Trends in gabapentinoid prescribing, co-prescribing of opioids and benzodiazepines, and associated deaths in Scotland

Background: Gabapentinoid drugs (gabapentin and pregabalin) are effective in neuropathic pain, which has a prevalence of ~7%. Concerns about increased prescribing have implications for patient safety, misuse, and diversion. Drug-related deaths (DRDs) have increased and toxicology often implicates gabapentinoids. We studied national and regional prescribing rates (2006–2016) and identified associated sociodemographic factors, co-prescriptions and mortality, including DRDs. Methods: National data from the Information Service Division, NHS Scotland were analysed for prescribing, sociodemographic, and mortality data from the Health Informatics Centre, University of Dundee. DRDs in which gabapentinoids were implicated were identified from National Records of Scotland and Tayside Drug Death Databases. Results: From 2006 to 2016, the number of gabapentin prescriptions in Scotland increased 4-fold (164 630 to 694 293), and pregabalin 16-fold (27 094 to 435 490). In 2016 ‘recurrent users’ (three or more prescriptions) had mean age 58.1 yr, were mostly females (62.5%), and were more likely to live in deprived areas. Of these, 60% were co-prescribed an opioid, benzodiazepine, or both (opioid 49.9%, benzodiazepine 26.8%, both 17.1%). The age-standardised death rate in those prescribed gabapentinoids was double that in the Scottish population (relative risk 2.16, 95% confidence interval 2.08–2.25). Increases in gabapentinoids contributing to cause of DRDs were reported regionally and nationally (gabapentin 23% vs 15%; pregabalin 21% vs 7%). In Tayside, gabapentinoids were implicated in 22 (39%) of DRDs, 17 (77%) of whom had not received a prescription. Conclusions: Gabapentinoid prescribing has increased dramatically since 2006, as have dangerous co-prescribing and death (including DRDs). Older people, women, and those living in deprived areas were particularly likely to receive prescriptions. Their contribution to DRDs may be more related to illegal use with diversion of prescribed medication

Nuclear RNA sequencing of the mouse erythroid cell transcriptome.

In addition to protein coding genes a substantial proportion of mammalian genomes are transcribed. However, most transcriptome studies investigate steady-state mRNA levels, ignoring a considerable fraction of the transcribed genome. In addition, steady-state mRNA levels are influenced by both transcriptional and posttranscriptional mechanisms, and thus do not provide a clear picture of transcriptional output. Here, using deep sequencing of nuclear RNAs (nucRNA-Seq) in parallel with chromatin immunoprecipitation sequencing (ChIP-Seq) of active RNA polymerase II, we compared the nuclear transcriptome of mouse anemic spleen erythroid cells with polymerase occupancy on a genome-wide scale. We demonstrate that unspliced transcripts quantified by nucRNA-seq correlate with primary transcript frequencies measured by RNA FISH, but differ from steady-state mRNA levels measured by poly(A)-enriched RNA-seq. Highly expressed protein coding genes showed good correlation between RNAPII occupancy and transcriptional output; however, genome-wide we observed a poor correlation between transcriptional output and RNAPII association. This poor correlation is due to intergenic regions associated with RNAPII which correspond with transcription factor bound regulatory regions and a group of stable, nuclear-retained long non-coding transcripts. In conclusion, sequencing the nuclear transcriptome provides an opportunity to investigate the transcriptional landscape in a given cell type through quantification of unspliced primary transcripts and the identification of nuclear-retained long non-coding RNAs

The Grizzly, November 3, 1989

Wismer Woes • Curriculum Changes Affect all Students at U.C. • Letters: A Voice for Love ; Coaching Cowardess • Alcohol Awareness • Club Sails Smoothly • For Nature\u27s Nurture • Bears Struggle with Division I • Honors Galore • X-C Teams Look to MAC\u27s • Hoopla!https://digitalcommons.ursinus.edu/grizzlynews/1245/thumbnail.jp

The Grizzly, October 30, 1990

Ursinus Honored at Governor\u27s Mansion • Sam Stretton To Speak • Glassmoyer Retires • Heefner New Board President • The Gender of Speech: A Tri-Lambda Lecture • Career Day November 6th • Forbes to Speak to Clergy • Animal Lovers Unite • Mock DWI A Hit • Student Camp Experience • David is Great!! • Presenting Protheatre: The Changeling • Crutcher Leads Team• Muhlenberg Falls • Swimmers Open Season at Relay Meet • Women Running To MAC\u27s • Men Go for MAC Title • Soccer • Letters: Keep Ursinus Clean; Quad Keys Revoked?; Signs Stolen; Security, Please Hold • Environmentally Concerned? Get Active • Bush\u27s Environmental Lip Service • This Time for Real • Nature Versus Nurture: A Step in Solving the Puzzlehttps://digitalcommons.ursinus.edu/grizzlynews/1262/thumbnail.jp

The Lantern Vol. 56, No. 2, Spring 1990

• Brasil • Plastic Flowers • Be a Pepper • Grunge • Handling the Responsibility • Returning to the Forest • How Nice • Nooze • Emma • Restoration • Chestnuts • Frozen Moments • Once Upon A • Clipped Wings • Gerard Manley Hopkins • Roaches • In Grand Central • The Steelville Shark • Panama 1989 • Betrayal • Violations • Detourhttps://digitalcommons.ursinus.edu/lantern/1136/thumbnail.jp

The Grizzly, March 26, 1991

First Dance Marathon for Leukemia a Success • U.S.G.A. Proposes S.A.C. Reorganization • Student Debate on Use of Force Held • College Fax for Official College Use • Residential Village Centralized • New Materials to Recycle • Financial Aid Update • The Soviets: An Inside Portrait • Communication Arts Career Night • Lange Promoted to Assistant Dean of Continuing Education • 1990 Fall Dean\u27s List • Symposium at Berman • Men\u27s Track Runs Well Despite Conditions • Women\u27s Track Makes a Splash at Greyhound Invitational • Women Win ECAC Title • Men\u27s Lacrosse Upsets Penn State Del. Co. • Women\u27s Lacrosse Hopes for Third NCAA Title • Golf Opens With a Win • Derstine First Swimming All-American • Softball Swings into Season • Men\u27s Tennis Nets Good Results • Letter: Student Apathy, Who Cares! • The New Drugstore: Nature\u27s Pharma-Sea • Don\u27t Can Your Aluminumhttps://digitalcommons.ursinus.edu/grizzlynews/1274/thumbnail.jp

Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

Background: Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods: People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results: One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions: People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019