Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30 days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6 months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6 months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227

Translational Studies of Fatty Acid Ethyl Esters (FAEE) in Meconium and Hair as Biomarkers of Prenatal Ethanol Exposure Risk

The development of effective maternal and neonatal screening methods to identify individuals at risk for FASD is essential in addressing this substantially prevalent disorder. FAEE are non-oxidative ethanol metabolites validated as biomarkers of chronic ethanol exposure. This thesis presents a series of studies in animals and humans examining meconium and hair FAEE as measures of fetal exposure, population-health, and maternal ethanol use. Characteristics of meconium FAEE production were examined in guinea pig fetuses chronically exposed to a maternal ethanol dose of 4g/kg/day. Fetuses were sacrificed at three gestational ages (GD45, GD55, GD65) and evaluated for FAEE, hippocampal weight, and hepatic CYP2E1 activity. FAEE above 0.642 nmol/g was 96% sensitive and 100% specific in distinguishing ethanol-exposed fetuses from isocaloric-sucrose pair-fed controls (AUCROC = 0.999). FAEE correlated inversely with hippocampal weight at GD45 (rs = -0.943), GD55 (rs = -0.536) and GD65 (rs = -0.549). FAEE exhibited an inverse correlation with fetal hepatic CYP2E1 activity (rs = -0.799, p = 0.002), suggesting variability in CYP2E1 induction as a possible source of intra-litter variability in FAEE concentrations noted in this animal model and similar differences clinically observed in dizygotic twins. Performance of FAEE as a population screening tool was examined through collection of meconium from 93% of live PEI neonates over a one-year period (n=1307). This study, the first provincial incidence assessment of fetal ethanol exposure conducted in Canada; revealed a 3.1-4.4% incidence, 3-to-4 fold higher than estimates locally reported by the PEI Reproductive Care database. Performance of hair FAEE as a measure of maternal ethanol use was evaluated through examination of FAEE-positive hair samples from 199 female and 73 male subjects. Risk of false-positivity through use of ethanol-containing hair products was identified, however no population-level tendency towards higher FAEE in females was observed. Females exhibited lower concentrations of EtG, an alternative biomarker of consumption. FAEE EtG concordance was higher in males (69.9% vs. 36.2%), with evidence of EtG false-negativity in 26% of individuals with discordant results (n=111). These findings suggest that combined analysis of FAEE and EtG is optimal when assessing a female population through hair analysis.Ph.D

Utilisation de la cotinine contenue dans les cheveux comme marqueur d'une exposition à la fumée de tabac. Méta-analyse d'études internationales

Au cours des 12 dernières années, nous avons établi et validé l'utilisation de la cotinine contenue dans les cheveux comme marqueur de l'exposition à la fumée de tabac. Cette méta-analyse, réalisée à partir de toutes les études disponibles de notre laboratoire et d'autres centres, est destinée à établir des valeurs de cotinine dans les cheveux, dans le contexte de l'exposition f à la fumée de tabac environnante. Les valeurs ci-dessous ont été mesurées sur plus de 1000 patients :
Femmes non enceintes : Fumeuses actives $\rightarrow$ cotinine (ng/mg) = 2.72 et [95% IC] = 2.32-3.13 Fumeuses passives $\rightarrow$ cotinine (ng/mg) = 0.62 et [95% IC] = 0.51-0.74 Non exposées $\rightarrow$ cotinine (ng/mg) = 0.29 et [95% IC] = 0.23-0.36 
Femmes enceintes : Fumeuses actives $\rightarrow$ cotinine (ng/mg) = 1. 7 et [95% IC] = 1.46-1.94 Fumeuses passives $\rightarrow$ cotinine (ng/mg) = 0.07 et [95% IC] = 0-0.09 Non exposées $\rightarrow$ cotinine (ng/mg) = 0.08 et [95% IC] = 0-0.09 
Enfants : Passifs $\rightarrow$ cotinine (ng/mg) = 0.96 et [95% IC] = 0.86-1.07 Non exposés $\rightarrow$ cotinine (ng/mg) = 0.33 et [95% IC] = 0.25-0.4 
Nouveau-nés : Exposés in utéro $\rightarrow$ cotinine (ng/mg) = 1.42 et [95% IC] = 1.18-1.65 
 
 La séparation entre les différents états d'exposition avec un intervalle de confiance à 95% devrait pouvoir faciliter les recherches, ainsi que les cas cliniques où une exposition passive peut être dangereuse (par exemple des enfants avec de l'asthme vivant dans une maison de fumeurs) et aider l'assurance maladie

Rates of positivity for individual compounds.

