percent of all birds contained residues of two or more SGARs. A significant increase in exposures to multiple SGARs occurred in later years in the study. Pesticide use reports (PURs) filed with the Massachusetts Department of Agricultural Resources were reviewed to determine the frequency of use of different ARs by pest management professionals (PMPs) across five years. This study finds that the three SGARs favored by PMPs—bromadiolone, difethialone, brodifacoum—were present in combination in the majority of birds, with increases in multiple exposures driven by increased detections of bromadiolone and difethialone. Continued monitoring of AR residues in nontarget species following full implementation of sales and packaging restrictions in the US is needed in order to elucidate the role of PMP use of SGARs in wildlife exposures and to evaluate the effectiveness of current mitigation measures.     

The epidemiology of intentional non-fatal self-harm poisoning in the United States: 2001–2004

Introduction

Suicide attempts through intentional poisoning are an important public health concern. This investigation sought to determine the different US incident rates of poisonings (with intent to do self-harm) by race, sex, and gender.

Methods

We used data from the National Electronic Injury Surveillance System — All Injury Program (NEISS-AIP) to describe differences in incidence rates of non-fatal, self-harm poisonings evaluated in US emergency departments (ED) from 2001 to 2004. WISQARS defines self-harm as “either confirmed or suspected from injury or poisoning resulting from a deliberate act inflicted on oneself with the intent to take one’s own life or harm oneself.”

Results

From 2001 to 2004, there were 976,974 (95% Confidence Interval (CI) 772,884 – 1,181,065) non-fatal self-harm poisonings reported in US Emergency Departments. Young white females between 15 to 19 years of age were at highest risk with an incidence rate of 248 per 100,000 (95% CI 180 – 315). Females had higher rates of self-harm poisonings than males: the rate for females was 101 per 100,000 (95% CI 81 – 123); the rate for males was 66 per 100,000 (95% CI 51 – 81), p < 0.001. Whites had slightly higher rates than blacks, and significantly higher rates than Hispanics: whites rates were 71 per 100,000 (95% 51 – 91); black rates were 65 per 100,000 (95% CI 35 – 96), and Hispanic rates were 23 per 100,000 (95% 10 – 37). There was a significant increase in the incidence rate from 2002 to 2003 (p < 0.001). Incident rates decreased for females and males older than 19 years of age (p < 0.001 for males and females).

Conclusion

Recently, the incidence of self-harm poisoning has risen considerably. It rose from 75 (CI 53–98) per 100,000 in 2002 to 94 (CI 74–115) per 100,000 in 2003; incidence remained relatively steady in 2004. Whites have higher incidence rates than blacks and significantly higher incidence rates than Hispanics. Females are at higher risk than males, and adolescent white females are at highest risk. An understanding of the demographic factors associated with self-harm poisoning may provide useful information to improve prevention and treatment strategies.     

The History of MDMA as an Underground Drug in the United States, 1960–1979

MDMA (3,4-methylenedioxy-methylamphetamine, a.k.a. “ecstasy”) was first synthesized in 1912 and resynthesized more than once for pharmaceutical reasons before it became a popular recreational drug. Partially based on previously overlooked U.S. government documentation, this article reconstructs the early history of MDMA as a recreational drug in the U.S. from 1960 to 1979. According to the literature, MDMA was introduced as a street drug at the end of the 1960s. The first forensic detection of MDMA “on the street” was reported in 1970 in Chicago. It appears that MDMA was first synthesized by underground chemists in search of “legal alternatives” for the closely related and highly sought-after drug MDA, which was scheduled under the Controlled Substances Act (CSA) in 1970. Until 1974, nearly all MDMA street samples seized came from the U.S. Midwest, the first “hot region” of MDMA use. In Canada, MDMA was first detected in 1974 and scheduled in 1976. From 1975 to 1979, MDMA was found in street samples in more than 10 U.S. states, the West Coast becoming the major “hot region” of MDMA use. Recreational use of MDMA spread across the U.S. in the early 1980s, and in 1985 it was scheduled under the CSA.     

Initial opportunity to use marijuana and the transition to first use: United States, 1979–1994

A renewed American interest in marijuana has coincided with our research group's focus on the earliest stages of drug involvement. Here, we have studied the transition from an initial opportunity to try marijuana to the subsequent use of this drug. We analyzed self-report interview data gathered from nationally representative samples of the United States National Household Surveys on Drug Abuse, 1979–1994. The evidence indicates that the estimated prevalence of an opportunity to try marijuana has been rather stable for 15 years. However, there are recent increases in the probability of rapidly progressing from first marijuana opportunity to first marijuana use, among persons given an opportunity to use. In addition, the transition from first marijuana opportunity to eventual marijuana use seems to depend upon age at first opportunity. This epidemiological evidence on the transition from marijuana opportunity to marijuana use, the first to be published based on a nationally representative US sample, highlights directions for future research and a focus for prevention efforts.     

