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Alcohol, Other Drugs, and Health: Current Evidence

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Alcohol, Other Drugs, and Health: Current Evidence TABLE OF CONTENTS Alcohol, Other Drugs, and Health: INTERVENTIONS & ASSESSMENTS T A B L E O F Lack of EfficacyC O N of T a E 3-Medication N T S Treatment Protocol for Current Evidence Methamphetamine Dependence, 1 JANUARY–FEBRUARY 2012 Retention in Opioid Agonist Treatment after Prison Release Re- duces Re-incarceration, 1 Adding N-Acetylcysteine to INTERVENTIONS & ASSESSMENTS Glucocorticoids May Improve Outcomes in Patients with Severe Alcoholic Hepatitis, 2 Lack of Efficacy of a 3-Medication Treatment Protocol for Methamphetamine Dependence People Receiving Buprenorphine and Methadone Are More Likely to Be The PROMETA™ protocol, which includes − proportion of methamphetamine- Responsible for Traffic Crashes, 3 the benzodiazepine antagonist flumazenil, negative urine tests (50%, 40%, and Recent Notable Developments in the GABA-agonist gabapentin, and the H 1- 30% versus 50%, 50%, and 40%, Addiction Pharmacotherapies, 3 histamine antagonist hydroxyzine, is un- respectively); proven for the treatment of methampheta- − mean methamphetamine craving HEALTH OUTCOMES mine dependence. In this double-blind trial, score (2.8, 3.1, and 2.2 versus 2.9, Modest Marijuana Exposure Does Not researchers randomized 120 patients with 2.9, and 2.4, respectively); or Adversely Affect Pulmonary Function, methamphetamine abuse or dependence − percentage with 3 consecutive but High Cumulative Exposure Does, to the PROMETA protocol (intravenous negative urine tests (36% and 39% 4 flumazenil 2 mg on days 1, 2, 3, 22, and 23; versus 46% and 51% at days 40 and Wine-specific Mortality Benefits oral gabapentin titrated to 1200 mg per 108, respectively). Disappear When Studied day by day 4 and continued to day 40; and • Mild, moderate, and severe adverse Appropriately, 4 oral hydroxyzine 50 mg prior to flumazenil events were reported by 73%, 23%, infusion and as take-home medication Thirty Years of Observational Studies and 4% of the experimental group and through day 10) or to placebo (active hy- of Alcohol’s Cardioprotective Effects: 59%, 40%, and 1% of the placebo Uncertainty Remains, 5 droxyzine only). Each group received 14 group, respectively. Lifestyle and Environmental Factors, weekly sessions of cognitive behavioral Including Tobacco and Alcohol Use, therapy. Outcomes were methampheta- Comments: The PROMETA protocol has and Risk of Cancer, 5 mine and other drug use documented by been promoted and used as a treatment for urine testing, self-reported methampheta- methamphetamine dependence despite lack HIV AND HCV mine craving, treatment retention, and of a strong scientific rationale and proven Baclofen: New Hope for Alcohol adverse events. efficacy. This randomized placebo- Abstinence in Patients with Alcohol- controlled trial found no benefit of the and HCV-related Cirrhosis? 5 • Fifty percent of the experimental group PROMETA protocol over placebo for Needle and Syringe Provision and and 70% of the placebo group re- treatment of methamphetamine abuse or Opioid Agonist Treatment May mained in the study through the medi- dependence. It raises serious questions Reduce the Spread of HCV in People cation phase (day 40). Only 30% of the about the use of the PROMETA protocol with Injection Drug Use, 6 for methamphetamine dependence. experimental group and 43% of the Mental-Health and Substance Use placebo group remained until the end Kevin L. Kraemer, MD, MSc Disorders Impact the Development of of the study (day 108). References: Ling W, Shoptaw S, Hillhouse M, AIDS-defining Illness and Death in • HIV-infected Veterans, 6 During follow-up at days 23, 40, and et al. Double-blind placebo-controlled 108, the experimental and placebo evaluation of the PROMETA™ protocol for Political Engagement Is Associated groups did not differ significantly with methamphetamine dependence. Addiction. with Reduced HIV Risk Behaviors, 7 regard to: 2012;107(2):361–369. JOURNAL ALERT Retention in Opioid Agonist Treatment after Prison Release Reduces Drug and Alcohol Review Publishes Special Issue on Low-Risk Drinking Re-incarceration Guidelines, 7 Opioid agonist treatment (OAT) in prison recruited in 1996–1997 for a randomized RESOURCE ALERT and after release might influence the risk of controlled trial of OAT in prison in New re-incarceration. This prospective cohort South Wales, Australia. Participants were NIAAA Releases Free Simplified study linked data on OAT and incarceration followed through 2006. Screening Guide to Identify Underage Drinking, 8 among 375 men with heroin use originally (continued on page 2) Alcohol, Other Drugs, and Health: Current Evidence is a project of the Boston Medical Center produced in cooperation with the Boston University Schools of Medicine and Public Health. Initially supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, the newsletter is currently supported by grant no. R25-DA013582 from the National Institute on Drug Abuse (NIDA). