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Doug Brunk is a San Diego-based award-winning reporter who began covering health care in 1991. Before joining the company, he wrote for the health sciences division of Columbia University and was an associate editor at Contemporary Long Term Care magazine when it won a Jesse H. Neal Award. His work has been syndicated by the Los Angeles Times and he is the author of two books related to the University of Kentucky Wildcats men's basketball program. Doug has a master’s degree in magazine journalism from the S.I. Newhouse School of Public Communications at Syracuse University. Follow him on Twitter @dougbrunk.
Effort to phenotype pulmonary hypertension patients under way
SAN DIEGO – A massive effort to better understand and treat patients with pulmonary hypertension and right heart dysfunction is underway.
The endeavor, funded by the National Heart, Lung, and Blood Institute and the Pulmonary Hypertension Association and known as Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics (PVDOMICS), began recruiting participants in 2017, with a goal of 1,500 by 2019. The aim is to perform comprehensive phenotyping and endophenotyping across the World Health Organization–classified pulmonary hypertension (PH) clinical groups 1 through 5 in order to deconstruct the traditional classification and define new meaningful subclassifications of patients with pulmonary vascular disease.
At an international conference of the American Thoracic Society, one of the study’s investigators, Robert P. Frantz, MD, discussed the role of echocardiography and MRI in the overall PVDOMICS program, which he characterized as a work in progress. “Imaging is critically important as we try to integrate severity of pulmonary vascular disease along with how well the ventricle functions as way to try and understand why some patients have a failing RV at a given pulmonary resistance and others don’t,” said Dr. Frantz, who directs the Mayo Pulmonary Hypertension Clinic in Rochester, Minn. The goals are to be able to integrate cardiac morphology and function with contemporaneous hemodynamics, he said. This will allow for validation of noninvasive hemodynamics versus right heart catheterization across all the phenotypes.
“In addition, we’ll have imaging parameters as predictors of hemodynamics at rest and with exercise, particularly in conditions like heart failure with preserved ejection fraction or concerns about left atrial stiffness,” he said. “In these cases, our ability on the basis of echocardiography or MRI to guess what the wedge pressure is at rest or exercise, or to think about other more recently described phenotypes like left atrial stiffness in patients who have left atrial ablation procedures, will be enabled by looking at parameters such as left atrial strain.”
Ultimately, he continued, a key goal of PVDOMICS is to be able to correlate the “-omics” with markers of RV compensation in an effort to understand what the determinants of RV compensation are across the varying types of pulmonary vascular disease.
“If we could do that, we might be able to develop new targets for therapy,” said Dr. Frantz. To illustrate how this might work, he cited findings from researchers who set out to identify and characterize homogeneous phenotypes by a cluster analysis in scleroderma patients with pulmonary hypertension, who were identified from two prospective cohorts in the United States and France (PLoS One 2018 May 15;13[5]:e0197112).
The researchers identified four different clusters of scleroderma patients: those with mild to moderate PAH with no or minimal interstitial lung disease and low-diffusing capacity for carbon monoxide; those with precapillary PH with severe ILD and worse survival; those with severe PAH, who trended toward worse survival, and those similar to the first cluster but with higher DLCO.
Dr. Frantz then shared preliminary findings of echocardiographic parameters by primary WHO group in PVDOMICS, on behalf of his PVDOMICS collaborators. They found, for example, that the mean right ventricular systolic pressure in group 3 was 45 mm Hg, as opposed to group 1, which was 64 mm Hg. “In general we had some patients in group 3 with less severe elevation of PA pressures,” he said.
Other parameters that can be compared across WHO groups include ventricular fractional area change, tricuspid annular plane systolic excursion, and RV free wall strain. “That strain of the right ventricle is one of the most important ways of looking at how the right ventricle works,” Dr. Frantz explained. “With this, we can integrate the concept of severity of RV dysfunction with severity of pulmonary vascular disease. This is where the rubber hits the road. It’s going to be very complicated and time consuming, but I think critically important. Ultimately, we can make proteomic heat maps that track these correlates, and ultimately identify pathways that may be driving RV compensation in pulmonary vascular disease.”
Dr. Frantz reported having no relevant financial disclosures.
SAN DIEGO – A massive effort to better understand and treat patients with pulmonary hypertension and right heart dysfunction is underway.
The endeavor, funded by the National Heart, Lung, and Blood Institute and the Pulmonary Hypertension Association and known as Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics (PVDOMICS), began recruiting participants in 2017, with a goal of 1,500 by 2019. The aim is to perform comprehensive phenotyping and endophenotyping across the World Health Organization–classified pulmonary hypertension (PH) clinical groups 1 through 5 in order to deconstruct the traditional classification and define new meaningful subclassifications of patients with pulmonary vascular disease.
At an international conference of the American Thoracic Society, one of the study’s investigators, Robert P. Frantz, MD, discussed the role of echocardiography and MRI in the overall PVDOMICS program, which he characterized as a work in progress. “Imaging is critically important as we try to integrate severity of pulmonary vascular disease along with how well the ventricle functions as way to try and understand why some patients have a failing RV at a given pulmonary resistance and others don’t,” said Dr. Frantz, who directs the Mayo Pulmonary Hypertension Clinic in Rochester, Minn. The goals are to be able to integrate cardiac morphology and function with contemporaneous hemodynamics, he said. This will allow for validation of noninvasive hemodynamics versus right heart catheterization across all the phenotypes.
“In addition, we’ll have imaging parameters as predictors of hemodynamics at rest and with exercise, particularly in conditions like heart failure with preserved ejection fraction or concerns about left atrial stiffness,” he said. “In these cases, our ability on the basis of echocardiography or MRI to guess what the wedge pressure is at rest or exercise, or to think about other more recently described phenotypes like left atrial stiffness in patients who have left atrial ablation procedures, will be enabled by looking at parameters such as left atrial strain.”
Ultimately, he continued, a key goal of PVDOMICS is to be able to correlate the “-omics” with markers of RV compensation in an effort to understand what the determinants of RV compensation are across the varying types of pulmonary vascular disease.
“If we could do that, we might be able to develop new targets for therapy,” said Dr. Frantz. To illustrate how this might work, he cited findings from researchers who set out to identify and characterize homogeneous phenotypes by a cluster analysis in scleroderma patients with pulmonary hypertension, who were identified from two prospective cohorts in the United States and France (PLoS One 2018 May 15;13[5]:e0197112).
The researchers identified four different clusters of scleroderma patients: those with mild to moderate PAH with no or minimal interstitial lung disease and low-diffusing capacity for carbon monoxide; those with precapillary PH with severe ILD and worse survival; those with severe PAH, who trended toward worse survival, and those similar to the first cluster but with higher DLCO.
Dr. Frantz then shared preliminary findings of echocardiographic parameters by primary WHO group in PVDOMICS, on behalf of his PVDOMICS collaborators. They found, for example, that the mean right ventricular systolic pressure in group 3 was 45 mm Hg, as opposed to group 1, which was 64 mm Hg. “In general we had some patients in group 3 with less severe elevation of PA pressures,” he said.
Other parameters that can be compared across WHO groups include ventricular fractional area change, tricuspid annular plane systolic excursion, and RV free wall strain. “That strain of the right ventricle is one of the most important ways of looking at how the right ventricle works,” Dr. Frantz explained. “With this, we can integrate the concept of severity of RV dysfunction with severity of pulmonary vascular disease. This is where the rubber hits the road. It’s going to be very complicated and time consuming, but I think critically important. Ultimately, we can make proteomic heat maps that track these correlates, and ultimately identify pathways that may be driving RV compensation in pulmonary vascular disease.”
Dr. Frantz reported having no relevant financial disclosures.
SAN DIEGO – A massive effort to better understand and treat patients with pulmonary hypertension and right heart dysfunction is underway.
The endeavor, funded by the National Heart, Lung, and Blood Institute and the Pulmonary Hypertension Association and known as Redefining Pulmonary Hypertension Through Pulmonary Vascular Disease Phenomics (PVDOMICS), began recruiting participants in 2017, with a goal of 1,500 by 2019. The aim is to perform comprehensive phenotyping and endophenotyping across the World Health Organization–classified pulmonary hypertension (PH) clinical groups 1 through 5 in order to deconstruct the traditional classification and define new meaningful subclassifications of patients with pulmonary vascular disease.
At an international conference of the American Thoracic Society, one of the study’s investigators, Robert P. Frantz, MD, discussed the role of echocardiography and MRI in the overall PVDOMICS program, which he characterized as a work in progress. “Imaging is critically important as we try to integrate severity of pulmonary vascular disease along with how well the ventricle functions as way to try and understand why some patients have a failing RV at a given pulmonary resistance and others don’t,” said Dr. Frantz, who directs the Mayo Pulmonary Hypertension Clinic in Rochester, Minn. The goals are to be able to integrate cardiac morphology and function with contemporaneous hemodynamics, he said. This will allow for validation of noninvasive hemodynamics versus right heart catheterization across all the phenotypes.
“In addition, we’ll have imaging parameters as predictors of hemodynamics at rest and with exercise, particularly in conditions like heart failure with preserved ejection fraction or concerns about left atrial stiffness,” he said. “In these cases, our ability on the basis of echocardiography or MRI to guess what the wedge pressure is at rest or exercise, or to think about other more recently described phenotypes like left atrial stiffness in patients who have left atrial ablation procedures, will be enabled by looking at parameters such as left atrial strain.”
