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Background and aims Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. Design Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. Setting Publicly funded drug treatment facilities in California, USA (2006-10). Participants A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. Measurements Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. Findings Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). Conclusions In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment. [ABSTRACT FROM AUTHOR]

Abstract: Aims: (1) To characterize the amount of prescription opioids prescribed for high‐risk patients by low‐volume prescribers; (2) to quantify how high‐ and low‐volume prescribers differ systematically in their prescribing patterns. Design: Cross‐sectional study using 2015 longitudinal, all‐payer QuintilesIMS pharmacy claims. We conducted an aggregated analysis for the first aim and an individual‐level analysis for the second aim. Setting: California, Florida, Georgia, Maryland, and Washington, USA. Participants: Among 4 046 275 patients, we identified 375 848 concomitant users (filling more than 30‐days of concomitant opioids and benzodiazepines), 150 814 chronic users (using 100+ morphine milligram equivalents (MMEs) per day for more than 90 days), and 3190 patients prescribed opioids by > 3 prescribers and filling opioids at > 3 pharmacies during any 90‐day period. Among 192 126 prescribers, we identified 8023 high‐volume prescribers, who comprised the highest fifth percentile of opioid volume during four calendar quarters. Measurements: (1) MME dose per transaction, (2) days supplied per transaction, (3) total opioid volume per patient and (4) number of prescriptions per patient. We also examined differences in opioid dispensing between high‐ and low‐volume prescribers among patients receiving opioids from both. Findings: Low‐volume prescribers accounted for 15–29% of opioid volume and 18–56% of opioid prescriptions for high‐risk patients, compared with 28–37% and 53–58% for low‐risk patients. After accounting for state of residence, comorbid burden, prescriber specialty and care sequence, patients were more likely to receive higher doses (60.9 versus 53.2 MMEs per day, P < 0.01), longer supplies (22.1 versus 15.6 days, P < 0.01), more prescriptions (4.0 versus 2.6 prescriptions, P < 0.01) and greater opioid volume (5.6 versus 1.9 g, P < 0.01) from high‐ than low‐volume prescribers. Conclusions: In the United States, high‐risk patients obtain a substantial proportion of prescription opioids from low‐volume prescribers. The differences in prescribing patterns between high‐ and low‐volume prescribers suggest the importance of interventions targeting prescriber behaviors. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes.Data Sources/setting: Electronic health records from a large, health care delivery system for 223,730 patients with diabetes prescribed 842,899 new cardiometabolic medications during 2006-2012.Study Design: Observational, new prescription cohort study of the effect of OOP cost on medication initiation and adherence.Data Collection: Adherence and OOP costs were based on pharmacy dispensing records and benefits.Principal Findings: Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index; 7 percent were never dispensed the new medication when OOP cost ≥$11, 5 percent with OOP cost of $1-$10, and 3 percent when the medication was free of charge (p < .0001). Higher OOP cost was also strongly associated with inadequate secondary adherence (≥20 percent of time without adequate medication). There was no clinically significant or consistent relationship between OOP costs and early nonpersistence (dispensed once, never refilled) or later stage nonpersistence (discontinued within 24 months).Conclusions: Cost-sharing may deter clinically vulnerable patients from initiating essential medications, undermining adherence and risk factor control. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Lack of familiarity with proper medication disposal options among patients can lead to personal and environmental safety concerns, besides signalling non-adherence. Given that community pharmacists are in a position to educate patients, this study assessed community pharmacists' knowledge on medication disposal and examined the utility of the theory of planned behaviour ( TPB) in predicting their intention to provide medication disposal education to their patients. Methods A cross-sectional, self-administered survey was distributed to community pharmacists in California. Descriptive statistics were reported for all survey items. Cronbach's alpha and Pearson correlation were used to determine the reliability for the four TPB constructs (attitude, subjective norm, perceived behavioural control and intention). Multiple linear regressions were performed to predict intent using the other three TPB constructs. Results Pharmacists ( n = 142) demonstrated a positive intention to provide education (mean = 5.91 ± 1.22; range: 2 to 8), but most (67.9%) provided this information once a month or less. Attitude (β = 0.266, P = 0.001), subjective norm (β = 0.333, P < 0.001) and perceived behavioural control (β = 0.211, P = 0.009) were significant predictors of intention, accounting for 40.8% of the variance in intention to provide disposal education. Scale reliability ranged from 0.596 to 0.619 for the four constructs. Few pharmacists accurately selected all of the appropriate recommendations of disposal for non-controlled and controlled substances (15.9% and 10.1%, respectively). Conclusion Pharmacists showed favourable attitude, subjective norm, perceived behaviour control and intention in providing such education. However, their knowledge in this area may be lacking and they are not consistently providing this information to their patients. [ABSTRACT FROM AUTHOR]

Aims To examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone®) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Methods This multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events. Results No group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [ P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 ( P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events. Conclusions Buprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. [ABSTRACT FROM AUTHOR]

This section offers news briefs on relating to addiction as of June 2016. It announces the implementation of the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules 2014 in India. It reports the prescription drug monitoring to be introduced in Victoria to prevent overdoses, as well as the ruling by the Texas Supreme Court upholding a state Supreme Court decision to impose a special tax on cigarette makers.

