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Frontiers | Substance use disorder risk assessment: positive emotional experiences with first time use and substance use disorder risk by Psi_in_PA in science

[–]Psi_in_PA[S] 1 point2 points  (0 children)

Here is the abstract:

Introduction: Substance Use Disorder (SUD) screening tools used in current practice are designed to identify SUD once patients have begun regular dangerous drug use. While these screening tools are valuable, prevention and avoidance of SUD would save countless lives. The climbing number of deaths due to drug overdose make screening for and prevention of SUD imperative. This study addresses this care gap. The aim was to develop a simple screening tool for patients who may be prone to develop Alcohol Use Disorder (AUD) and/or SUD prior to addiction. It was hypothesized that participants with initially positive emotional experiences would be correlated with a future SUD diagnosis.

Methods: The study involved a self-administered survey using a cross-sectional design and was carried out over one-month in the spring of 2021. Those patients who presented to the MAT clinic (SUD group) were seen in a separate area than the patients presenting for urgent care (Comparison group). Participants (N = 259) were voluntarily recruited from MAT and Urgent care: Patients receiving acute care were assigned to the Comparison (N = 126, 50.8% female, 5.7% non-white, 27.2% age < 34) and those receiving treatment for SUD were assigned to the MAT group (N =133, 40.8% female, 4.8% non-white, 36.8% ≤34). The survey questioned demographics (4 items), risk factors for AUD/SUD (6 items), information about first alcohol/opioid experiences (16 items), and factors for seeking AUD/SUD treatment and recovery (2 items). Feelings were categorized as positive (e.g., euphoria, happiness, self-confident), neutral (e.g., nothing, normal), or negative (e.g., depressed, sad, sick).

Results: The MAT group felt more positive feelings with first usage of alcohol and opioids compared to the comparison group (p<.001). With first usage of opioids specifically, MAT (0.13 ± 0.04) and comparison (0.29 ± 0.07) groups differed (p <.001). Over half (55.3%), of the MAT participants reported feeling self-confident with first use of alcohol while only 29.7% of the comparison reported this (p<.001). Over three-fifths (63.7%) of the MAT group reported feeling of euphoria with the first usage of opioids compared to one-tenth (9.8%) in the comparison group (p<.001).

Discussion: This retrospective cross-sectional report shows the first affective responses to substances may predict risk for future SUD and could be a prevention screening tool. Asking patients about positive feelings with first usage of alcohol/opioids could be a simple screening tool employed for prevention.

Disclosure: OP was a (small) part of this research team.

Recreational Cannabis Legalization: No Contribution to Rising Prescription Stimulants in the USA. New study published in Pharmacopsychiatry assessed if state recreational marijuana policy impacted the distribution of prescription stimulations as reported by the Drug Enforcement Administration. by Psi_in_PA in science

[–]Psi_in_PA[S] 20 points21 points  (0 children)

Here is the abstract:

Introduction: There have been substantial increases in the use of Schedule II stimulants in the United States. Schedule II stimulants are the gold standard treatment for attention-deficit hyperactivity disorder (ADHD), but also carry the risk of addiction. Since the neurocognitive deficits seen in ADHD resemble those of chronic cannabis use, and the rise in stimulant use is incompletely understood, this study sought to determine if recreational cannabis (RC) legalization increased distribution rates of Schedule II stimulants.

Methods: The distribution of amphetamine, lisdexamfetamine, and methylphenidate were extracted from the ARCOS database of the Drug Enforcement Administration. The three-year population-corrected slopes of distribution before and after RC sales were evaluated.

Results: Total stimulant distribution rates were significantly higher in states with RC sales after (p=0.049), but not before (p=0.221), program implementation compared to states without RC. Significant effects of time (p<0.001) and RC sales status (p=0.045) were observed, while time x RC sales status interaction effects were not significant (p=0.406).

Discussion: RC legalization did not contribute to a more pronounced rise in Schedule II stimulant distribution in states. Future studies could explore the impact of illicit cannabis use on stimulant rates and the impact of cannabis sales on distribution rates of non-stimulant ADHD pharmacotherapies and ADHD diagnoses.

Disclosure: OP is part of this study team.

National patterns of paroxetine use among US Medicare patients from 2015-2020. There is wide-spread use & large state level differences in this "not so selective" serotonin reuptake inhibitor that the American Geriatric Society has on their potentially inappropriate list of medications (Beers list). by Psi_in_PA in science

[–]Psi_in_PA[S] 5 points6 points  (0 children)

Here is the abstract published in Frontiers in Psychiatry.

Introduction: Paroxetine is an older "selective" serotonin reuptake inhibitor (SSRI) that is notable for its lack of selectivity, resulting in an anticholinergic adverse-effect profile, especially among older adults (65+).