Ultimately, he continued, a key goal of PVDOMICS is to be able to correlate the “-omics” with markers of RV compensation in an effort to understand what the determinants of RV compensation are across the varying types of pulmonary vascular disease.
“If we could do that, we might be able to develop new targets for therapy,” said Dr. Frantz. To illustrate how this might work, he cited findings from researchers who set out to identify and characterize homogeneous phenotypes by a cluster analysis in scleroderma patients with pulmonary hypertension, who were identified from two prospective cohorts in the United States and France (PLoS One 2018 May 15;13[5]:e0197112).
The researchers identified four different clusters of scleroderma patients: those with mild to moderate PAH with no or minimal interstitial lung disease and low-diffusing capacity for carbon monoxide; those with precapillary PH with severe ILD and worse survival; those with severe PAH, who trended toward worse survival, and those similar to the first cluster but with higher DLCO.
Dr. Frantz then shared preliminary findings of echocardiographic parameters by primary WHO group in PVDOMICS, on behalf of his PVDOMICS collaborators. They found, for example, that the mean right ventricular systolic pressure in group 3 was 45 mm Hg, as opposed to group 1, which was 64 mm Hg. “In general we had some patients in group 3 with less severe elevation of PA pressures,” he said.
Other parameters that can be compared across WHO groups include ventricular fractional area change, tricuspid annular plane systolic excursion, and RV free wall strain. “That strain of the right ventricle is one of the most important ways of looking at how the right ventricle works,” Dr. Frantz explained. “With this, we can integrate the concept of severity of RV dysfunction with severity of pulmonary vascular disease. This is where the rubber hits the road. It’s going to be very complicated and time consuming, but I think critically important. Ultimately, we can make proteomic heat maps that track these correlates, and ultimately identify pathways that may be driving RV compensation in pulmonary vascular disease.”
Dr. Frantz reported having no relevant financial disclosures.
AT ATS 2018
Think local when assessing adolescent heroin use
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
SAN DIEGO – Between 1999 and 2015, heroin use increased among high school students who live in Milwaukee, Chicago, and New York – trends that accompanied a rise in injection drug use in those cities.
“This implies that a subset of these students who are using heroin are probably injecting heroin as well; otherwise these trends wouldn’t be mirroring each other so well,” lead study author Sherri-Chanelle Brighthaupt said in an interview at the annual meeting of the College on Problems of Drug Dependence.
The finding comes from a trend analysis of heroin use and injection drug use in nine urban U.S. school districts drawn from Youth Risk Behavior Survey (YRBS) data from 1999-2015. The analysis was conducted using data from New York City, three Florida counties (Broward, Orange, and Miami-Dade), Dallas, Chicago, Milwaukee, and two California cities (San Diego and San Bernardino). a third-year doctoral student in the department of mental health at Johns Hopkins University, Baltimore. “National estimates may mask variation at the local level.”
The sample population studied included local-level YRBS responses from 260,952 students in grades 9-12. All responses were weighted by sex, grade, and race/ethnicity, and the researchers used logistic regression models to test for liner and quadratic trends in the pooled sample and in each city. Between 1999 and 2015, lifetime heroin use among this population increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001). However, during the same time frame, heroin use decreased in San Bernardino from 4.6% to 1.6% (P = .0001).
The researchers also found that between 1999 and 2015, lifetime injection drug use in this age group increased significantly, from 0.8% to 2.2% in New York (P less than .0001) and from 2.5% to 2.7% in Chicago (P = .05). During the same time period, lifetime injection drug use decreased in San Bernardino, (from 2.5% to 1.9%; P = .05) and in Dallas after peaking in 2007 (from 3.6% to 1%; P = .02).
“The take-home message is to look locally,” Ms. Brighthaupt said. “Some cities may have a historically entrenched culture of heroin use, and prevention and intervention efforts should be tailored to the unique social and cultural context of the geographic region.”
The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
AT CPDD 2018
Key clinical point: Trends in heroin use and injection drug use follow one another over time.
Major finding: Between 1999 and 2015, lifetime heroin use increased significantly, from 2.8% to 7.4% in Milwaukee (P = .0001), from 3.1% to 4.1% in Chicago (P = .02), and from 1% to 2.5% in New York (P less than .0001).
Study details: An analysis of local-level Youth Risk Behavior Survey responses from 260,952 students in grades 9-12.
Disclosures: The research was supported by grants from the National Institute on Drug Abuse. Ms. Brighthaupt reported having no financial disclosures.
Many veterans with comorbid pain and OUD not receiving MAT
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
SAN DIEGO – Less than 30% of veterans on medication-assisted treatment for opioids had a diagnosis of opioid use disorder, and only 7% of veterans with an opioid use disorder initiated medication-assisted treatment.
Those are key findings from a large study that set out to assess factors associated with initiating medication-assisted treatment (MAT) among veterans seeking pain care and to characterize the cohort of veterans seeking specialty pain care who initiated MAT.
“ but it was really low,” lead study author Lisham Ashrafioun, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “These findings are preliminary, but I think we need to understand a lot more about how to treat people with opioid use disorders who are receiving pain care as well.”
Dr. Ashrafioun, a research investigator at the Veteran Affairs Center of Excellence for Suicide Prevention at the Canandaigua VA Medical Center, N.Y., and his associates drew from national VA electronic medical record data to identify 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014. They used procedure and billing codes to identify veterans who started using MAT for opioids within the year following initiation of pain services, and extracted data on demographics, psychiatric and medical diagnoses, and pain intensity scores.
Of the 219,443 veterans, only 2,406 had received MAT in the year following the index visit (1.1%). In addition, only 26.4% of those on MAT had an opioid use disorder and just 6.6% of those with an opioid use disorder initiated MAT.
In adjusted analyses, opioid use disorders (adjusted odds ratio, 5.71) and opioid prescriptions (aOR, 2.33) were significantly associated with greater odds of receiving MAT. Moreover, having a diagnosis of depression was associated with a greater odds of receiving MAT (aOR, 1.26), while having a diagnosis of PTSD was associated with a greater odds of not receiving it (aOR, 0.90). The researchers also found that having a diagnosis of alcohol use disorder was associated with a greater odds of not receiving MAT (aOR, 0.85), while having a diagnosis of drug use disorder was associated with a greater odds of receiving it (aOR, 1.32).
Dr. Ashrafioun, who also holds a faculty position in the department of psychiatry at the University of Rochester (N.Y.), acknowledged certain limitations of the study. For example, the sample was restricted to only those receiving specialty pain care, provider and facility variation was not accounted for, and study participants might have initiated MAT outside of the VA.
He reported having no financial disclosures.
[email protected]
REPORTING FROM CPDD 2018
Key clinical point: Several clinical features differentiate veterans seeking specialty pain care who receive medication-assisted treatment (MAT) from those who do not.
Major finding: Only 26.5% of veterans on MAT had an opioid use disorder.
Study details: An analysis of 219,443 veterans who initiated specialty pain services during fiscal year 2012-2014.
Disclosures: Dr. Ashrafioun reported having no financial disclosures.
Cocaine use declining among young adults
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
SAN DIEGO – Use of cocaine by young adults in the United States has declined significantly since the early 2000s, but it remains relatively common. In fact, results from an analysis of national data suggest that about 5% of 18- to 22-year-olds have used cocaine in the past 12 months.
“We don’t typically think of cocaine use amongst young people, but it is of a nontrivial prevalence,” lead study author Kristin E. Schneider said in an interview at the annual meeting of the College on Problems of Drug Dependence. “If someone has risky alcohol use they might also have risky substance use. We need to be screening for those things as well, while most interventions these days focus on problem drinking.”
Ms. Schneider, a graduate student in the department of mental health at Johns Hopkins University, Baltimore, and her associates drew from the 2002-2014 waves of the National Survey on Drug Use and Health to describe trends in cocaine use among young adults by race/ethnicity, sex, and college enrollment. They assessed for lifetime use, any past 12-month cocaine use, past 30-day use, and any past 12-month use disorder. They also tested for linear and quadratic trends over time.
When the researchers averaged across all years, they found that 12.1% of young adults had ever used cocaine, 5.9% had used it in the past 12 months, 1.8% had used in the past 30 days, and 1% had a use disorder in the past 12 months. They also observed significant linear declines in cocaine use across the entire study period. For example, between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%, past 12-month use declined from 6.3% to 4.1%, and past 30-day use declined from 1.8% to 1.4%.
Nonstudents had higher lifetime rates of cocaine use, compared with students (14.8% vs. 7.8%, respectively), but differences between the two groups were small for other indicators. “Perhaps being an emerging environment with other [young] adults who are also making risky health behavior decisions compensates for this baseline difference of risk between people who go to college and those who do not,” Ms. Schneider said. At the same time, the lowest rates of past 12-month cocaine use was observed in black males (1.6%), Asian females (0.8%), and black females (0.8%).
The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
AT CPDD 2018
Key clinical point: Cocaine use has declined among young adults in the United States.
Major finding: Between 2002 and 2014, the prevalence of lifetime cocaine use declined from 13.7% to 8.6%.
Study details: An analysis drawn from the 2002-2014 waves of the National Survey on Drug Use and Health.
Disclosures: The National Institute on Drug Abuse supported the study. Ms. Schneider reported having no financial disclosures.