<p><b>^{^}</b>Pearson Chi-square test performed; <b>^&</b>Fisher’s Exact test performed; <b>*</b>Methadone positive n=113, Methadone negative n=92; <b>^#</b>Methadone positive n=112, Methadone negative n=92; <b>^$</b>Methadone positive n=111, Methadone negative n=92; <b>^%</b>Methadone positive n=22, Methadone negative n=66; <b>⁼</b>Methadone positive n=162, Methadone negative n=108; <b>⁺</b>Methadone positive n=162, Methadone negative n=106; <b>^<i>a</i></b>Methadone positive n=162, Methadone negative n=108</p

Rates of positivity for six drug classes.

<p><b>^{^}</b>Pearson Chi-square test performed; <b>^&</b>Fisher’s Exact test performed; *Methadone positive n=98, Methadone negative n=92; <b>^#</b>Methadone positive n=28, Methadone negative n=62; <b>⁺</b>Methadone positive n=68, Methadone negative n=60</p

Incidence of prenatal alcohol exposure in Prince Edward Island

Background: Fetal alcohol spectrum disorder (FASD) is a leading preventable cause of neurodevelopmental disability in North America. The stigma associated with alcohol use and abuse during pregnancy makes it difficult to obtain information on prenatal alcohol use through self-reporting. We assessed the incidence of prenatal alcohol exposure in Prince Edward Island to facilitate future public health initiatives addressing FASD. Methods: Prenatal alcohol exposure was examined via population-based collection of meconium and analysis of fatty acid ethyl esters (FAEEs). Fatty acid ethyl esters are nonoxidative metabolites of ethanol that are produced in the fetus. Meconium FAEE concentrations of 2.0 nmol/g or greater are indicative of frequent prenatal alcohol exposure during the last 2 trimesters of pregnancy. Samples were collected from 1307 neonates between Nov. 8, 2010, and Nov. 8, 2011, in hospitals in PEI, or from those born to mothers who resided in PEI but gave birth in Halifax, Nova Scotia. Samples were frozen and shipped for analysis. Fatty acid ethyl esters were analyzed by gas chromatography–mass spectrometry and quantified by means of deuterated internal standards. Results: Of the 1307 samples collected, 1271 samples were successfully analyzed. Positive results for FAEEs were obtained in 3.1% (n = 39) of samples collected within the first 24 hours after birth. Interpretation: Not all neonates exposed to heavy prenatal alcohol in utero will exhibit FASD; based on current estimates of predictive value for disease by exposure, our findings suggest that 1.3% of neonates born in PEI during this 1-year period will have FASD. In its application to an entire provincial birth cohort, this study successfully implemented a public health–centred approach for evaluating population-based risk of FASD, with implications for practice across Canada

Randomized clinical trial of the effects of screening and brief intervention for illicit drug use: the Life Shift/Shift Gears study.

BackgroundAlthough screening, brief intervention, and referral to treatment (SBIRT) has shown promise for alcohol use, relatively little is known about its effectiveness for adult illicit drug use. This randomized controlled trial assessed the effectiveness of the SBIRT approach for outcomes related to drug use among patients visiting trauma and emergency departments (EDs) at two large, urban hospitals.MethodsA total of 700 ED patients who admitted using illegal drugs in the past 30&nbsp;days were recruited, consented, provided baseline measures of substance use and related problems measured with the Addiction Severity Index-Lite (ASI-Lite), and then randomized to the Life Shift SBIRT intervention or to an attention-placebo control group focusing on driving and traffic safety (Shift Gears). Both groups received a level of motivational intervention matched to their condition and risk level by trained paraprofessional health educators. Separate measurement technicians conducted face-to-face follow-ups at 6&nbsp;months post-intervention and collected hair samples to confirm reports of abstinence from drug use. The primary outcome measure of the study was past 30-day drug abstinence at 6&nbsp;months post-intervention, as self-reported on the ASI-Lite.ResultsOf 700 participants, 292 (42%) completed follow-up. There were no significant differences in self-reported abstinence (12.5% vs. 12.0% , p = 0.88) for Life Shift and Shift Gears groups, respectively. When results of hair analyses were applied, the abstinence rate was 7 percent for Life Shift and 2 percent for Shift Gears (p = .074). In an analysis in which results were imputed (n = 694), there was no significant difference in the ASI-Lite drug use composite scores (Life Shift +0.005 vs. Shift Gears +0.017, p = 0.12).ConclusionsIn this randomized controlled trial, there was no evidence of effectiveness of SBIRT on the primary drug use outcome.Trial registrationClinicalTrials.gov NCT01683227