Surveillance of Diversion and Nonmedical Use of Extended-Release Prescription Amphetamine and Oral Methylphenidate in the United States

This article examines rates of nonmedical use and diversion of extended-release amphetamine and extended-release oral methylphenidate in the United States. Prescription dispensing data were sourced from retail pharmacies. Nonmedical use data were collected from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System Drug Diversion Program and Poison Center Program. Drug diversion trends nearly overlapped for extended-release amphetamine and extended-release oral methylphenidate. Calls to poison centers were generally similar; however, calls regarding extended-release amphetamine trended slightly lower than those for extended-release oral methylphenidate. Data suggest similar diversion and poison center call rates for extended-release amphetamine and extended-release oral methylphenidate

Intergenerational Transmission of Multiple Problem Behaviors: Prospective Relationships between Mothers and Daughters

Much of the research examining intergenerational continuity of problems from mother to offspring has focused on homotypic continuity (e.g., depression), despite the fact that different types of mental health problems tend to cluster in both adults and children. It remains unclear whether mothers with multiple mental health problems compared to mothers with fewer or no problems are more likely to have daughters with multiple mental health problems during middle childhood (ages 7 to 11). Six waves of maternal and child data from the Pittsburgh Girls Study (n = 2,451) were used to examine the specificity of effects of maternal psychopathology on child adjustment. Child multiple mental health problems comprised disruptive behavior, ADHD symptoms, depressed mood, anxiety symptoms and somatic complaints, while maternal multiple mental health problems consisted of depression, prior conduct problems and somatic complaints. Generalized Estimating Equations (GEE) was used to examine the prospective relationships between mother’s single and multiple mental health problems and their daughter’s single and multiple mental health problems across the elementary school-aged period (ages 7–11 years). The results show that multiple mental health problems in the mothers predicted multiple mental health problems in the daughters even when earlier mental health problem of the daughters, demographic factors, and childrearing practices were controlled. Maternal low parental warmth and harsh punishment independently contributed to the prediction of multiple mental health problems in their daughter, but mediation analyses showed that the contribution of parenting behaviors to the explanation of girls’ mental health problems was small

Prediction of abstinence at 10 weeks based smoking status at 2 weeks during a quit attempt: Secondary analysis of two parallel, 10-week, randomized, double-blind, placebo-controlled clinical trials of 21-mg nicotine patch in adult smokers

Background: Smoking cessation outcomes are calculated as the probability of abstinence at follow-up among all enrolled smokers, but it is also useful to estimate the probability of success for those who experienced success or failure at earlier time points. Objectives: The primary aims were to estimate the probability of maintaining abstinence through week 10 among subjects who were abstinent at week 2, and to assess the effect of active treatment with a nicotine patch. We also examined outcomes at week 6 and, among subjects who smoked during the first 2 weeks of treatment, the probability of reestablishing abstinence later, as well as the effect of active treatment on this outcome. Methods: We analyzed pooled data from 2 previously published, parallel, double-blind studies in which subjects were initially randomized to receive an active nicotine patch (starting at 21 mg) or a placebo patch. Subjects randomized to active treatment followed a double-blind step-down dosing regimen: 24-h/21-mg patches for the first 6 weeks of treatment, followed by 14- and 7-mg patches for successive 2-week periods. Biochemically verified abstinence (exhaled carbon monoxide ¡Ü8 ppm) was assessed during laboratory visits. Results: Most subjects were white (94.8%) and female (61.6%), with a mean (SD) age of 43.1 (10.2) years. Subjects had been smoking for a mean of 24.5 (10.2) years and smoked a mean of 30.6 (10.4) cigarettes per day. In both the nicotine (n = 249) and placebo (n = 253) groups, all subjects who were abstinent during the first 2 weeks had a high probability of maintaining abstinence through week 10, but subjects treated with the active patch were significantly more likely to remain abstinent (active: 79.8% [67/84], placebo: 52.6% [20/38]; relative risk [RR] = 1.52 [95% CI, 1.10¨C2.09]). Also, at week 6, subjects receiving active treatment had a greater chance of remaining abstinent (active: 94.3% [82/87], placebo: 78.0% [32/41]; RR = 1.21 [95% CI, 1.02¨C1.43]). To assess the effect of treatment on recovery from smoking lapses, we examined the probability of abstinence during week 10 among subjects who smoked during the first 2 weeks of treatment. Among them, treatment was associated with a greater probability of later success: 31.4% (50/159) of those treated with the active patch and 12.5% (26/208) of those receiving placebo were abstinent at week 10 (RR = 2.52 [95% CI, 1.64¨C3.85]). Similar results were observed at week 6 (49.4% [80/162] vs 21.2% [45/212]; RR = 2.33 [95% CI, 1.72¨C3.15]). Conclusions: More than two thirds (71.3%) of subjects who were abstinent 2 weeks into a quit attempt maintained that abstinence through the end of 10 weeks of treatment. Use of a nicotine patch was significantly associated with maintaining abstinence and with recovering abstinence after an early lapse

Consumer Understanding of Prescription Drug Information: An Illustration Using an Antidepressant Medication

Background Patient education and warnings have emerged as prominent interventions for improving drug safety. As part of the provision of information and guidance on safe use of drugs, patients often receive multiple pieces of written information when they obtain a prescription medication, including a Food and Drug Administration (FDA)–mandated medication guide (MG), consumer medication information (CMI), and patient package insert (PPI). Objective: To determine whether patients understand the materials providing drug information and whether the materials convey the intended information. Methods: Fifty-two adults with a high school education or less were shown an actual (blinded) MG, CMI, and PPI for a marketed antidepressant medication. Comprehension was tested with methods used by the FDA to assess label comprehension for nonprescription products. Results: The majority of participants (88.2%) looked at all 3 pieces of information provided. The mean (SD) time spent reviewing the CMI was 5.2 (4.8) minutes (range 0-21.9). 16.5(13.3) minutes for the PPI (range 0-43.0), and 2.5 (1.6) minutes for the MG (range 0-7.6). Less than 20% of participants were able to identify the symptoms of a rare but potentially life-threatening situation that can occur with this medication and only 61.5% recalled the risk of teen suicide, which is the sole focus of the MG. Respondents with lower literacy scores performed more poorly than those with higher literacy scores. Conclusions: Information provided with at least some prescription drugs is not adequately understood by less-educated consumers and does not effectively communicate critical safety messages or directions. </jats:sec