Watch for substance use risks among never-deployed reservists
SAN DIEGO – Reserve soldiers who have never been deployed are just as likely to have poor outcomes related to mental health and substance use as their peers who have been deployed, results from a novel survey suggest.
“We tend to focus on screening and intervention efforts for soldiers who have been deployed and who have experienced combat, but we should also focus our intervention and screening efforts on soldiers who have never been deployed,” lead study author Rachel A. Hoopsick, MPH, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “Both are at risk for substance use and mental illness.”
Measures included the Non-Deployment Emotions Questionnaire, the Alcohol Use Disorders Identification Test, the National Institute on Drug Abuse Modified Alcohol, Smoking and Substance Involvement Screening Test 2.0, and the Marital Adjustment Test. The researchers used separate models to examine the relationship between nondeployment emotions and alcohol problems, frequent heavy drinking, current nonmedical use of prescription drugs, and current illicit drug use, and controlled for years of military service, number of military friends in the social network, and marital satisfaction.
Ms. Hoopsick reported results from 121 never-deployed, male soldiers who completed the survey at baseline and at a 1-year follow-up. Their mean age was 30 years, 76% were non-Hispanic white, and 84% had at least some college education. In addition, the soldiers had served a mean of 5.5 years, had a mean of 0.6 military friends in the social network, and had a mean marital satisfaction score of 114 out of 158 possible points.
On responses to the Non-Deployment Emotions Questionnaire, 65% of nondeployed soldiers felt guilt, 56% felt decreased value within his unit, 50% felt decreased camaraderie within his unit, and 50% felt decreased connectedness within his unit for having never been deployed. “We did anticipate that some of these soldiers were going to have poor outcomes related to their nondeployment emotions, but it was surprising to see how many of the soldiers did express having negative emotions related to having never been deployed,” Ms. Hoopsick said. After the researchers controlled for years of military service, the number of military friends in the soldier’s social network, and marital satisfaction, more negative nondeployment emotions were associated with a greater likelihood of alcohol problems (adjusted risk ratio, 1.06), frequent heavy drinking (ARR, 1.03), and current nonmedical use of prescription drugs (ARR, 1.21).
She acknowledged certain limitations of the study, including its cross-sectional nature. she said.
The National Institute on Drug Abuse provided funding to Ms. Hoopsick’s mentor and coauthor, Gregory G. Homish, PhD, and the study received additional funding from the National Center for Advancing Translational Sciences and the Health Resources and Services Administration.
SAN DIEGO – Reserve soldiers who have never been deployed are just as likely to have poor outcomes related to mental health and substance use as their peers who have been deployed, results from a novel survey suggest.
“We tend to focus on screening and intervention efforts for soldiers who have been deployed and who have experienced combat, but we should also focus our intervention and screening efforts on soldiers who have never been deployed,” lead study author Rachel A. Hoopsick, MPH, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “Both are at risk for substance use and mental illness.”
Measures included the Non-Deployment Emotions Questionnaire, the Alcohol Use Disorders Identification Test, the National Institute on Drug Abuse Modified Alcohol, Smoking and Substance Involvement Screening Test 2.0, and the Marital Adjustment Test. The researchers used separate models to examine the relationship between nondeployment emotions and alcohol problems, frequent heavy drinking, current nonmedical use of prescription drugs, and current illicit drug use, and controlled for years of military service, number of military friends in the social network, and marital satisfaction.
Ms. Hoopsick reported results from 121 never-deployed, male soldiers who completed the survey at baseline and at a 1-year follow-up. Their mean age was 30 years, 76% were non-Hispanic white, and 84% had at least some college education. In addition, the soldiers had served a mean of 5.5 years, had a mean of 0.6 military friends in the social network, and had a mean marital satisfaction score of 114 out of 158 possible points.
On responses to the Non-Deployment Emotions Questionnaire, 65% of nondeployed soldiers felt guilt, 56% felt decreased value within his unit, 50% felt decreased camaraderie within his unit, and 50% felt decreased connectedness within his unit for having never been deployed. “We did anticipate that some of these soldiers were going to have poor outcomes related to their nondeployment emotions, but it was surprising to see how many of the soldiers did express having negative emotions related to having never been deployed,” Ms. Hoopsick said. After the researchers controlled for years of military service, the number of military friends in the soldier’s social network, and marital satisfaction, more negative nondeployment emotions were associated with a greater likelihood of alcohol problems (adjusted risk ratio, 1.06), frequent heavy drinking (ARR, 1.03), and current nonmedical use of prescription drugs (ARR, 1.21).
She acknowledged certain limitations of the study, including its cross-sectional nature. she said.
The National Institute on Drug Abuse provided funding to Ms. Hoopsick’s mentor and coauthor, Gregory G. Homish, PhD, and the study received additional funding from the National Center for Advancing Translational Sciences and the Health Resources and Services Administration.
SAN DIEGO – Reserve soldiers who have never been deployed are just as likely to have poor outcomes related to mental health and substance use as their peers who have been deployed, results from a novel survey suggest.
“We tend to focus on screening and intervention efforts for soldiers who have been deployed and who have experienced combat, but we should also focus our intervention and screening efforts on soldiers who have never been deployed,” lead study author Rachel A. Hoopsick, MPH, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “Both are at risk for substance use and mental illness.”
Measures included the Non-Deployment Emotions Questionnaire, the Alcohol Use Disorders Identification Test, the National Institute on Drug Abuse Modified Alcohol, Smoking and Substance Involvement Screening Test 2.0, and the Marital Adjustment Test. The researchers used separate models to examine the relationship between nondeployment emotions and alcohol problems, frequent heavy drinking, current nonmedical use of prescription drugs, and current illicit drug use, and controlled for years of military service, number of military friends in the social network, and marital satisfaction.
Ms. Hoopsick reported results from 121 never-deployed, male soldiers who completed the survey at baseline and at a 1-year follow-up. Their mean age was 30 years, 76% were non-Hispanic white, and 84% had at least some college education. In addition, the soldiers had served a mean of 5.5 years, had a mean of 0.6 military friends in the social network, and had a mean marital satisfaction score of 114 out of 158 possible points.
On responses to the Non-Deployment Emotions Questionnaire, 65% of nondeployed soldiers felt guilt, 56% felt decreased value within his unit, 50% felt decreased camaraderie within his unit, and 50% felt decreased connectedness within his unit for having never been deployed. “We did anticipate that some of these soldiers were going to have poor outcomes related to their nondeployment emotions, but it was surprising to see how many of the soldiers did express having negative emotions related to having never been deployed,” Ms. Hoopsick said. After the researchers controlled for years of military service, the number of military friends in the soldier’s social network, and marital satisfaction, more negative nondeployment emotions were associated with a greater likelihood of alcohol problems (adjusted risk ratio, 1.06), frequent heavy drinking (ARR, 1.03), and current nonmedical use of prescription drugs (ARR, 1.21).
She acknowledged certain limitations of the study, including its cross-sectional nature. she said.
The National Institute on Drug Abuse provided funding to Ms. Hoopsick’s mentor and coauthor, Gregory G. Homish, PhD, and the study received additional funding from the National Center for Advancing Translational Sciences and the Health Resources and Services Administration.
REPORTING FROM CPDD 2018
Key clinical point: All military personnel, regardless of deployment status, could be at risk for substance use.
Major finding:. More negative nondeployment emotions were associated with a greater likelihood of alcohol problems (adjusted risk ratio, 1.06), frequent heavy drinking (ARR, 1.03), and current nonmedical use of prescription drugs (ARR, 1.21).
Study details: Responses from 121 never-deployed, male U.S. Army Reserve/National Guard soldiers who completed surveys at baseline and at a 1-year follow-up.
Disclosures: The National Institute on Drug Abuse provided funding to Ms. Hoopsick’s mentor and coauthor, Gregory G. Homish, PhD, and the study received additional funding from the National Center for Advancing Translational Sciences and the Health Resources and Services Administration.
A call for ‘changing the social norms’ on naloxone
SAN DIEGO – Among individuals with a history of injection drug use, more than one-third reported never or sometimes carrying naloxone, while just one in four reported carrying with it them at all times.
Those are key findings from a survey that set out to examine gaps in the naloxone cascade in a sample of people who inject drugs.
“In order to save a life, you have to have the naloxone with you at all times,” lead study author Karin E. Tobin, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
While emerging research demonstrates the positive impact of opioid overdose education and community naloxone distribution programs to reduce opioid-related overdose deaths, opiate overdose continues to be a major cause of mortality, said Dr. Tobin, who is affiliated with the department of health behavior and society at Johns Hopkins University, Baltimore. “We’ve made a lot of progress in convincing people that naloxone is not addictive, and that it’s not going to cause any harm,” she said. “Now, drug users aren’t afraid to ask for it. Still, we wondered: If everyone knows about naloxone and no one is embarrassed to talk about it, why are people still dying [from opioid overdoses] in Baltimore?”
She and her associates conducted a cross-sectional survey of 353 individuals aged 18 and older in Baltimore who self-reported a lifetime history of injection drug use. The data came from a baseline survey that was conducted as part of a randomized, controlled trial testing the efficacy of a behavioral intervention focused on the Hepatitis C cascade. Individuals were asked to answer questions related to the five steps of the naloxone cascade: awareness (have you ever heard about naloxone?), access (have you ever received naloxone?), training (have you ever been trained to use naloxone?), use (have you ever used naloxone during an opiate overdose?), and possession (how often do you carry naloxone?)