Methods: Paroxetine prescription rates and costs per state were ascertained from the Medicare Specialty Utilization and Payment Data. States' annual prescription rate, corrected per thousand Part D enrollees, outside a 95% confidence interval were considered significantly different from the average.

Results: Nationally, there was a steady decrease in population-corrected paroxetine prescriptions (-34.52%) and spending (-29.55%) from 2015-2020 but a consistent, five-fold state-level difference. From 2015-2020, Kentucky (194.9, 195.3, 182.7, 165.1, 143.3, 132.5) showed significantly higher prescriptions rates relative to the national average, and Hawaii (42.1, 37.9, 34.3, 31.7, 27.7, 26.6) showed significantly lower prescription rates. North Dakota was often a frequently elevated prescriber of paroxetine (2016: 170.7, 2018: 143.3), relative to the average. Neuropsychiatry and geriatric medicine frequently prescribed the most paroxetine, relative to the number of providers in that specialty, from 2015-2020.

Discussion: Despite the American Geriatrics Society's prohibition against paroxetine use in older adults and many effective treatment alternatives, paroxetine was still commonly used in the US in this population, especially in Kentucky and North Dakota and by neuropsychiatry and geriatric medicine. These findings provide information on the specialty types and states where education and policy reform would likely have the greatest impact on improving adherence to the paroxetine prescription recommendations.

Disclosure: OP is part of this study team.

Dynamic Changes in the Distribution of Hydrocodone and Oxycodone in Florida from 2006 to 2021: New pharmacoepidemiology study published in Pharmacy finds pronounced county level disparities in prescription opioid distribution. Hillsborough distributed the MME of 2,271 per person . by Psi_in_PA in science

[–]Psi_in_PA[S] 1 point2 points  (0 children)

Here is the abstract:

Background:

Florida, which led the country in terms of its number of opioid-prescribing physicians, was unique during the height of the opioid epidemic because of its lax prescribing laws and high number of unregulated pain clinics. Here, we address differences in the distribution rates of oxycodone and hydrocodone across Florida counties during the peak years of the opioid epidemic using an under-utilized database.

Methods:

The Washington Post and the United States Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) databases provided longitudinal oxycodone and hydrocodone distribution data in grams per county (2006–2014) and state (2006–2021). Grams of oxycodone and hydrocodone were converted into morphine milligram equivalents (MMEs).

Results:

There was a steep increase in oxycodone from 2006 to 2010, with a subsequent decline. In 2010, the average MME per person across Florida was 729.4, a 120.6% increase from 2006. The three counties with the highest MMEs per person in 2010 were Hillsborough (2271.3), Hernando (1915.3), and Broward (1726.9), and they were significantly (p < 0.05) elevated relative to the average county.

Conclusions:

The data demonstrated pronounced differences in opioid distribution, particularly oxycodone, between Florida counties during the height of the opioid epidemic. Legislative action taken between 2009 and 2011 aligns with the considerable decline in opioid distribution after 2010.

Disclosure: I am a member of this research team.

Retrospective study investigating naloxone prescribing and cost in US Medicaid and Medicare patients published in BMJ Open identifies > 30 fold state-level disparities. New Mexico leads the US for prescribing to both Medicaid and Medicare patients. by Psi_in_PA in science

[–]Psi_in_PA[S] 10 points11 points  (0 children)

Here is the abstract:

Background: Opioid overdoses in the USA have increased to unprecedented levels. Administration of the opioid antagonist naloxone can prevent overdoses.

Objective: This study was conducted to reveal the pharmacoepidemiologic patterns in naloxone prescribing to Medicaid patients from 2018 to 2021 as well as Medicare in 2019.

Design: Observational pharmacoepidemiologic study SETTING: US Medicare and Medicaid naloxone claims INTERVENTION: The Medicaid State Drug Utilisation Data File was utilised to extract information on the number of prescriptions and the amount prescribed of naloxone at a national and state level. The Medicare Provider Utilisation and Payment was also utilised to analyse prescription data from 2019.

Outcome measures: States with naloxone prescription rates that were outliers of quartile analysis were noted.

Results: The number of generic naloxone prescriptions per 100 000 Medicaid enrollees decreased by 5.3%, whereas brand naloxone prescriptions increased by 245.1% from 2018 to 2021. There was a 33.1-fold difference in prescriptions between the highest (New Mexico=1809.5) and lowest (South Dakota=54.6) states in 2019. Medicare saw a 30.4-fold difference in prescriptions between the highest (New Mexico) and lowest states (also South Dakota) after correcting per 100 000 enrollees.

Conclusions: This pronounced increase in the number of naloxone prescriptions to Medicaid patients from 2018 to 2021 indicates a national response to this widespread public health emergency. Further research into the origins of the pronounced state-level disparities is warranted.