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIDA or the National Institutes of Health. P A G E 2 Editorial Board Retention in OAT after Prison Release (continued from page 1) Editor • During 9+ years of observation, 331 tions have shown that initiating OAT Richard Saitz, MD, MPH, FASAM, FACP participants engaged in OAT 1081 prior to release maximizes post-release Professor of Medicine & Epidemiology times, with a median of 2 episodes treatment retention, the current study Boston University Schools of Medicine & Public per participant (mean length of suggests active linkage to ongoing Health engagement, 156 days); 58% started treatment is an essential component. OAT in prison. Continuing or initiating OAT during Co-Editor • Ninety percent of participants were incarceration is necessary but not David A. Fiellin, MD re-incarcerated after the first sufficient to optimize post-release Professor of Medicine and Public Health outcomes among opioid-dependent Yale University School of Medicine incarceration. inmates; correctional systems and • Engagement in OAT at the time of treatment providers must also provide Associate Editors release had no effect on re- transitional assistance to ensure that incarceration. former inmates reach OAT programs Nicolas Bertholet, MD, MSc • Alcohol Treatment Center Post-release retention in OAT was after release. Clinical Epidemiology Center associated with a one-fifth reduction Peter D. Friedmann, MD, MPH Lausanne University Hospital in the number of re-incarcerations. R. Curtis Ellison, MD Reference: Larney S, Toson B, Burns L, Professor of Medicine & Public Health Comments: This study affirms that et al. Effect of prison-based opioid Boston University School of Medicine retention in OAT following release is substitution treatment and post-release Peter D. Friedmann, MD, MPH associated with reduced re-incarceration retention in treatment on risk of re- Professor of Medicine & Community Health among former prisoners with opioid incarceration. Addiction. 2012;107 Warren Alpert Medical School of Brown University dependence. Although other investiga- (2):372–380. Kevin L. Kraemer, MD, MSc Associate Professor of Medicine and Health Policy & Adding N-Acetylcysteine to Glucocorticoids May Improve Outcomes in Management Patients with Severe Alcoholic Hepatitis University of Pittsburgh Schools of Medicine & Public Health This randomized controlled trial con- PRED- 95% OUT- PRED HR Hillary Kunins, MD, MPH, MS ducted in 11 French university hospitals COME NAC CI Associate Clinical Professor of Medicine and sought to determine whether N- 1-month 0.14 - 24% 8% 0.58 Psychiatry & Behavioral Sciences acetylcysteine [NAC], an antioxidant used mortality 0.76 Albert Einstein College of Medicine to treat acetaminophen-induced hepatitis, 3-month 0.33† 34% 22% 0.33 Darius A. Rastegar, MD further reduced mortality in patients mortality - 1.04 6-month 0.37 - Assistant Professor of Medicine treated with prednisolone for severe al- 38% 27% 0.62 mortality 1.06 Johns Hopkins School of Medicine coholic hepatitis. Subjects (N=174) were †As reported in the paper. Jeffrey H. Samet, MD, MA, MPH age 18 or older; had consumed, on aver- Professor of Medicine & Social & Behavioral Sciences age, >50 g alcohol per day in the past 3 • Adverse events were no higher in Boston University Schools of Medicine & Public months; had a Maddrey’s discriminant the PRED-NAC arm, and 2 major Health function* of 32 or more; and had liver adverse events (hepatorenal syn- Jeanette M. Tetrault, MD histologic findings consistent with alco- drome and infection) were signifi- Assistant Professor of Internal Medicine holic hepatitis. The long list of exclusion cantly lower. Yale University School of Medicine criteria included other possible causes of Judith Tsui, MD, MPH liver disease (e.g., hepatitis B or C), HIV Comments: Although this study failed to Assistant Professor of Medicine infection, and “serious cardiac, respira- show significantly reduced mortality at 6 Section of General Internal Medicine tory or neurologic disease.” All patients months (the primary endpoint), a signifi- Boston Medical Center received oral prednisolone for 28 days, Boston University School of Medicine cant short-term benefit was seen in the while 85 also received intravenous NAC PRED-NAC arm with no serious ad- Alexander Y. Walley, MD, MSc on days 1–5. verse events. The failure may simply Assistant Professor of Medicine have been due to lack of sufficient Section of General Internal Medicine • Boston Medical Center Mortality rates and hazard ratios (HR) power.
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