More than half of the survey respondents (65%) were male; mean age was 47 years. For the previous 6 months, more than half of the sample reported the use of crack (64%), heroin (74%), and other injectable drugs (57%), while 90% reported having ever witnessed an overdose – 59% in the prior year alone. Dr. Tobin and her associates found that 90% of respondents had heard about naloxone, 69% had received it, and 60% had been trained to use it. In addition, 37% reported never carrying naloxone, 38% sometimes carried it, 33% said they had used naloxone at some point, and 25% said they always carried it with them.
On multinomial regression analysis, the researchers found that carrying naloxone often or always was significantly associated with the following variables: female sex (odds ratio, 2.77), having ever witnessed an overdose (OR, 1.84), having injected in the past 12 months (OR, 1.75), and having ever used naloxone during an overdose (OR, 4.33). The latter finding is especially important, “because it means that we just have to let people practice using it,” said Dr. Tobin, who noted that more research is needed to understand reasons why injection drug users do not always carry naloxone. “We need to start changing the social norms about carrying naloxone. You never know when it will be useful.”
The National Institute on Drug Abuse supported the study. Dr. Tobin reported having no financial disclosures.
SAN DIEGO – Among individuals with a history of injection drug use, more than one-third reported never or sometimes carrying naloxone, while just one in four reported carrying with it them at all times.
Those are key findings from a survey that set out to examine gaps in the naloxone cascade in a sample of people who inject drugs.
“In order to save a life, you have to have the naloxone with you at all times,” lead study author Karin E. Tobin, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
While emerging research demonstrates the positive impact of opioid overdose education and community naloxone distribution programs to reduce opioid-related overdose deaths, opiate overdose continues to be a major cause of mortality, said Dr. Tobin, who is affiliated with the department of health behavior and society at Johns Hopkins University, Baltimore. “We’ve made a lot of progress in convincing people that naloxone is not addictive, and that it’s not going to cause any harm,” she said. “Now, drug users aren’t afraid to ask for it. Still, we wondered: If everyone knows about naloxone and no one is embarrassed to talk about it, why are people still dying [from opioid overdoses] in Baltimore?”
She and her associates conducted a cross-sectional survey of 353 individuals aged 18 and older in Baltimore who self-reported a lifetime history of injection drug use. The data came from a baseline survey that was conducted as part of a randomized, controlled trial testing the efficacy of a behavioral intervention focused on the Hepatitis C cascade. Individuals were asked to answer questions related to the five steps of the naloxone cascade: awareness (have you ever heard about naloxone?), access (have you ever received naloxone?), training (have you ever been trained to use naloxone?), use (have you ever used naloxone during an opiate overdose?), and possession (how often do you carry naloxone?)
More than half of the survey respondents (65%) were male; mean age was 47 years. For the previous 6 months, more than half of the sample reported the use of crack (64%), heroin (74%), and other injectable drugs (57%), while 90% reported having ever witnessed an overdose – 59% in the prior year alone. Dr. Tobin and her associates found that 90% of respondents had heard about naloxone, 69% had received it, and 60% had been trained to use it. In addition, 37% reported never carrying naloxone, 38% sometimes carried it, 33% said they had used naloxone at some point, and 25% said they always carried it with them.
On multinomial regression analysis, the researchers found that carrying naloxone often or always was significantly associated with the following variables: female sex (odds ratio, 2.77), having ever witnessed an overdose (OR, 1.84), having injected in the past 12 months (OR, 1.75), and having ever used naloxone during an overdose (OR, 4.33). The latter finding is especially important, “because it means that we just have to let people practice using it,” said Dr. Tobin, who noted that more research is needed to understand reasons why injection drug users do not always carry naloxone. “We need to start changing the social norms about carrying naloxone. You never know when it will be useful.”
The National Institute on Drug Abuse supported the study. Dr. Tobin reported having no financial disclosures.
SAN DIEGO – Among individuals with a history of injection drug use, more than one-third reported never or sometimes carrying naloxone, while just one in four reported carrying with it them at all times.
Those are key findings from a survey that set out to examine gaps in the naloxone cascade in a sample of people who inject drugs.
“In order to save a life, you have to have the naloxone with you at all times,” lead study author Karin E. Tobin, PhD, said in an interview at the annual meeting of the College on Problems of Drug Dependence.
While emerging research demonstrates the positive impact of opioid overdose education and community naloxone distribution programs to reduce opioid-related overdose deaths, opiate overdose continues to be a major cause of mortality, said Dr. Tobin, who is affiliated with the department of health behavior and society at Johns Hopkins University, Baltimore. “We’ve made a lot of progress in convincing people that naloxone is not addictive, and that it’s not going to cause any harm,” she said. “Now, drug users aren’t afraid to ask for it. Still, we wondered: If everyone knows about naloxone and no one is embarrassed to talk about it, why are people still dying [from opioid overdoses] in Baltimore?”
She and her associates conducted a cross-sectional survey of 353 individuals aged 18 and older in Baltimore who self-reported a lifetime history of injection drug use. The data came from a baseline survey that was conducted as part of a randomized, controlled trial testing the efficacy of a behavioral intervention focused on the Hepatitis C cascade. Individuals were asked to answer questions related to the five steps of the naloxone cascade: awareness (have you ever heard about naloxone?), access (have you ever received naloxone?), training (have you ever been trained to use naloxone?), use (have you ever used naloxone during an opiate overdose?), and possession (how often do you carry naloxone?)
More than half of the survey respondents (65%) were male; mean age was 47 years. For the previous 6 months, more than half of the sample reported the use of crack (64%), heroin (74%), and other injectable drugs (57%), while 90% reported having ever witnessed an overdose – 59% in the prior year alone. Dr. Tobin and her associates found that 90% of respondents had heard about naloxone, 69% had received it, and 60% had been trained to use it. In addition, 37% reported never carrying naloxone, 38% sometimes carried it, 33% said they had used naloxone at some point, and 25% said they always carried it with them.
On multinomial regression analysis, the researchers found that carrying naloxone often or always was significantly associated with the following variables: female sex (odds ratio, 2.77), having ever witnessed an overdose (OR, 1.84), having injected in the past 12 months (OR, 1.75), and having ever used naloxone during an overdose (OR, 4.33). The latter finding is especially important, “because it means that we just have to let people practice using it,” said Dr. Tobin, who noted that more research is needed to understand reasons why injection drug users do not always carry naloxone. “We need to start changing the social norms about carrying naloxone. You never know when it will be useful.”
The National Institute on Drug Abuse supported the study. Dr. Tobin reported having no financial disclosures.
AT CPDD 2018
Key clinical point: Increasing possession of naloxone among people who use opiates is essential.
Major finding:. Carrying naloxone often or always was significantly associated with several variables, including female sex (odds ratio, 2.77) and having ever used naloxone during an overdose (OR, 4.33).
Study details: A cross-sectional survey of 353 individuals aged 18 and older in Baltimore who self-reported a lifetime history of injection drug use.
Disclosures: The National Institute on Drug Abuse supported the study. Dr. Tobin reported having no financial disclosures.
Lung volume reduction procedures on the rise since 2011
SAN DIEGO – The number of has been increasing since 2011, according to a large national analysis.
Lung volume–reduction surgery (LVRS) has been available for decades, but results from the National Emphysema Treatment Trial (NETT) in 2003 (N Engl J Med 2003;348:2059-73) demonstrated that certain COPD patients benefited from the surgery, Amy Attaway, MD, said at an international conference of the American Thoracic Society.
In that trial, overall mortality at 30 days was 3.6% for the surgical group. “If you excluded high-risk patients, the 30-day mortality was only 2.2%,” said Dr. Attaway, a staff physician at the Cleveland Clinic Respiratory Institute. “If you look at the upper lobe–predominant, low-exercise group, their mortality at 30 days was 1.4%.”
Subsequent studies that evaluated NETT patients over time showed continued improvements in their mortality. For example, one study found that in the upper lobe–predominant patients who received surgery in the NETT trial, their survival at 3 years was 81% vs. 74% in the medical group (P = .05), while survival at 5 years was 70% in the surgery group vs. 60% in the medical group (P = .02; J Thorac Cardiovasc Surg. 2010;140[3]:564-72). Despite this improved mortality, other studies have shown that LVRS remains underutilized. Once such analysis of the Nationwide Inpatient Sample showed a logarithmic drop from 2000 to 2010 (Chest 2014;146[6]:e228-9). The authors also noted that the overall mortality was 6% and that the need for a tracheostomy was 7.9%. Age greater than 65 years was associated with increased mortality (odds ratio 2.8).
Dr. Attaway and her associates hypothesized that availability of the long-term survival data from the NETT, support from GOLD guidelines, and the lack of a Food and Drug Administration–approved alternative may have increased utilization of this surgery from 2007 through 2013. With data from the Nationwide Inpatient Sample for 2007-2013, the researchers performed a retrospective cohort analysis of 2,805 patients who underwent LVRS. The composite primary outcome was mortality or need for tracheostomy. Logistic regression was performed to analyze factors associated with the composite primary outcome.
The average patient age was 59 years, and 64% were male. Medicare was the payer in nearly half of cases, in-hospital mortality and need for tracheostomy were both 5.5%, and the risk for tracheostomy or mortality was 10.5%. Linear regression analysis showed a significant increase in LVRS over time, with the 320 surgeries in 2007 and 605 in 2013 (P = .0016).