Association between urinary biomarkers of exposure to organophosphate insecticides and serum reproductive hormones in men from NHANES 1999–2002

Exposure to organophosphate (OP) insecticides may alter reproductive hormone levels in men and increase the risk for poor reductive health and other adverse health outcomes. However, relevant epidemiology studies in men are limited. We evaluated urinary concentrations of OP metabolites (3,5,6-trichloro-2-pyridinol and six dialkyl phosphates) in relation to serum concentrations of testosterone (T) and estradiol among 356 men aged 20–55 years old from the U.S. National Health and Nutrition Examination Survey. Biomarkers were detected in greater than 50% of the samples, except for diethyldithiophosphate, dimethylphosphate, and dimethyldithiophosphate. In adjusted regression models, we observed a statistically significant inverse relationship between diethyl phosphate (DEP) and T when DEP was modeled as either a continuous or categorical variable. These findings add to the limited evidence that exposure to certain OP insecticides is linked to altered T in men, which may have important implications for male health.     

Dietary exposure of the Italian population to inorganic arsenic: The 2012–2014 Total Diet Study

Dietary exposure of the Italian population to inorganic arsenic has been assessed in the national Total Diet Study (TDS) carried out in 2012-2014. Within the TDS, food samples (>3000) were collected to be representative of the whole diet of the population, prepared as consumed, and pooled into 51 food groups, thus modelling the Italian diet. Inorganic arsenic was determined by HPLC-ICP-MS after chemical extraction and quantified in all samples. Occurrence data were combined with national individual consumption data to estimate mean and high level dietary exposure of the general population and of population subgroups according to age and gender, both at the national level and for each of the four main geographical areas of Italy. The intakes assessed are in the lower range of iAs exposure estimates in other European countries carried out without the support of the TDS approach. However, taking the lower limit of the BMDL₀₁ range established by the EFSA as reference point, the margins of exposure are <2 for the mean intake in infants and toddlers and <1 for the 95th percentile intakes in all younger age groups. Our results indicate the goal to check and further reduce the dietary exposure to inorganic arsenic.     

Total,organic, and inorganic mercury in human breast milk: levels and maternal factors of exposure,systematic literature review, 1976–2017

Abstract

This systematic review summarizes the finding of 58 studies from 33 countries, which assessed mercury concentrations in breast milk and the factors related to the level of contamination. We performed a literature search in Pubmed, Science Direct, and Google Scholar databases for studies published between 1976 and 2017 that are monitoring and measuring mercury in human breast milk and investigating the associated factors. Then, we extracted more information about the aim of the study, the country, samples size, time of lactation, mercury concentration, and other data. Most of the studies used mature milk or colostrum for analysis and in about 60% of them, the concentrations exceed significantly the limit set by the World Health Organization (WHO) of 1.7?µg/l; In addition, many factors and parameters were related to the level of mercury contamination in breast milk. Periodic monitoring surveys are recommended in each country to evaluate the level of mercury in milk of lactating women and to estimate the level of exposure of newborns.     

Patterns and correlates of polytobacco use in the United States over a decade: NSDUH 2002–2011

BackgroundFew studies have examined the patterns and correlates of polytobacco use among a large, nationally representative population over an extended period of time.MethodsThis study examined 10 years of data from the National Survey on Drug Use and Health (NSDUH) to establish time trends and correlates for exclusive and mixed use of cigarettes, smokeless tobacco (SLT), cigars, and pipes.ResultsResults show that rates of polytobacco use were essentially unchanged from 2002 to 2011 (8.7% to 7.4%), though some product combinations, including cigarettes and SLT, cigars and SLT, and use of more than two products have increased. In tobacco users under age 26, the proportion of polytobacco use increased, even as overall tobacco use declined. The factors associated with polytobacco use among tobacco users included sex, income, education, risk taking/seeking behaviors, and outward indicators of ‘risk-liability’.ConclusionsFindings provide a snapshot of trends of single and polytobacco product use as well as trends in combinations of product use. Longitudinal studies are needed to examine the sequence of individual patterns of tobacco product use and to identify whether polytobacco use results in greater nicotine dependence, increased exposure to harmful and potentially harmful constituents and/or greater risk of tobacco related disease.     