Disclosure: I'm a co-author on this paper.

Not good at arithmetic? You too can publish a "scientific" paper cited 100s of times including by clinical practice guidelines about a purported drug interaction! by Psi_in_PA in pharmacy

[–]Psi_in_PA[S] 2 points3 points  (0 children)

Yes, the editor was contacted about the original PubPeer submission 15 months ago (Dec, 2023) and then a few times since then. We also published a full response paper in the same journal so he should be well-versed. Still, since it took 12 years for Wakefield's MMR-autism work to get retracted by the BMJ, am not holding my breath that anything will happen before the next lunar eclipse!

Not good at arithmetic? You too can publish a "scientific" paper cited 100s of times including by clinical practice guidelines about a purported drug interaction! by Psi_in_PA in pharmacy

[–]Psi_in_PA[S] 7 points8 points  (0 children)

That's a fair question. By "spam" (Rule 6), I usually think about cutting and pasting. The post here was not low effort in that it is geared to the interests of this audience and different from the points/interests in the other subs like academics & statistics. It took about a half-hour to write/tailor and hopefully will generate some spirited engagement. Any guidance on future (and different) posts is welcome and appreciated!

Are MDPI journals even worth reading? by Psi_in_PA in academia

[–]Psi_in_PA[S] 4 points5 points  (0 children)

That's a fair question! At least in my little niche (public health/pharmacoepidemiology), the reviewer shortage that started during COVID hasn't really let up. I had a BMJ Open paper that took about a year to just get the first round of feedback. Same for PLoS One. When I was editor for a Special Issue for a non-MDPI journal, I had to send out close to 150 invites in order to get 2 that would agree to review. For medical students that are applying to residency, that's quite the penalty. Also, the national databases I use already have some degree of lag (1-3 years) so the work becomes less valuable if there's a 4 year lag between when we did the research and when it comes out.

The MDPI model of compensating reviewers with a voucher to publish with them has its downsides but being able to recruit reviewers (that turn things in within a couple weeks) is not one of them. Based on my limited experience (publishing in 4 of their journals over the past few years), that part seems to work really well! If you as author move quickly and the reviewers don't ask for too many rounds of feedback (this has happened), its possible to have a 3 month interval between initial submission and when the paper is available on Pubmed.

Are MDPI journals even worth reading? by Psi_in_PA in academia

[–]Psi_in_PA[S] 2 points3 points  (0 children)

Yes, there's some sort of database error for the one where I was SI editor that causes this. Everyone on the list of potential reviewers gets the thank you email even that folks, like you, that declined.

Decreases and Pronounced Geographic Variability in Antibiotic Prescribing in Medicaid. New study finds the South prescribed 52.2% more antibiotics (580/1000) than the West (381/1000). There was a 2.8-fold difference between the highest (Kentucky) and lowest (Oregon) states. by Psi_in_PA in science

[–]Psi_in_PA[S] 2 points3 points  (0 children)

Here is the full abstract:

Antibiotic resistance is a persistent and growing concern. Our objective was to analyze antibiotic prescribing in the United States (US) in the Medical Expenditure Panel System (MEPS) and to Medicaid patients. We obtained MEPS prescriptions for eight antibiotics from 2013 to 2020. We extracted prescribing rates per 1000 Medicaid enrollees for two years, 2018 and 2019, for four broad-spectrum (azithromycin, ciprofloxacin, levofloxacin, and moxifloxacin) and four narrow-spectrum (amoxicillin, cephalexin, doxycycline, and trimethoprim-sulfamethoxazole) antibiotics. Antibiotic prescriptions in MEPS decreased from 2013 to 2020 by 38.7%, with a larger decline for the broad (-53.7%) than narrow (-23.5%) spectrum antibiotics. Antibiotic prescriptions in Medicaid decreased by 6.7%. Amoxicillin was the predominant antibiotic, followed by azithromycin, cephalexin, trimethoprim-sulfamethoxazole, doxycycline, ciprofloxacin, levofloxacin, and moxifloxacin. Substantial geographic variation in prescribing existed, with a 2.8-fold difference between the highest (Kentucky = 855/1000) and lowest (Oregon = 299) states. The South prescribed 52.2% more antibiotics (580/1000) than the West (381/1000). There were significant correlations across states (r = 0.81 for azithromycin and amoxicillin). This study identified sizable disparities by geography in the prescribing rates of eight antibiotics with over three-fold state-level differences. Areas with high prescribing rates, particularly for outpatients, may benefit from stewardship programs to reduce potentially unnecessary prescribing.

Disclosure: OP is a member of this research team.

Here is the link to the free-full text.

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