On univariate analysis, the following factors were found to be significantly associated with the composite primary outcome: in-hospital mortality or the need for tracheostomy (P less than .001), respiratory failure (P less than .001), septicemia (P = .01), shock (P less than .001), acute kidney injury (P less than .001), secondary pulmonary hypertension (P less than .001), and a higher mean number of diagnoses or number of chronic conditions on admission (P less than .001 and P = .017, respectively).
On multivariate logistic regression, only two factors were found to be significantly associated with the composite primary outcome: a higher number of diagnoses (adjusted OR of 1.17 per additional diagnosis), and the presence of secondary pulmonary hypertension (adjusted OR 4.4).
“Availability of long-term survival data from NETT, support from the GOLD guidelines, and lack of current FDA-approved alternatives are potential reasons for increased utilization [of LVRS],” Dr. Attaway said. “However, our study showed that in-hospital mortality and morbidity is high, compared to the NETT results. We also found that secondary pulmonary hypertension and comorbidities are associated with poor outcomes. This is important to keep in mind for patient selection.”
Dr. Attaway and her associates reported having no financial disclosures.
SOURCE: Attaway A et al. ATS 2018, Abstract 4436.
SAN DIEGO – The number of has been increasing since 2011, according to a large national analysis.
Lung volume–reduction surgery (LVRS) has been available for decades, but results from the National Emphysema Treatment Trial (NETT) in 2003 (N Engl J Med 2003;348:2059-73) demonstrated that certain COPD patients benefited from the surgery, Amy Attaway, MD, said at an international conference of the American Thoracic Society.
In that trial, overall mortality at 30 days was 3.6% for the surgical group. “If you excluded high-risk patients, the 30-day mortality was only 2.2%,” said Dr. Attaway, a staff physician at the Cleveland Clinic Respiratory Institute. “If you look at the upper lobe–predominant, low-exercise group, their mortality at 30 days was 1.4%.”
Subsequent studies that evaluated NETT patients over time showed continued improvements in their mortality. For example, one study found that in the upper lobe–predominant patients who received surgery in the NETT trial, their survival at 3 years was 81% vs. 74% in the medical group (P = .05), while survival at 5 years was 70% in the surgery group vs. 60% in the medical group (P = .02; J Thorac Cardiovasc Surg. 2010;140[3]:564-72). Despite this improved mortality, other studies have shown that LVRS remains underutilized. Once such analysis of the Nationwide Inpatient Sample showed a logarithmic drop from 2000 to 2010 (Chest 2014;146[6]:e228-9). The authors also noted that the overall mortality was 6% and that the need for a tracheostomy was 7.9%. Age greater than 65 years was associated with increased mortality (odds ratio 2.8).
Dr. Attaway and her associates hypothesized that availability of the long-term survival data from the NETT, support from GOLD guidelines, and the lack of a Food and Drug Administration–approved alternative may have increased utilization of this surgery from 2007 through 2013. With data from the Nationwide Inpatient Sample for 2007-2013, the researchers performed a retrospective cohort analysis of 2,805 patients who underwent LVRS. The composite primary outcome was mortality or need for tracheostomy. Logistic regression was performed to analyze factors associated with the composite primary outcome.
The average patient age was 59 years, and 64% were male. Medicare was the payer in nearly half of cases, in-hospital mortality and need for tracheostomy were both 5.5%, and the risk for tracheostomy or mortality was 10.5%. Linear regression analysis showed a significant increase in LVRS over time, with the 320 surgeries in 2007 and 605 in 2013 (P = .0016).
On univariate analysis, the following factors were found to be significantly associated with the composite primary outcome: in-hospital mortality or the need for tracheostomy (P less than .001), respiratory failure (P less than .001), septicemia (P = .01), shock (P less than .001), acute kidney injury (P less than .001), secondary pulmonary hypertension (P less than .001), and a higher mean number of diagnoses or number of chronic conditions on admission (P less than .001 and P = .017, respectively).
On multivariate logistic regression, only two factors were found to be significantly associated with the composite primary outcome: a higher number of diagnoses (adjusted OR of 1.17 per additional diagnosis), and the presence of secondary pulmonary hypertension (adjusted OR 4.4).
“Availability of long-term survival data from NETT, support from the GOLD guidelines, and lack of current FDA-approved alternatives are potential reasons for increased utilization [of LVRS],” Dr. Attaway said. “However, our study showed that in-hospital mortality and morbidity is high, compared to the NETT results. We also found that secondary pulmonary hypertension and comorbidities are associated with poor outcomes. This is important to keep in mind for patient selection.”
Dr. Attaway and her associates reported having no financial disclosures.
SOURCE: Attaway A et al. ATS 2018, Abstract 4436.
SAN DIEGO – The number of has been increasing since 2011, according to a large national analysis.
Lung volume–reduction surgery (LVRS) has been available for decades, but results from the National Emphysema Treatment Trial (NETT) in 2003 (N Engl J Med 2003;348:2059-73) demonstrated that certain COPD patients benefited from the surgery, Amy Attaway, MD, said at an international conference of the American Thoracic Society.
In that trial, overall mortality at 30 days was 3.6% for the surgical group. “If you excluded high-risk patients, the 30-day mortality was only 2.2%,” said Dr. Attaway, a staff physician at the Cleveland Clinic Respiratory Institute. “If you look at the upper lobe–predominant, low-exercise group, their mortality at 30 days was 1.4%.”
Subsequent studies that evaluated NETT patients over time showed continued improvements in their mortality. For example, one study found that in the upper lobe–predominant patients who received surgery in the NETT trial, their survival at 3 years was 81% vs. 74% in the medical group (P = .05), while survival at 5 years was 70% in the surgery group vs. 60% in the medical group (P = .02; J Thorac Cardiovasc Surg. 2010;140[3]:564-72). Despite this improved mortality, other studies have shown that LVRS remains underutilized. Once such analysis of the Nationwide Inpatient Sample showed a logarithmic drop from 2000 to 2010 (Chest 2014;146[6]:e228-9). The authors also noted that the overall mortality was 6% and that the need for a tracheostomy was 7.9%. Age greater than 65 years was associated with increased mortality (odds ratio 2.8).
Dr. Attaway and her associates hypothesized that availability of the long-term survival data from the NETT, support from GOLD guidelines, and the lack of a Food and Drug Administration–approved alternative may have increased utilization of this surgery from 2007 through 2013. With data from the Nationwide Inpatient Sample for 2007-2013, the researchers performed a retrospective cohort analysis of 2,805 patients who underwent LVRS. The composite primary outcome was mortality or need for tracheostomy. Logistic regression was performed to analyze factors associated with the composite primary outcome.
The average patient age was 59 years, and 64% were male. Medicare was the payer in nearly half of cases, in-hospital mortality and need for tracheostomy were both 5.5%, and the risk for tracheostomy or mortality was 10.5%. Linear regression analysis showed a significant increase in LVRS over time, with the 320 surgeries in 2007 and 605 in 2013 (P = .0016).
On univariate analysis, the following factors were found to be significantly associated with the composite primary outcome: in-hospital mortality or the need for tracheostomy (P less than .001), respiratory failure (P less than .001), septicemia (P = .01), shock (P less than .001), acute kidney injury (P less than .001), secondary pulmonary hypertension (P less than .001), and a higher mean number of diagnoses or number of chronic conditions on admission (P less than .001 and P = .017, respectively).
On multivariate logistic regression, only two factors were found to be significantly associated with the composite primary outcome: a higher number of diagnoses (adjusted OR of 1.17 per additional diagnosis), and the presence of secondary pulmonary hypertension (adjusted OR 4.4).
“Availability of long-term survival data from NETT, support from the GOLD guidelines, and lack of current FDA-approved alternatives are potential reasons for increased utilization [of LVRS],” Dr. Attaway said. “However, our study showed that in-hospital mortality and morbidity is high, compared to the NETT results. We also found that secondary pulmonary hypertension and comorbidities are associated with poor outcomes. This is important to keep in mind for patient selection.”
Dr. Attaway and her associates reported having no financial disclosures.
SOURCE: Attaway A et al. ATS 2018, Abstract 4436.
AT ATS 2018
Key clinical point: Lung volume–reduction surgery remains an evidence-based therapy for a cohort of severe COPD patients.
Major finding: Linear regression analysis showed a significant increase in LVRS over time, with the 320 surgeries in 2007 and 605 in 2013 (P = .0016).
Study details: A retrospective cohort analysis of 2,805 patients who underwent LVRS.
Disclosures: The researchers reported having no financial disclosures.
Source: Attaway A et al. Abstract 4436, ATS 2018.
Mobile app engages individuals with opioid use disorders
SAN DIEGO – Individuals with opioid use disorder generally embraced the idea of using a novel mobile application to learn about recovery options and medication-assisted treatment, according to results from a pilot study.
“We found that, after participants engaged with our mobile app, their interest for recovery and attitudes about recovery improved,” lead study author Patricia Cavazos-Rehg, PhD, of the department of psychiatry at Washington University in St. Louis, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We were not expecting results to be so positive, and these findings are very promising because they suggest that individuals may not have interest in or be reluctant to engage in treatment. But we can engage them with a tool that will get them interested and move them toward treatment recovery.”
