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Download PDF of Newsletter Alcohol, Other Drugs, and Health: TABLE OF TABLECONTENTS OF CONTENTS Current Evidence JAN-MAR 2008 INTERVENTIONS & ASSESSMENTS Topiramate Reduces Drinking in Adults With Alcohol Dependence, 1 InterventionsAlcohol and Health and Assessments Outcomes Methadone Maintenance Plus Syringe Exchange Reduces HIV and HCV Topiramate Reduces Drinking in Adults With Alcohol Dependence Incidence, 1 Topiramate may decrease alcohol con- differences between the topiramate sumption among people with alcohol de- and placebo groups were even Extended-Release Naltrexone Works Particularly Well for Abstinent pendence by reducing the release of dopa- greater. Patients With Dependence, 2 mine. To determine topiramate’s efficacy • With both analytic approaches, topi- for reducing drinking, researchers ran- ramate recipients achieved ≥28 days Prevalence of Adolescent Substance domized 371 patients with alcohol de- of both continuous abstinence and Use Identified by Screening in Primary pendence from 17 sites across the U.S. to continuous nonheavy drinking faster Care, 3 receive topiramate (up to 300 mg per day) than placebo recipients did. Melatonin, Benzodiazepines, and or placebo for 14 weeks. Only subjects Sleep Quality Among Patients Receiv- without comorbid conditions (e.g., other Comments: Topiramate is a promising ing Methadone, 3 substance use, depression) who wanted to treatment for alcohol dependence. Both quit or reduce drinking were eligible to analytic approaches suggest that broaden- Inpatient Medical Care Plus Substance enroll. All subjects received weekly, man- ing the use of topiramate to treat alcohol Use Treatment Improves Health Ser- vices Utilization, 4 ual-guided adherence enhancement coun- dependence among adults who want to seling. reduce their drinking is warranted. How- Do Patient Characteristics Moderate ever, because this randomized controlled Naltrexone’s Effects on Drinking?, 4 • In analyses that considered all drop- trial had strict eligibility criteria to ensure outs as having relapsed to baseline that safety and efficacy could be measured, measures, topiramate recipients had the generalizability of these findings to HEALTH OUTCOMES greater reductions in the percentage patients with comorbid illnesses, such as of drinking days (from a mean of 82% other substance disorders or psychiatric to 44% compared with 82% to 52% disease, may be limited. Prescription Opioid Use and Diver- for placebo recipients) and in liver Julia H. Arnsten, MD, MPH sion, 5 enzymes. They also had greater in- creases in abstinent days (from a Reference: Johnson BA, et al. Topiramate Impact of Substance Use on Adher- ence to HIV Medications, 5 mean of 10% to 38% compared with for treating alcohol dependence: a ran- 9% to 29% for placebo recipients). domized controlled trial. JAMA. 2007;298 Combining Healthy Behaviors, Includ- • In analyses that considered dropouts (14):1641–1651. ing Moderate Drinking, Reduces MI as missing rather than as relapses, the in Women, 6 Characteristics of Adolescents Who Use Cannabis But Not Tobacco, 6 Methadone Maintenance Plus Syringe Exchange Reduces HIV and HCV Incidence Racial Differences in Alcohol Treat- Sharing syringe and other injection equip- for HIV or HCV. ment Received and in Treatment Com- pleted, 6 ment places injection drug users (IDUs) at risk for bloodborne infections like HIV and • Over 20 years of follow-up, neither Moderate Drinking May Improve Fast- HCV. Participation in syringe exchange methadone maintenance alone nor ing Glucose in People With Diabetes, 7 programs plus receipt of methadone main- needle exchange alone was signifi- tenance may reduce the likelihood of cantly associated with HIV or HCV these infections, although few studies have seroincidence. JOURNAL ALERT examined this possibility. Therefore, re- • However, daily methadone mainte- Issues of Substance Abuse Dedicated searchers in Amsterdam assessed the ef- nance of ≥60 mg plus no drug injec- to Screening and Brief Intervention, 8 fects of the combination of these strate- tion or injection only with exchanged gies among 714 injection drug users at risk (continued on page 2) Alcohol, Other Drugs, and Health: Current Evidence is a project of the Boston Medical Center, supported by the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, and produced in cooperation with the Boston University Schools of Medicine and Public Health. PAGE 2 Methadone Maintenance (continued on from page 1) PAGE 2 needles (all in the past 6 recent outbreaks of HIV and HCV Editorial Board months) significantly reduced among IDUs, these findings are also both HIV and HCV seroinci- applicable to communities in the dence (adjusted incidence rate United States that lack adequate ac- Editor ratios 0.43 and 0.36, respec- cess