News Article | April 17, 2017
One area of concern is the amount of aldehydes present in e-cigarette smoke. These aldehydes are present in tobacco cigarettes in larger quantities than in e-cigarettes, but the levels in e-cigarettes are still not known. Additionally, the amount that is considered dangerous for cardio vascular disease (CVD) is a topic of debate. Some studies have shown that even small amounts of certain aldehydes can lead to progression of CVD. Researchers from the University of Louisville's Tobacco Regulation and Addiction Center conducted quantitative analyses of both older (first generation) and newer-model e-cigarette cartridges using a variety of flavors. They used a new method for trapping reactive carbonyls that are then subsequently stabilized using an oximation reaction. They found that newer devices produced more harmful aldehydes than first generation e-cigarettes. Their work appears in ACS Omega. E-cigarettes cartridges contain battery-powered coils that serve to heat and vaporize e-Liquid. Based on this study, the amount of reactive aldehydes in e-cigarette vapor are largely due to the cartridge's battery power. The higher the battery power, the higher the aldehyde levels. While e-cigarette aerosols contain aldehydes that are known to contribute to CVD, the exact levels have not been definitively determined largely because of the difficulties associated with trapping and studying reactive aldehydes. New models, or "next-generation," e-cigarettes have a higher battery power than older ones. Furthermore, older models have a fixed battery output (4.6 W) while the next-generation ones have variable output (9.1 W, 11.7 W, 14.7 W, 16.6 W). The authors wanted to look at this next-generation of e-cigarettes to quantitatively determine aldehyde levels as well as determine if e-Liquid flavor makes a difference in aldehyde formation. In order to do this, they took into account the formation of hemiacetals from aldehydes, something that prior studies did not address. The aldehydes that are of greatest concern are acetaldehyde, acrolein, and formaldehyde. Acrolein, in particular, has been shown to advance CVD, even when a person is exposed to low levels. Formaldehyde has also been associated with CVD in low concentrations. E-Liquids are usually comprised of glycerin and propylene glycol along with a flavor additive. Glycerin, when heated, predominantly forms acrolein and formaldehyde, while propylene glycol predominantly forms acetone and acetaldehyde. Certain flavor additives have shown enhanced aldehyde formation, as well. Ogunwale et al. used a microreactor-capture approach that they had previously developed to obtain an accurate look at aldehyde levels in e-cigarette vapor. This method employs a 4-(2-aminooxyethyl)-morpholin-4-ium chloride (AMAH) coating on a silicon base. Aldehydes selectively react with AMAH to form an oxime, which is more stable and easier to study than an aldehyde. Aerosols were generated using a cigarette-smoking robot and were collected in Tedlar bags. The robot allowed for control over puff duration, puff volume, and puff frequency. The aerosols flowed through the microreactors from the bags using an evacuation process and then reacted with AMAH. The AMAH oxime compound was neutralized to form an AMA adduct that was then studied using gas chromatography. Both the first generation and next generation e-cigarettes produced some amount of acetaldehyde, acrolein, and formaldehyde, but acealdehyde and formaldehyde were in higher concentrations than acrolein. All of the aldehydes were present in lower concentrations than what is found in cigarette smoke using Health Canada Intense Puffing Regime. Notably, the next-generation e-cigarettes, which have a tank-type atomizer, produced higher levels of aldehydes and acetone. The authors attribute this to the higher battery output. To understand the puffing topology, Ogunwale et al., used 60-mL syringes to manually vary puff duration and volume to more accurately replicate real-life usage. Puffing duration and the particular flavor contributed to the formation of reactive aldehydes, although these factors played a smaller role than battery output in the amount of aldehydes present. If puffing duration was around 4.0 seconds/puff, more aldehydes were present compared to shorter or longer puffing. The average user puffs for 3.5 to 4.3 seconds. Finally, Ogunwale et al. used 1H NMR to detect and quantify the presence of hemiacetals formed from aldehydes. They found that hemiacetals did not form in any of the first-generation e-cigarettes flavors, and they did not form in three of the next-generation flavors tested. Only one flavor that was tested formed hemiacetals within a battery output that was within the range of normal use. This study provides valuable information on the safety of e-cigarettes. In general, the higher the battery output, the higher the aldehyde levels in the vapor. Certain aldehydes, such as acrolein, acetaldehyde, and formaldehyde, have been shown to contribute to CVD even in low levels. All of the e-cigarettes tested in this study had some amount of these aldehydes present. More information: Mumiye A. Ogunwale et al. Aldehyde Detection in Electronic Cigarette Aerosols, ACS Omega (2017). DOI: 10.1021/acsomega.6b00489 Abstract Acetaldehyde, acrolein, and formaldehyde are the principal toxic aldehydes present in cigarette smoke and contribute to the risk of cardiovascular disease and noncancerous pulmonary disease. The rapid growth of the use of electronic cigarettes (e-cigarettes) has raised concerns over emissions of these harmful aldehydes. This work determines emissions of these aldehydes in both free and bound (aldehyde–hemiacetal) forms and other carbonyls from the use of e-cigarettes. A novel silicon microreactor with a coating phase of 4-(2-aminooxyethyl)-morpholin-4-ium chloride (AMAH) was used to trap carbonyl compounds in the aerosols of e-cigarettes via oximation reactions. AMAH–aldehyde adducts were measured using gas chromatography–mass spectrometry. 1H nuclear magnetic resonance spectroscopy was used to analyze hemiacetals in the aerosols. These aldehydes were detected in the aerosols of all e-cigarettes. Newer-generation e-cigarette devices generated more aldehydes than the first-generation e-cigarettes because of higher battery power output. Formaldehyde–hemiacetal was detected in the aerosols generated from some e-liquids using the newer e-cigarette devices at a battery power output of 11.7 W and above. The emission of these aldehydes from all e-cigarettes, especially higher levels of aldehydes from the newer-generation e-cigarette devices, indicates the risk of using e-cigarettes.