Dr. Cavazos-Rehg and her associates set out to examine the effectiveness of a mobile application called “uMAT-R,” which includes evidence-based health information about opioid use disorder recovery and medication-assisted treatment (MAT). The app is being develop in partnership with iTether, an Arizona-based mobile health software company. Material for the user is derived from the Substance Abuse and Mental Health Services Administration’s online handbook, “Decisions in Recovery: Treatment for Opioid Disorders,” and is divided into consumer-friendly content modules that provide information on MAT, including costs, latest research findings, and potential side effects.
For the study, researchers recruited 161 individuals 18 years of age and older from three opioid-focused groups on Reddit to pilot the use of uMAT-R. To be eligible, they had to be a U.S. resident, be fluent in English, have misused opioids in the past 30 days, and not currently be using medication-assisted treatment. Participants had access to the app for 1 month, and the researchers administered a baseline questionnaire that assessed demographics, opioid dependence, and history of treatment. They also administered pre- and postapplication engagement questionnaires that assessed attitudes toward MAT, treatment interest, and usefulness of the app.
Of the 161 invited participants, 44 downloaded the app, and 26 completed all content modules and all pre- and postapp assessments. The median age of the 26 participants was 28 years; 65% were male, and 88% were non-Hispanic white. Nearly all (96%) met criteria for opioid dependence, and 12% had received treatment for opioid misuse in the past 6 months. Dr. Cavazos-Rehg and her associates found that only 32% expressed interest in starting treatment for their opioid use disorder before using the app, compared with 48% after using the app, a difference that reached statistical significance (P = 0.046). Feedback from participants was mostly positive. For example, 92% agreed that the app includes useful tips on how to make life better; 88% would consult the app if they had to make a decision about their recovery; 88% believed the app has a positive outlook; 84% said the app helped them have a better understanding of options for recovery, and 84% said they learned something new from the app.
In addition, scores on the MAT attitudes scale rose from a mean of 3.3 to a mean of 3.5 (P = 0.044).
“,” Dr. Cavazos-Rehg said. “We want to develop a mobile app that will teach individuals who have opioid use disorder about their recovery options so that we can nudge them towards considering recovery, and our findings indicate some success with this goal.”
Next, she and her associates plan to pair use of the app with traditional in-person care among pregnant women with opioid use disorders. “Even if people are engaged in treatment, they still only see a therapist or a clinician once or twice a week,” she said. “We want to be able to use a mobile health treatment to support their needs while they are outside of treatment.”
The study was funded by a grant from the National Institutes of Health. Dr. Cavazos-Rehg reported having no financial disclosures.
SAN DIEGO – Individuals with opioid use disorder generally embraced the idea of using a novel mobile application to learn about recovery options and medication-assisted treatment, according to results from a pilot study.
“We found that, after participants engaged with our mobile app, their interest for recovery and attitudes about recovery improved,” lead study author Patricia Cavazos-Rehg, PhD, of the department of psychiatry at Washington University in St. Louis, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We were not expecting results to be so positive, and these findings are very promising because they suggest that individuals may not have interest in or be reluctant to engage in treatment. But we can engage them with a tool that will get them interested and move them toward treatment recovery.”
Dr. Cavazos-Rehg and her associates set out to examine the effectiveness of a mobile application called “uMAT-R,” which includes evidence-based health information about opioid use disorder recovery and medication-assisted treatment (MAT). The app is being develop in partnership with iTether, an Arizona-based mobile health software company. Material for the user is derived from the Substance Abuse and Mental Health Services Administration’s online handbook, “Decisions in Recovery: Treatment for Opioid Disorders,” and is divided into consumer-friendly content modules that provide information on MAT, including costs, latest research findings, and potential side effects.
For the study, researchers recruited 161 individuals 18 years of age and older from three opioid-focused groups on Reddit to pilot the use of uMAT-R. To be eligible, they had to be a U.S. resident, be fluent in English, have misused opioids in the past 30 days, and not currently be using medication-assisted treatment. Participants had access to the app for 1 month, and the researchers administered a baseline questionnaire that assessed demographics, opioid dependence, and history of treatment. They also administered pre- and postapplication engagement questionnaires that assessed attitudes toward MAT, treatment interest, and usefulness of the app.
Of the 161 invited participants, 44 downloaded the app, and 26 completed all content modules and all pre- and postapp assessments. The median age of the 26 participants was 28 years; 65% were male, and 88% were non-Hispanic white. Nearly all (96%) met criteria for opioid dependence, and 12% had received treatment for opioid misuse in the past 6 months. Dr. Cavazos-Rehg and her associates found that only 32% expressed interest in starting treatment for their opioid use disorder before using the app, compared with 48% after using the app, a difference that reached statistical significance (P = 0.046). Feedback from participants was mostly positive. For example, 92% agreed that the app includes useful tips on how to make life better; 88% would consult the app if they had to make a decision about their recovery; 88% believed the app has a positive outlook; 84% said the app helped them have a better understanding of options for recovery, and 84% said they learned something new from the app.
In addition, scores on the MAT attitudes scale rose from a mean of 3.3 to a mean of 3.5 (P = 0.044).
“,” Dr. Cavazos-Rehg said. “We want to develop a mobile app that will teach individuals who have opioid use disorder about their recovery options so that we can nudge them towards considering recovery, and our findings indicate some success with this goal.”
Next, she and her associates plan to pair use of the app with traditional in-person care among pregnant women with opioid use disorders. “Even if people are engaged in treatment, they still only see a therapist or a clinician once or twice a week,” she said. “We want to be able to use a mobile health treatment to support their needs while they are outside of treatment.”
The study was funded by a grant from the National Institutes of Health. Dr. Cavazos-Rehg reported having no financial disclosures.
SAN DIEGO – Individuals with opioid use disorder generally embraced the idea of using a novel mobile application to learn about recovery options and medication-assisted treatment, according to results from a pilot study.
“We found that, after participants engaged with our mobile app, their interest for recovery and attitudes about recovery improved,” lead study author Patricia Cavazos-Rehg, PhD, of the department of psychiatry at Washington University in St. Louis, said in an interview at the annual meeting of the College on Problems of Drug Dependence. “We were not expecting results to be so positive, and these findings are very promising because they suggest that individuals may not have interest in or be reluctant to engage in treatment. But we can engage them with a tool that will get them interested and move them toward treatment recovery.”
Dr. Cavazos-Rehg and her associates set out to examine the effectiveness of a mobile application called “uMAT-R,” which includes evidence-based health information about opioid use disorder recovery and medication-assisted treatment (MAT). The app is being develop in partnership with iTether, an Arizona-based mobile health software company. Material for the user is derived from the Substance Abuse and Mental Health Services Administration’s online handbook, “Decisions in Recovery: Treatment for Opioid Disorders,” and is divided into consumer-friendly content modules that provide information on MAT, including costs, latest research findings, and potential side effects.
For the study, researchers recruited 161 individuals 18 years of age and older from three opioid-focused groups on Reddit to pilot the use of uMAT-R. To be eligible, they had to be a U.S. resident, be fluent in English, have misused opioids in the past 30 days, and not currently be using medication-assisted treatment. Participants had access to the app for 1 month, and the researchers administered a baseline questionnaire that assessed demographics, opioid dependence, and history of treatment. They also administered pre- and postapplication engagement questionnaires that assessed attitudes toward MAT, treatment interest, and usefulness of the app.
Of the 161 invited participants, 44 downloaded the app, and 26 completed all content modules and all pre- and postapp assessments. The median age of the 26 participants was 28 years; 65% were male, and 88% were non-Hispanic white. Nearly all (96%) met criteria for opioid dependence, and 12% had received treatment for opioid misuse in the past 6 months. Dr. Cavazos-Rehg and her associates found that only 32% expressed interest in starting treatment for their opioid use disorder before using the app, compared with 48% after using the app, a difference that reached statistical significance (P = 0.046). Feedback from participants was mostly positive. For example, 92% agreed that the app includes useful tips on how to make life better; 88% would consult the app if they had to make a decision about their recovery; 88% believed the app has a positive outlook; 84% said the app helped them have a better understanding of options for recovery, and 84% said they learned something new from the app.
In addition, scores on the MAT attitudes scale rose from a mean of 3.3 to a mean of 3.5 (P = 0.044).
“,” Dr. Cavazos-Rehg said. “We want to develop a mobile app that will teach individuals who have opioid use disorder about their recovery options so that we can nudge them towards considering recovery, and our findings indicate some success with this goal.”
Next, she and her associates plan to pair use of the app with traditional in-person care among pregnant women with opioid use disorders. “Even if people are engaged in treatment, they still only see a therapist or a clinician once or twice a week,” she said. “We want to be able to use a mobile health treatment to support their needs while they are outside of treatment.”
The study was funded by a grant from the National Institutes of Health. Dr. Cavazos-Rehg reported having no financial disclosures.
REPORTING FROM CPDD 2018
Key clinical point: Social media can be leveraged to connect individuals with opioid use disorder to a mobile app that encourages recovery.
Major finding:. Only 32% expressed interest in starting treatment for their opioid use disorder before using the app, compared with 48% after using the app, a difference that reached statistical significance (P = 0.046).
Study details: A study of 26 opioid users who piloted the use of a mobile app.
Disclosures: The study was funded by a grant from the National Institutes of Health. Dr. Cavazos-Rehg reported having no financial disclosures.