to opioid treatment programs tively, when compared with and/or syringe exchange. Richard Saitz, MD, MPH, FASAM, FACP no methadone maintenance Peter D. Friedmann, MD, MPH Professor of Medicine & Epidemiology Boston University Schools of Medicine & Public Health and drug injection without exchanging needles). Reference: Van Den Berg C, et al. Full participation in harm reduction Co-Editor Comments: This study provides pro- programmes is associated with David A. Fiellin, MD spective evidence that a long-term, decreased risk for human Associate Professor of Medicine comprehensive public strategy to re- immunodeficiency virus and hepatitis Yale University School of Medicine duce bloodborne infections among C virus: evidence from the IDUs must include both syringe ex- Amsterdam Cohort Studies among change and opioid agonist therapy at drug users. Addiction. 2007;102 Associate Editors effective dose levels. Although most (9):1454–1462. Julia H. Arnsten, MD, MPH relevant to policy in countries with Associate Professor of Medicine, Epidemiology, & Psychiatry Albert Einstein College of Medicine Extended-Release Naltrexone Works Particularly Well for Abstinent Patients With Dependence R. Curtis Ellison, MD Many patients with alcohol dependence versus 7.2); Professor of Medicine & Public Health do not receive the full benefits of treat- • decreased days with heavy Boston University School of Medicine ment because they do not adhere to it. drinking (median days per In part to address issues with adher- month, 0.2 versus 2.9). Peter D. Friedmann, MD, MPH ence, extended-release naltrexone, Associate Professor of Medicine & Community Health which is released over a month after Smaller benefits, which were not Warren Alpert Medical School of Brown University one injection, was developed. always statistically significant, were found among the 28 subjects treated Marc N. Gourevitch, MD, MPH In the pivotal randomized, placebo- with 190 mg of naltrexone. Dr. Adolph & Margaret Berger Professor of Medicine controlled trial that showed the effi- New York University School of Medicine cacy of naltrexone combined with psy- Comments: Requiring abstinence chosocial therapy, subjects with ≥7 Kevin L. Kraemer, MD, MSc before starting treatment for alcohol days of abstinence benefited the most Associate Professor of Medicine & Health Policy & dependence can be a barrier to care. Management from the drug. However, achieving 7 But at least in this industry- University of Pittsburgh Schools of Medicine & Public days of abstinence before treatment is sponsored secondary analysis of a Health difficult. Therefore, researchers as- small subgroup of subjects, those sessed naltrexone’s efficacy, in that who achieved 4 days of abstinence Jeffrey H. Samet, MD, MA, MPH same clinical trial, among the subgroup before entering treatment re- Professor of Medicine & Social & Behavioral Sciences of 82 subjects with ≥4 days of absti- sponded well to extended-release Boston University Schools of Medicine & Public Health nence. naltrexone. Unfortunately, this and other medications with proven effi- Alexander Y. Walley, MD, MSc In that subgroup, 380 mg of naltrexone cacy (e.g., acamprosate, oral naltrex- Instructor of Medicine in 28 subjects versus placebo in 28 one, and disulfiram) remain underuti- Boston University School of Medicine subjects lized in the treatment of alcohol de- pendence. • increased the time to first drink Richard Saitz, MD, MPH Managing Editor (median days, 41 versus 12); Rosanne T. Guerriero, MPH • increased continuous abstinence Reference: O’Malley SS, et al. Efficacy Boston Medical Center over 6 months (32% versus 11%); of extended-release naltrexone in • increased time to first heavy drink- alcohol-dependent patients who are ing (>180 versus 20 days); abstinent before treatment. J Clin • decreased days with any drinking Psychopharm. 2007;27(5):507–512. (median days per month, 0.7 Alcohol, Other Drugs, and Health: Current Evidence, Jan-Mar 2008 PAGE 3 Prevalence of Adolescent Substance Use Identified by Screening in Primary Care Screening for alcohol and drug use among adolescents is • The prevalence of positive screens was lower at well- advocated by the American Medical Association and others. child visits (11%) than at sick visits (23%). However, the prevalence of adolescent substance use prob- • Statistical modeling estimated that 22% of the adoles- lems and disorders identified with an accepted screening cents had nonproblematic use, 11% had problematic instrument is not known. use (>1 substance-related problem during the past year but no diagnosis of abuse or dependence), 7% Using the validated CRAFFT* instrument, researchers had abuse, and 3% had dependence. screened 2133 12- to 18-year olds (representing a 93% par-
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