Correct knowledge of medical cannabis legal status in one's own state: Differences between adolescents and adults in the United States, 2004–2013

BackgroundStudies have found age-specific effects of medical cannabis laws (MCLs), particularly affecting adult cannabis use but not adolescent use. We examined whether age differences in MCL knowledge are in accordance with age differences in MCL effects on cannabis use.MethodsData from the 2004–2013 repeated cross-sectional National Surveys on Drug Use and Health included people ages 12 and older in the United States. State-aggregated MCL knowledge was the proportion of people that correctly identified living in a state that did not allow medical cannabis prior to MCL enactment, or that allowed medical cannabis after MCL enactment. We regressed state-aggregated MCL knowledge on time-varying MCL enactment (i.e., no MCL by 2015, before MCL, after MCL), testing associations by age strata (12–17, 18–25, 26+), open dispensary status, and adjusting for time and state-level demographics.ResultsModel-based MCL knowledge was significantly lower among adolescents than adults; after enactment, 36.8% of ages 12–17, 48.8% of ages 18–25, and 45.4% of ages 26+ were aware of their state's MCL status. Correct MCL status knowledge decreased across all age groups after MCL enactment (i.e., low knowledge of MCL changes at the time they occurred). Open cannabis dispensaries significantly increased correct MCL knowledge, with a 7.7-point increase for adolescents and a 17.5-point increase for adults 26 + .ConclusionsLower MCL knowledge among adolescents than adults was in accordance with MCL effects on cannabis use previously observed among adults only. Studies should assess whether MCL knowledge is a consequence or predictor of individual-level cannabis use across age groups.     

The diverse drivers of relative changes in excise taxes on beer and spirits in Australia, 1902–2012

In Australia there have been calls for volumetric alcohol taxation, or some variant of this, to eliminate the complexities and inequalities of the existing system. While the arguments have been made on economic rationality and evidence-based public health grounds, this article examines the historical drivers of alcoholic beverage excise tax changes in order to facilitate a more informed debate about how to achieve alcohol taxation reform. Excise taxation on spirits and beer (wine has almost never been taxed through excise taxes in Australia) was examined in greater detail using primary data sourced from national excise taxation schedules from 1902 to 2012. Interpretation of this data was based on primary sources such as Hansard speeches and Government reports, and secondary sources provided by historians. Australia had a long history of not taxing spirits more heavily than beer except in the early part of the twentieth century; this changed after 1988. Setting alcohol excise taxes in Australia has been a balancing exercise between industry protection, revenue raising and political expediency, as well as public health. The historical instances examined in this article support the conclusion that while public health has been a driving force for some excise taxation changes, it has not been the only driver. These findings should inform policy making on excise taxation on alcoholic beverages in Australia.     

Dielectric Study of Equimolar Acetaminophen–Aspirin,Acetaminophen–Quinidine,and Benzoic Acid–Progesterone Molecular Alloys in the Glass and Ultraviscous States and Their Relevance to Solubility and Stability

Equimolar mixtures of acetaminophen–aspirin, acetaminophen–quinidine, and benzoic acid–progesterone have been vitrified and dielectric properties of their glassy and ultraviscous alloys have been studied. For 20 K/min heating rate, their T_gs are 266, 330, and 263 K, respectively. The relaxation has an asymmetric distribution of times, and the distribution parameter increases with increase in temperature. The dielectric relaxation time varies with T according to the Vogel–Fulcher–Tammann equation, log₁₀(τ₀) = A_VFT + [B_VFT/(T ? T₀)], where A_VFT, B_VFT, and T₀ are empirical constants. The equilibrium permittivity is highest for the aspirin–acetaminophen and lowest for the benzoic acid‐progesterone alloy, indicating a substantial interpharmaceutical hydrogen bonding that makes the alloy more stable against crystallization than the pure components. The benzoic acid–progesterone alloy is thermodynamically the most nonideal. It showed cold crystallization on heating, which is attributed to its relatively greater magnitude of the JG relaxation in relation to its α‐relaxation. It is argued that the difference between the free energy of an alloy and the pure components would have an effect on the solubility. Studies of solution thermodynamics of a glassy molecular alloy may be useful for optimizing choice of components and composition to form molecular alloys and to impact drug delivery. © 2009 Wiley‐Liss, Inc. and the American Pharmacists Association J Pharm Sci 99: 1358–1374, 2010     

The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005–2014

Introduction and objectives: Acute abdominal pain (AAP) is one of the most common complaints in the emergency department (ED). Rapid diagnosis is essential and is often achieved through imaging. Computed tomography (CT) is widely considered an exemplary test in the diagnosis of AAP in adult patients. As previous studies show disparities in healthcare treatment based on insurance status, our objective was to assess the association between insurance status and frequency of CT ordered for adult patients presenting to the ED with AAP from 2005 to 2014.