High-dose opioid prescribing linked to heroin use risk among U.S. veterans
SAN DIEGO – High-dose opioid prescribing is associated with an increased risk of heroin use among U.S. veterans, a prospective study showed.
“Despite evidence linking increased risk of opioid use disorder with specific opioid prescribing patterns, the relationship between these practices and heroin use is less understood,” researchers led by Geetanjoli Banerjee wrote in an abstract presented during the annual meeting of the College on Problems of Drug Dependence. “Understanding the relationship between prescription opioid use and initiation of heroin use among veterans is particularly important, as this population has both a higher underlying prevalence of substance abuse disorders and pain conditions.”
Ms. Banerjee, a graduate student at Brown University, Providence, R.I., and her associates examined data from 3,570 individuals enrolled in the Veterans Aging Cohort Study without nonmedical use or prescription opioids or heroin use in the year prior to baseline, and who received more than one prescription opioid from the VA during follow-up. between 2002 and 2012.
Among the 3,833 eligible participants, the proportion who were prescribed high-dose opioids (defined as a morphine equivalent daily dose of 90 mg or greater) did not change significantly between 2002 and 2012, and ranged from 4.4% to 5.9% (P = .22). The researchers also found that the 10-year incidence rate of recent heroin use was 8.15 event per 1,000 person-years. The time to recent heroin use differed significantly between participants with and without prior receipt of a high-dose prescription at baseline (P less than .001). Multivariable Cox regression analysis showed that prior receipt of a high-dose opioid prescription was associated with recent heroin use (adjusted hazard ratio, 2.54).
“Among patients who report no past year illicit use of opioids at baseline and who are receiving prescription opioids from the VA, receipt of high-dose prescription opioid increased the risk of subsequent heroin use,” the researchers concluded. “Patients receiving high-dose opioids, ages 50-56, with a history of HCV infection, injecting, opioid use disorder, or recent stimulant use should be screened for heroin use.”
They acknowledged certain limitations of the study, including its self-reported design and the fact that VA pharmacy data do not capture opioid prescriptions filled outside of the VA.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Ms. Banerjee reported having no financial disclosures.
SAN DIEGO – High-dose opioid prescribing is associated with an increased risk of heroin use among U.S. veterans, a prospective study showed.
“Despite evidence linking increased risk of opioid use disorder with specific opioid prescribing patterns, the relationship between these practices and heroin use is less understood,” researchers led by Geetanjoli Banerjee wrote in an abstract presented during the annual meeting of the College on Problems of Drug Dependence. “Understanding the relationship between prescription opioid use and initiation of heroin use among veterans is particularly important, as this population has both a higher underlying prevalence of substance abuse disorders and pain conditions.”
Ms. Banerjee, a graduate student at Brown University, Providence, R.I., and her associates examined data from 3,570 individuals enrolled in the Veterans Aging Cohort Study without nonmedical use or prescription opioids or heroin use in the year prior to baseline, and who received more than one prescription opioid from the VA during follow-up. between 2002 and 2012.
Among the 3,833 eligible participants, the proportion who were prescribed high-dose opioids (defined as a morphine equivalent daily dose of 90 mg or greater) did not change significantly between 2002 and 2012, and ranged from 4.4% to 5.9% (P = .22). The researchers also found that the 10-year incidence rate of recent heroin use was 8.15 event per 1,000 person-years. The time to recent heroin use differed significantly between participants with and without prior receipt of a high-dose prescription at baseline (P less than .001). Multivariable Cox regression analysis showed that prior receipt of a high-dose opioid prescription was associated with recent heroin use (adjusted hazard ratio, 2.54).
“Among patients who report no past year illicit use of opioids at baseline and who are receiving prescription opioids from the VA, receipt of high-dose prescription opioid increased the risk of subsequent heroin use,” the researchers concluded. “Patients receiving high-dose opioids, ages 50-56, with a history of HCV infection, injecting, opioid use disorder, or recent stimulant use should be screened for heroin use.”
They acknowledged certain limitations of the study, including its self-reported design and the fact that VA pharmacy data do not capture opioid prescriptions filled outside of the VA.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Ms. Banerjee reported having no financial disclosures.
SAN DIEGO – High-dose opioid prescribing is associated with an increased risk of heroin use among U.S. veterans, a prospective study showed.
“Despite evidence linking increased risk of opioid use disorder with specific opioid prescribing patterns, the relationship between these practices and heroin use is less understood,” researchers led by Geetanjoli Banerjee wrote in an abstract presented during the annual meeting of the College on Problems of Drug Dependence. “Understanding the relationship between prescription opioid use and initiation of heroin use among veterans is particularly important, as this population has both a higher underlying prevalence of substance abuse disorders and pain conditions.”
Ms. Banerjee, a graduate student at Brown University, Providence, R.I., and her associates examined data from 3,570 individuals enrolled in the Veterans Aging Cohort Study without nonmedical use or prescription opioids or heroin use in the year prior to baseline, and who received more than one prescription opioid from the VA during follow-up. between 2002 and 2012.
Among the 3,833 eligible participants, the proportion who were prescribed high-dose opioids (defined as a morphine equivalent daily dose of 90 mg or greater) did not change significantly between 2002 and 2012, and ranged from 4.4% to 5.9% (P = .22). The researchers also found that the 10-year incidence rate of recent heroin use was 8.15 event per 1,000 person-years. The time to recent heroin use differed significantly between participants with and without prior receipt of a high-dose prescription at baseline (P less than .001). Multivariable Cox regression analysis showed that prior receipt of a high-dose opioid prescription was associated with recent heroin use (adjusted hazard ratio, 2.54).
“Among patients who report no past year illicit use of opioids at baseline and who are receiving prescription opioids from the VA, receipt of high-dose prescription opioid increased the risk of subsequent heroin use,” the researchers concluded. “Patients receiving high-dose opioids, ages 50-56, with a history of HCV infection, injecting, opioid use disorder, or recent stimulant use should be screened for heroin use.”
They acknowledged certain limitations of the study, including its self-reported design and the fact that VA pharmacy data do not capture opioid prescriptions filled outside of the VA.
The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Ms. Banerjee reported having no financial disclosures.
REPORTING CPDD 2018
Key clinical point: Screen patients who receive high-dose opioids and meet several other criteria for heroin use.
Major finding:. On multivariate Cox regression, prior prescription of high-dose opioids was an independent predictor of recent heroin use (adjusted hazard ratio, 2.54).
Study details: A prospective analysis of 3,833 participants in the Veterans Aging Cohort Study.
Disclosures: The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse. Ms. Banerjee reported having no financial disclosures.
Aclidinium bromide for COPD: No impact on MACE
SAN DIEGO – The use of aclidinium bromide 400 mcg b.i.d. did not increase the risk of major adverse cardiac events or mortality in patients with moderate to very severe , compared with placebo.
Those are two key findings from the ASCENT COPD trial presented by Robert A. Wise, MD, at an international conference of the American Thoracic Society. “Cardiovascular risk factors and comorbidities are prevalent in patients with COPD, and about 30% of COPD patients die of cardiovascular disease,” said Dr. Wise, who serves as director of research for the division of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine, Baltimore. “However, patients who have cardiovascular disease are often excluded from, or not enrolled in, COPD clinical trials. Moreover, there has been controversy as to whether or not treatment with a long-acting muscarinic antagonist is associated with an increased risk of cardiovascular events. That’s been seen in randomized trials, meta-analyses, as well as in observational studies.”
Aclidinium bromide 400 mcg b.i.d., administered by the Pressair inhaler, is approved as a maintenance treatment for patients with COPD. However, during the registration studies, there were not an adequate number of cardiovascular events in order to ascertain clearly whether or not the drug was associated with increased risk, Dr. Wise said. Therefore, he and his associates in the ASCENT COPD study set out to assess the long-term cardiovascular safety profile of aclidinium 400 mcg b.i.d. in patients with moderate to very severe COPD at risk of major adverse cardiovascular events (MACE) for up to 3 years (Chronic Obstr Pulm Dis. 2018;5[1]:5-15). For the randomized, placebo-controlled, parallel-group study, patients received treatment with aclidinium bromide or a placebo inhaler of similar appearance. The study was designed to be terminated when at least 122 patients experienced an adjudicated MACE. The primary safety endpoint was time to first MACE during follow-up of up to 3 years, while the primary efficacy endpoint was the rate of moderate to severe exacerbations per patient per year during the first year of treatment.
To be included in the study, patients had to be at least 40 years of age with moderate to very severe stable COPD, have a smoking history of at least 10 pack-years, and have at least one of the following significant risk factors: cerebrovascular disease; coronary artery disease; peripheral vascular disease, or history of claudication; or at least two atherothrombotic risk factors (male at least 65 years of age, female at least 70 years of age; waist circumference of at least 40 inches among males or at least 38 inches among females; an estimated glomerular filtration rate of less than 60 mL/min and microalbuminuria; dyslipidemia; or hypertension).
The researchers randomized 1,791 patients to the aclidinium group and 1,798 to the placebo group. Their mean age was 67 years, and about 60% of patients had an exacerbation in the preceding year. Nearly two-thirds of patients (63%) were receiving concomitant long-acting beta 2-agonists (LABA) or LABA/inhaled corticosteroid therapy. In addition, 44% of patients entered the study with a history of a prior cardiovascular event plus at least two atherothrombotic risk factors, 52% reported at least two atherothrombotic risk factors without any prior cardiovascular events, and 4% had a history of a prior cardiovascular event only.