Kaberg M.,Karolinska University Hospital |
Kaberg M.,Addiction Center |
Hammarberg A.,Karolinska Institutet |
Hammarberg A.,Stockholm Health Care Services |
And 2 more authors.
Infectious Diseases | Year: 2017
Background: People who inject drugs (PWID) are the driving force of the hepatitis C virus (HCV) epidemic. Still, treatment is scarcely offered and the awareness of HCV status in PWID is poor. Prevention includes clean needles, syringes and other paraphernalia. HCV awareness was investigated in 1500 PWID in a needle exchange program (NEP) in Stockholm, Sweden, together with HCV prevalence, and time to HCV infection after start of injection drug use. Methods: 1500 PWID in the Stockholm NEP were consecutively enrolled. At baseline, awareness of the individual pre-test HCV status was measured followed with tests for anti-HCV and HCV RNA if anti-HCV was positive. Results: Mean age of participants was 39 years and the mean time of injection drug use 18 (0–51) years. The overall anti-HCV prevalence was 82% whereof 76% were HCV RNA positive. Within 4 years after start of injection drug use 50% of the participants were anti-HCV positive. Self-awareness of HCV status was low. Hence, 32% who believed that they never have encountered HCV were anti-HCV positive, and 24% were HCV RNA positive. For those who reported not being aware of their HCV status 62% were anti-HCV positive, and 47% were HCV RNA positive. Conclusion: The very high prevalence of chronic HCV in PWID in Stockholm indicates that both measures for prevention with increased awareness of HCV, and a higher antiviral treatment utilisation in combination need to be implemented in order to reduce the HCV prevalence and combat the HCV epidemic. © 2017 Society for Scandinavian Journal of Infectious Diseases
Witteman J.,Leiden University |
Post H.,Addiction Center |
Tarvainen M.,University of Eastern Finland |
De Bruijn A.,Dutch Institute for Alcohol Policy |
And 3 more authors.
Psychopharmacology | Year: 2015
The present study investigated the nature of physiological cue reactivity and craving in response to alcohol cues among alcohol-dependent patients (N∈=∈80) who were enrolled in detoxification treatment. Further, the predictive value with regard to future drinking of both the magnitude of the physiological and craving response to alcohol cues while in treatment and the degree of alcohol-cue exposure in patients' natural environment was assessed. Physiological reactivity and craving in response to experimental exposure to alcohol and soft drink advertisements were measured during detoxification treatment using heart rate variability and subjective rating of craving. Following discharge, patients monitored exposure to alcohol advertisements for five consecutive weeks with a diary and were followed up with an assessment of relapse at 5 weeks and 3 months post-discharge. The results indicated that the presence of alcohol cues such as the portrayal of the drug and drinking behaviour induced physiological cue reactivity and craving. Additionally, cue reactivity and craving were positively correlated, and cue reactivity was larger for patients with shorter histories of alcohol dependence. Further, patients reported a substantial daily exposure to alcohol cues. The magnitude of cue reactivity and the craving response to alcohol cues at baseline and degree of exposure to alcohol cues in patients' natural environment did not predict relapse. It is concluded that the presence of alcohol cues such as portrayal of alcoholic beverages and drinking behaviour induces cue reactivity and craving in alcohol dependence through a conditioned appetitive response. © 2015 The Author(s).
Skrberg K.,Örebro University |
Skrberg K.,Addiction Center |
Nyberg F.,Uppsala University |
Engstrom I.,Örebro University |
Engstrom I.,Psychiatric Research Center
European Addiction Research | Year: 2010
Aims: The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality. Methods: The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use. Results: The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS. Conclusion: The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse. Copyright © 2010 S. Karger AG.