Methods: This study used the National Hospital and Ambulatory Medical Care Survey: Emergency Department Record (NHAMCS) database, which collects data over a randomly assigned 4 week period in the 50 states and DC, to perform an observational retrospective analysis of patients presenting to the ED with AAP. Patients with Medicaid, Medicare or no insurance were compared to patients with private insurance. The association between insurance status and frequency of CT ordered was measured by obtaining odds ratios along with 95% CIs adjusted for age, gender and race/ethnicity.

Results: Individuals receiving Medicaid are 20% less likely to receive CT than those with private insurance (OR 0.8, CI 0.6–0.99, p?=?.046). Those on Medicare or who are uninsured have no difference in odds of obtaining a CT scan compared to patients with private insurance. Additional findings are that black patients are 42% less likely to receive a CT scan than white patients.

Conclusions and implications: Patients on Medicaid are significantly less likely to receive a CT when presenting to the ED with AAP. Differences in diagnostic care may correlate to inferior health outcomes in patients without private insurance.     

EXPANSION of diabetes education in a United States–Mexico border community (Expanding Services for Patients to Acquire New Skills,Set Goals,and Improve Overall Knowledge)

Objectives

To describe the process used by a pharmacy team at a community health center to coordinate and expand diabetes education services (English and Spanish) for a predominantly Hispanic, Spanish-speaking population.

Drug–drug interactions in the metabolism of imidafenacin: Role of the human cytochrome P450 enzymes and UDP-glucuronic acid transferases,and potential of imidafenacin to inhibit human cytochrome P450 enzymes

Imidafenacin (IM), 4-(2-methyl-1H-imidazol-1-yl)-2,2-diphenylbutanamide, is a newly synthesized antimuscarinic drug developed for the treatment of overactive bladder. To predict clinically relevant drug interactions in the metabolism of IM, the paper investigated: (1) the major enzymes responsible for the metabolism of IM, (2) the effects of concomitant drugs on the inhibition of metabolism of IM, and (3) the effects of IM and its metabolites on the inhibition of human cytochrome P450 (CYP). The elimination of IM and production of oxidative metabolites were mainly catalysed by recombinant CYP3A4, and the elimination of IM by human liver microsomes (HLM) was markedly inhibited by co-incubation with ketoconazole. The production of the N-glucuronide metabolite was only catalysed by recombinant UGT1A4. Clinically established CYP3A4 inhibitors including itraconazole, ketoconazole, erythromycin and clarithromycin inhibited the elimination of IM in HLM. IM and its major metabolites did not affect the activities of CYP enzymes in vitro. The results suggest that the major enzymes responsible for the metabolism of IM are CYP3A4 and UGT1A4, and oxidative metabolism of IM is reduced by concomitant administration of CYP3A4 inhibitors. In contrast, IM and its metabolites have no inhibitory effect on the CYP-mediated metabolism of concomitant drugs.     

The contribution of heavy metals in cigarette smoke condensate to malignant transformation of breast epithelial cells and in vivo initiation of neoplasia through induction of a PI3K–AKT–NFκB cascade

Cigarette smoking is a crucial factor in the development and progression of multiple cancers including breast. Here, we report that repeated exposure to a fixed, low dose of cigarette smoke condensate (CSC) prepared from Indian cigarettes is capable of transforming normal breast epithelial cells, MCF-10A, and delineate the biochemical basis for cellular transformation. CSC transformed cells (MCF-10A-Tr) were capable of anchorage-independent growth, and their anchorage dependent growth and colony forming ability were higher compared to the non-transformed MCF-10A cells. Increased expression of biomarkers representative of oncogenic transformation (NRP-1, Nectin-4), and anti-apoptotic markers (PI3K, AKT, NFκB) were also noted in the MCF-10A-Tr cells. Short tandem repeat (STR) profiling of MCF-10A and MCF-10A-Tr cells revealed that transformed cells acquired allelic variation during transformation, and had become genetically distinct. MCF-10A-Tr cells formed solid tumors when implanted into the mammary fat pads of Balb/c mice. Data revealed that CSC contained approximately 1.011 μg Cd per cigarette equivalent, and Cd (0.0003 μg Cd/1 × 10⁷ cells) was also detected in the lysates from MCF-10A cells treated with 25 μg/mL CSC. In similar manner to CSC, CdCl₂ treatment in MCF-10A cells caused anchorage independent colony growth, higher expression of oncogenic proteins and increased PI3K–AKT–NFκB protein expression. An increase in the expression of PI3K–AKT–NFκB was also noted in the mice xenografts. Interestingly, it was noted that CSC and CdCl₂ treatment in MCF-10A cells increased ROS. Collectively, results suggest that heavy metals present in cigarettes of Indian origin may substantially contribute to tumorigenesis by inducing intercellular ROS accumulation and increased expression of PI3K, AKT and NFκB proteins.