Dr. Wise reported that aclidinium did not increase the risk of MACE in patients with moderate to very severe COPD with significant cardiovascular risk factors, compared with placebo (hazard ratio 0.89; P = .469); non-inferiority was concluded as the upper bound of the 95% confidence interval was less than 1.8). In terms of all-cause mortality, aclidinium did not increase the risk of death, compared with placebo (HR 0.99; P = .929).
During the first year of treatment, Dr. Wise and his associates also observed a 22% reduction in COPD exacerbation rate for aclidinium vs. placebo groups (HR 0.44 vs. 0.57, respectively; P less than .001), and a 35% reduction in the rate of COPD exacerbations leading to hospitalizations (HR 0.07 vs. 0.10; P = .006). “The reduction in exacerbation risk was similar, whether or not patients had an exacerbation in the past year,” Dr. Wise said. He reported being a consultant to, and receiving research support from, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and ContraFect.
[email protected]
SOURCE: Wise, R., et al., Abstract 7711, ATS 2018.
SAN DIEGO – The use of aclidinium bromide 400 mcg b.i.d. did not increase the risk of major adverse cardiac events or mortality in patients with moderate to very severe , compared with placebo.
Those are two key findings from the ASCENT COPD trial presented by Robert A. Wise, MD, at an international conference of the American Thoracic Society. “Cardiovascular risk factors and comorbidities are prevalent in patients with COPD, and about 30% of COPD patients die of cardiovascular disease,” said Dr. Wise, who serves as director of research for the division of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine, Baltimore. “However, patients who have cardiovascular disease are often excluded from, or not enrolled in, COPD clinical trials. Moreover, there has been controversy as to whether or not treatment with a long-acting muscarinic antagonist is associated with an increased risk of cardiovascular events. That’s been seen in randomized trials, meta-analyses, as well as in observational studies.”
Aclidinium bromide 400 mcg b.i.d., administered by the Pressair inhaler, is approved as a maintenance treatment for patients with COPD. However, during the registration studies, there were not an adequate number of cardiovascular events in order to ascertain clearly whether or not the drug was associated with increased risk, Dr. Wise said. Therefore, he and his associates in the ASCENT COPD study set out to assess the long-term cardiovascular safety profile of aclidinium 400 mcg b.i.d. in patients with moderate to very severe COPD at risk of major adverse cardiovascular events (MACE) for up to 3 years (Chronic Obstr Pulm Dis. 2018;5[1]:5-15). For the randomized, placebo-controlled, parallel-group study, patients received treatment with aclidinium bromide or a placebo inhaler of similar appearance. The study was designed to be terminated when at least 122 patients experienced an adjudicated MACE. The primary safety endpoint was time to first MACE during follow-up of up to 3 years, while the primary efficacy endpoint was the rate of moderate to severe exacerbations per patient per year during the first year of treatment.
To be included in the study, patients had to be at least 40 years of age with moderate to very severe stable COPD, have a smoking history of at least 10 pack-years, and have at least one of the following significant risk factors: cerebrovascular disease; coronary artery disease; peripheral vascular disease, or history of claudication; or at least two atherothrombotic risk factors (male at least 65 years of age, female at least 70 years of age; waist circumference of at least 40 inches among males or at least 38 inches among females; an estimated glomerular filtration rate of less than 60 mL/min and microalbuminuria; dyslipidemia; or hypertension).
The researchers randomized 1,791 patients to the aclidinium group and 1,798 to the placebo group. Their mean age was 67 years, and about 60% of patients had an exacerbation in the preceding year. Nearly two-thirds of patients (63%) were receiving concomitant long-acting beta 2-agonists (LABA) or LABA/inhaled corticosteroid therapy. In addition, 44% of patients entered the study with a history of a prior cardiovascular event plus at least two atherothrombotic risk factors, 52% reported at least two atherothrombotic risk factors without any prior cardiovascular events, and 4% had a history of a prior cardiovascular event only.
Dr. Wise reported that aclidinium did not increase the risk of MACE in patients with moderate to very severe COPD with significant cardiovascular risk factors, compared with placebo (hazard ratio 0.89; P = .469); non-inferiority was concluded as the upper bound of the 95% confidence interval was less than 1.8). In terms of all-cause mortality, aclidinium did not increase the risk of death, compared with placebo (HR 0.99; P = .929).
During the first year of treatment, Dr. Wise and his associates also observed a 22% reduction in COPD exacerbation rate for aclidinium vs. placebo groups (HR 0.44 vs. 0.57, respectively; P less than .001), and a 35% reduction in the rate of COPD exacerbations leading to hospitalizations (HR 0.07 vs. 0.10; P = .006). “The reduction in exacerbation risk was similar, whether or not patients had an exacerbation in the past year,” Dr. Wise said. He reported being a consultant to, and receiving research support from, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and ContraFect.
[email protected]
SOURCE: Wise, R., et al., Abstract 7711, ATS 2018.
SAN DIEGO – The use of aclidinium bromide 400 mcg b.i.d. did not increase the risk of major adverse cardiac events or mortality in patients with moderate to very severe , compared with placebo.
Those are two key findings from the ASCENT COPD trial presented by Robert A. Wise, MD, at an international conference of the American Thoracic Society. “Cardiovascular risk factors and comorbidities are prevalent in patients with COPD, and about 30% of COPD patients die of cardiovascular disease,” said Dr. Wise, who serves as director of research for the division of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine, Baltimore. “However, patients who have cardiovascular disease are often excluded from, or not enrolled in, COPD clinical trials. Moreover, there has been controversy as to whether or not treatment with a long-acting muscarinic antagonist is associated with an increased risk of cardiovascular events. That’s been seen in randomized trials, meta-analyses, as well as in observational studies.”
Aclidinium bromide 400 mcg b.i.d., administered by the Pressair inhaler, is approved as a maintenance treatment for patients with COPD. However, during the registration studies, there were not an adequate number of cardiovascular events in order to ascertain clearly whether or not the drug was associated with increased risk, Dr. Wise said. Therefore, he and his associates in the ASCENT COPD study set out to assess the long-term cardiovascular safety profile of aclidinium 400 mcg b.i.d. in patients with moderate to very severe COPD at risk of major adverse cardiovascular events (MACE) for up to 3 years (Chronic Obstr Pulm Dis. 2018;5[1]:5-15). For the randomized, placebo-controlled, parallel-group study, patients received treatment with aclidinium bromide or a placebo inhaler of similar appearance. The study was designed to be terminated when at least 122 patients experienced an adjudicated MACE. The primary safety endpoint was time to first MACE during follow-up of up to 3 years, while the primary efficacy endpoint was the rate of moderate to severe exacerbations per patient per year during the first year of treatment.
To be included in the study, patients had to be at least 40 years of age with moderate to very severe stable COPD, have a smoking history of at least 10 pack-years, and have at least one of the following significant risk factors: cerebrovascular disease; coronary artery disease; peripheral vascular disease, or history of claudication; or at least two atherothrombotic risk factors (male at least 65 years of age, female at least 70 years of age; waist circumference of at least 40 inches among males or at least 38 inches among females; an estimated glomerular filtration rate of less than 60 mL/min and microalbuminuria; dyslipidemia; or hypertension).
The researchers randomized 1,791 patients to the aclidinium group and 1,798 to the placebo group. Their mean age was 67 years, and about 60% of patients had an exacerbation in the preceding year. Nearly two-thirds of patients (63%) were receiving concomitant long-acting beta 2-agonists (LABA) or LABA/inhaled corticosteroid therapy. In addition, 44% of patients entered the study with a history of a prior cardiovascular event plus at least two atherothrombotic risk factors, 52% reported at least two atherothrombotic risk factors without any prior cardiovascular events, and 4% had a history of a prior cardiovascular event only.
Dr. Wise reported that aclidinium did not increase the risk of MACE in patients with moderate to very severe COPD with significant cardiovascular risk factors, compared with placebo (hazard ratio 0.89; P = .469); non-inferiority was concluded as the upper bound of the 95% confidence interval was less than 1.8). In terms of all-cause mortality, aclidinium did not increase the risk of death, compared with placebo (HR 0.99; P = .929).
During the first year of treatment, Dr. Wise and his associates also observed a 22% reduction in COPD exacerbation rate for aclidinium vs. placebo groups (HR 0.44 vs. 0.57, respectively; P less than .001), and a 35% reduction in the rate of COPD exacerbations leading to hospitalizations (HR 0.07 vs. 0.10; P = .006). “The reduction in exacerbation risk was similar, whether or not patients had an exacerbation in the past year,” Dr. Wise said. He reported being a consultant to, and receiving research support from, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and ContraFect.
[email protected]
SOURCE: Wise, R., et al., Abstract 7711, ATS 2018.
AT ATS 2018
Key clinical point: Researchers found no increased risk of MACE in at-risk patients with COPD receiving aclidinium.
Major finding: MACE risk and mortality in COPD patients with significant cardiovascular risk given aclidinium bromide had a hazard ratio 0.89 (P = .469), compared to placebo.
Study details: A randomized, placebo-controlled, parallel-group study of 3,589 patients with moderate to very severe COPD at risk of major adverse cardiovascular events.
Disclosures: Dr. Wise reported being a consultant to, and receiving research support from, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and ContraFect.
Source: Wise, R. et al, ATS 2018, Abstract 7711.