News Article | February 15, 2017
ANN ARBOR, MI - The number of older Americans who take three or more medicines that affect their brains has more than doubled in just a decade, a new study finds. The sharpest rise occurred in seniors living in rural areas, where the rate of doctor visits by seniors taking combinations of such drugs - opioids, antidepressants, tranquilizers and antipsychotics - more than tripled. This "polypharmacy" of drugs that act on the central nervous system is concerning, the researchers say, because of the special risks to older adults that come with combining multiple such medications. Falls - and the injuries that can result from them - are the chief concern, along with problems with driving, memory and thinking. Combining opioid painkillers with certain other brain-affecting drugs such as benzodiazepine tranquilizers is of particular concern, recently receiving the strongest possible warning from the U.S. Food and Drug Administration due to an increased risk of death from combined use. Publishing in JAMA Internal Medicine, the team from the University of Michigan and VA Ann Arbor Healthcare System reports findings from their analysis of data collected from a representative sample of doctors' offices between 2004 and 2013 by the Centers for Disease Control and Prevention. While only 0.6 percent of doctor visits by people over the age of 65 involved three or more CNS-affecting drugs in 2004, the number had risen to 1.4 percent in 2013. If that percentage is applied to the entire U.S. senior population, that means 3.68 million doctor visits a year involve seniors taking three or more CNS drugs. "The rise we saw in these data may reflect the increased willingness of seniors to seek help and accept medication for mental health conditions - but it's also concerning because of the risks of combining these medications," says Donovan Maust, M.D., M.S., the study's lead author and a geriatric psychiatrist at Michigan Medicine, the U-M academic medical center. Also concerning: nearly half of seniors taking these drug combinations did not appear to have a formal diagnosis of a mental health condition, insomnia or pain condition - the three chief types of issues they're usually prescribed for. "We hope that the newer prescribing guidelines for older adults encourage providers and patients to reconsider the potential risks and benefits from these combinations," he says. In 2015, the American Geriatrics Society updated its guideline for the use of prescription drugs in older people, called the 2015 Beers Criteria. Some of the CNS medication groups have been on the Beers Criteria since it was first published in 1997, but this update is the first to raise concern about CNS polypharmacy as potentially inappropriate. Other work on CNS drugs alone or in combination Maust, who is an assistant professor of psychiatry at the U-M Medical School, also recently published two other papers on the use of CNS drugs in older people with colleagues from U-M and VAAHS. In the December issue of the Journal of the American Geriatrics Society, they reported that 5.6 percent of doctor visits by people aged 65 or older included a prescription for a benzodiazepine tranquilizer in 2010. More than a quarter of those visits also included a prescription for an antidepressant, and 10 percent included a prescription for an opioid drug. Only 16 percent of those who were continuing to receive a benzodiazepine prescription had a diagnosis of a mental health condition. Almost none were referred to psychotherapy. The data for this study came from the same source as the JAMA Internal Medicine study, the CDC's National Ambulatory Medical Care Survey, though it focused on the years 2007 through 2010. "Prescribing of benzodiazepines to older adults continues despite decades of evidence showing safety concerns, effective alternative treatments, and effective methods for tapering even chronic users," says Maust. Meanwhile, in a paper published online-first in Psychiatric Services in January, they report that more than half of 231 older patients who had been prescribed an antidepressant for depression by their primary care doctor for depression (as opposed to off-label use for sleep, for example) did not actually meet the criteria for Major Depressive Disorder. The patients were participating in a randomized controlled trial aimed at improving depression outcomes and are not considered a representative sample of older Americans, but Maust and his colleagues note that their findings could indicate an over-prescribing trend. Maust and his colleague Helen Kales, M.D. also wrote an invited commentary in JAMA Internal Medicine in January, about the use of CNS drugs to "medicate distress" in older people. In addition to Maust and Kales, the authors of the JAMA Internal Medicine research letter are Lauren B. Gerlach, D.O., Anastasia Gibson, and Frederic Blow, Ph.D. of U-M, and Mark Olfson, M.D., M.P.H. of Columbia University and the New York State Psychiatric Institute. Ilse Wiechers, M.D., M.P.P., M.H.S., of Yale University co-authored the benzodiazepine study. Maust, Kales and Blow are members of the U-M Institute for Healthcare Policy and Innovation and the VA Center for Clinical Management Research. Blow is the director of the U-M Addiction Center and Kales directs the Program for Positive Aging. The study was supported by a National Institute on Aging Beeson Career Development Award (NIA K08AG048321, AFAR, The John A. Hartford Foundation, and The Atlantic Philanthropies)