Pilot Safety Evaluation of Varenicline for the Treatment of Methamphetamine Dependence.

Despite the worldwide extent of methamphetamine dependence, no medication has been shown to effectively treat afflicted individuals. One relatively unexplored approach is modulation of cholinergic system function. Animal research suggests that enhancement of central cholinergic activity, possibly at nicotinic acetylcholine receptors (nAChRs), can reduce methamphetamine-related behaviors. Further, preliminary findings indicate that rivastigmine, a cholinesterase inhibitor, may reduce craving for methamphetamine after administration of the drug in human subjects. We therefore performed a double-blind, placebo-controlled, crossover pilot study of the safety and tolerability of varenicline in eight methamphetamine-dependent research subjects. Varenicline is used clinically to aid smoking cessation, and acts as a partial agonist at α4β2 nAChRs with full agonist properties at α7 nAChRs. Oral varenicline dose was titrated over 1 week to reach 1 mg bid, and then was co-administered with 30 mg methamphetamine, delivered in ten intravenous infusions of 3 mg each. Varenicline was found to be safe in combination with IV methamphetamine, producing no cardiac rhythm disturbances or alterations in vital sign parameters. No adverse neuropsychiatric sequelae were detected either during varenicline titration or following administration of methamphetamine. The results suggest that varenicline warrants further investigation as a potential treatment for methamphetamine dependence

Situational Prescription Drug Abuse-Related Communication Confidence among Community Pharmacists: An Exploratory Analysis

Prescription drug abuse and misuse (PDA/M) prevalence has increased dramatically in the United States over the last two decades. Community pharmacists are intimately involved in the dispensing of a majority of eventually abused/misused prescription drugs and are thus well positioned to engage in PDA/M prevention and treatment. A known barrier to engagement in prevention efforts among providers is discomfort with PDA/M communication. The objective of this study was to explore relative situational self-perceived PDA/M communication confidence among Tennessee community pharmacists. Using the validated Self-Perceived Communication Competence instrument as a framework, an 18-item survey instrument (0-100 scale; 0=completely unconfident, 100=completely confident) was developed and administered to 2000 Tennessee pharmacists. Items elicited communication confidence across multiple contexts and receivers, including PDA/M situations and common community pharmacy situations. Parametric statistical tests were used to examine differences in communication confidence across demographic variables. A 40% response rate was obtained. Mean self-perceived communication confidence ratings ranged from 54.2 to 92.6. Statistically significant differences were noted across receiver type and context. Addiction communication confidence was significantly lower than all other scenarios involving patient communication, including items that could be considered accusatory to patients (non-adherence, smoking cessation). Differences in communicative self-confidence were noted across gender, practice setting, years in practice, hours worked per week, and number of prescriptions filled per week. Pharmacists’ self-perceived communication confidence is situational and varies across pharmacist and practice setting characteristics. Efforts to engage community pharmacists in PDA/M prevention and treatment should foster development of communicative self-confidence across multiple PDA/M situations

Situational Communication Self-Confidence Among Community Pharmacists: A Descriptive Analysis

Objective: To compare community pharmacists\u27 self-perceived communication confidence in prescription drug abuse and addiction (PDAA)-related scenarios to their self-confidence in other scenarios. Methods: An 18-item survey instrument adapted from the Self-Perceived Communication Competence instrument was administered to 2000 licensed Tennessee community pharmacists. Items elicited communication confidence across common community pharmacy scenarios. Analysis of communication self-confidence scores across context, receiver, audience, and demographic variables was conducted. Results: Mean self-confidence ratings ranged from 54.2 to 92.6 (0-100 scale). Self-perceived communication confidence varied across context, receiver, audience, personal and practice setting characteristics. Scenarios that involved PDAA communication with patients were scored significantly lower than non-PDAA patient scenarios (mean = 84.2 vs. 90.4, p Conclusion: Community pharmacists are less confident in their ability to communicate with patients about PDAA as compared to non-PDAA scenarios. Practice Implications: Engaging patients and prescribers in PDAA conversations is a critical component of preventing and treating PDAA. Research is warranted to further explore measures of situational communication self-confidence and interventions to optimize self-confidence beliefs across PDAA scenarios

Pilot safety evaluation of varenicline for the treatment of methamphetamine dependence

Todd Zorick1, Rajkumar J Sevak1, Karen Miotto1, Steven Shoptaw2,4, Aimee-Noelle Swanson2, Clayton Clement1, Richard De La Garza II1*, Thomas F Newton1*, Edythe D London1,3,41Departments of Psychiatry and Biobehavioral Sciences, 2Family Medicine, 3Molecular and Medical Pharmacology, 4The Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; *Present address: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USAAbstract: Despite the worldwide extent of methamphetamine dependence, no medication has been shown to effectively treat afflicted individuals. One relatively unexplored approach is modulation of cholinergic system function. Animal research suggests that enhancement of central cholinergic activity, possibly at nicotinic acetylcholine receptors (nAChRs), can reduce methamphetamine-related behaviors. Further, preliminary findings indicate that rivastigmine, a cholinesterase inhibitor, may reduce craving for methamphetamine after administration of the drug in human subjects. We therefore performed a double-blind, placebo-controlled, crossover pilot study of the safety and tolerability of varenicline in eight methamphetamine-dependent research subjects. Varenicline is used clinically to aid smoking cessation, and acts as a partial agonist at α4b2 nAChRs with full agonist properties at α7 nAChRs. Oral varenicline dose was titrated over one week to reach 1 mg twice daily, and then was co-administered with 30 mg methamphetamine, delivered in 10 intravenous (iv) infusions of 3 mg each. Varenicline was found to be safe in combination with iv methamphetamine, producing no cardiac rhythm disturbances or alterations in vital sign parameters. No adverse neuropsychiatric sequelae were detected either during varenicline titration or following administration of methamphetamine. The results suggest that varenicline warrants further investigation as a potential treatment for methamphetamine dependence.Keywords: varenicline, methamphetamine, treatment, safety, nicotinic, acetylcholin

Community Pharmacists’ Perceptions of Neonatal Abstinence Syndrome and Opioid-Based Medication-Assisted Treatment in Northeast Tennessee

Abstract available through Pharmacotherapy