Aims To test aripiprazole for efficacy in decreasing use in methamphetamine-dependent adults, compared to placebo. Design Participants were randomized to receive 12 weeks of aripiprazole or placebo, with a 3-month follow-up and a platform of weekly 30-minute substance abuse counseling. Setting The trial was conducted from January 2009 to March 2012 at the San Francisco Department of Public Health. Participants Ninety actively using, methamphetamine-dependent, sexually active adults were recruited from community venues. Measurements The primary outcome was regression estimated reductions in weekly methamphetamine-positive urines. Secondary outcomes were study medication adherence [by self-report and medication event monitoring systems ( MEMS)], sexual risk behavior and abstinence from methamphetamine. Findings Participant mean age was 38.7 years, 87.8% were male, 50.0% white, 18.9% African American, and 16.7% Latino. Eighty-three per cent of follow-up visits and final visits were completed. By intent-to-treat, participants assigned to aripiprazole had similar reductions in methamphetamine-positive urines as participants assigned to placebo [risk ratio ( RR) 0.88, 95% confidence interval ( CI): 0.66-1.19, P = 0.41]. Urine positivity declined from 73% (33 of 45 participants) to 45% (18 of 40) in the placebo arm and from 77% (34 of 44) to 44% (20 of 35) in the aripiprazole arm. Adherence by MEMS and self-report was 42 and 74%, respectively, with no significant difference between arms ( MEMS P = 0.31; self-report P = 0.17). Most sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug, although participants randomized to aripiprazole reported more akathisia, fatigue and drowsiness ( P < 0.05). Conclusion Compared with placebo, aripiprazole did not reduce methamphetamine use significantly among actively using, dependent adults. [ABSTRACT FROM AUTHOR]

CONTEXT: During its first year of operation (1997-1998), California's family planning program, Family PACT, helped more than 750,000 clients to avert an estimated 108,000 pregnancies. Given subsequent increases in the numbers of clients served and contraceptive methods offered by the program, updated estimates of its impact on fertility are needed. METHODS: Claims data on contraceptives dispensed were used to estimate the number of pregnancies experienced by women in the program in 2002. Medical record data on methods used prior to enrollment were used to predict client fertility in the absence of the program. Further analyses examined the sensitivity of these estimates to alternative assumptions about contraceptive failure rates, contraceptive continuation and contraceptive use in the absence of program services. RESULTS: Almost 6.4 million woman-months of contraception, provided primarily by oral contraceptives (57%), barrier methods (19%) and the injectable (18%), were dispensed through Family PACT during 2002. As a result, an estimated 205,000 pregnancies--which would have resulted in 79,000 abortions and 94,000 births, including 21,400 births to Adolescents--were averted. Changing the base assumptions regarding contraceptive failure rates or method use had relatively small effects on the estimates, whereas assuming that clients would use no contraceptives in the absence of Family PACT nearly tripled the estimate of pregnancies averted. CONCLUSION: Because all contraceptive methods substantially reduce the risk of pregnancy, Family PACT's impact on preventing pregnancy lies primarily in providing contraceptives to women who would otherwise not use any method. [ABSTRACT FROM AUTHOR]

This article discusses a study on the three-stage learning theory of drug use. The desire to use a drug and the element of fear are a function of learning process over a period of time. There are three stages in this process with different effects on the individual and different behavioral consequences. The first stage involves the actor in primarily a respondent role, learning with his friend, the desire, risks and techniques of using drugs. The second stage is the period during which an individual transfers to an operant role and actually tries a drug. The third stage is the stage of stable drug-use patterns. In order to test this theory of drug use, the authors used an ex post facto design. The study employed a questionnaire administered anonymously to a random sample of undergraduate classes at the University of Southern California. It is evident that students are learning to use drugs at the university. For instance, 28% of freshman tried cannabis, while the percentages of juniors and seniors were 44% and 45%, respectively. One further observation involves the distribution among fraternity and sorority students. It was suggested that the Greek community might be less likely to use drugs due to the supposedly conservative political nature of the fraternities and sororities.