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News Article | May 17, 2017
Site: www.eurekalert.org

New study shows that bystander CPR is associated with favorable neurological survival for drowning victims in cardiac arrest LOS ANGELES - Imagine yourself relaxing at the beach when the worst happens -- someone notices a boy in trouble in the water. In the mad rush to get him to shore, you have two choices: wait for emergency responders to arrive or start administering CPR yourself. Your decision could be the difference between a good neurological recovery or a coma, brain death or even death for a drowning victim in cardiac arrest, according to a new study led by Joshua Tobin, MD, associate professor of clinical anesthesiology at the Keck School of Medicine of the University of Southern California (USC), published in the June 2017 issue of Resuscitation. "What we found is that when bystanders begin CPR before emergency personnel arrive, the person has a higher chance of leaving the hospital and leading a life reasonably close to the one they had before the drowning," Tobin says. Drowning is a significant public health issue that claims the lives of about 10 people every day in the United States, according to the Centers for Disease Control and Prevention. The World Health Organization says that drowning is the third-leading cause of accidental injury death worldwide. Tobin, who is a member of the American Red Cross Scientific Advisory Council, collaborated with other members for the study. Using a database, the team identified more than 900 children and adults who had experienced cardiac arrest after drowning. The researchers then set out to determine what factors influenced positive and negative outcomes for these patients. "When we talk about cardiac arrest, there's no doubt that we want people to survive. But surviving and being in a persistent vegetative state would not be considered a success by most people. That's why we chose to stratify the results by favorable or unfavorable neurological outcomes," Tobin says. A favorable neurological outcome was defined as good cerebral performance or moderate cerebral disability at hospital discharge, and an unfavorable neurological outcome was defined as coma or vegetative state, brain death or death. The results showed that bystander CPR had a clear effect: Drowning victims in cardiac arrest were three times more likely to have a favorable neurological outcome if bystanders initiated CPR. The study also found that application of an automated external defibrillator (AED) prior to the arrival of emergency services was associated with a worse neurological outcome. Tobin cautions, however, that this finding needs further investigation. "It's difficult to say why AED application prior to EMS arrival portended a worse neurological outcome in this study. Perhaps AED application distracted bystanders from giving good, uninterrupted CPR," Tobin says. "What we do know, though, is that this study adds to a growing body of evidence that bystander CPR improves outcomes in cardiac arrest. It also provides a compelling reason for people to learn this life-saving technique." CPR classes are offered through the American Red Cross, American Heart Association or local fire departments, hospitals and schools, he says. But what if the worst happens and you haven't been trained in CPR? Don't assume you can't help, Tobin says. If you call 911, a dispatcher can teach you CPR during an emergency. "Call 911, do chest compressions at 100 beats per minute and you could save someone's life," Tobin says. Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has approximately 1,650 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2017, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu.


News Article | May 17, 2017
Site: www.prnewswire.com

"What we found is that when bystanders begin CPR before emergency personnel arrive, the person has a higher chance of leaving the hospital and leading a life reasonably close to the one they had before the drowning," Tobin says. Drowning is a significant public health issue that claims the lives of about 10 people every day in the United States, according to the Centers for Disease Control and Prevention. The World Health Organization says that drowning is the third-leading cause of accidental injury death worldwide. Tobin, who is a member of the American Red Cross Scientific Advisory Council, collaborated with other members for the study. Using a database, the team identified more than 900 children and adults who had experienced cardiac arrest after drowning. The researchers then set out to determine what factors influenced positive and negative outcomes for these patients. "When we talk about cardiac arrest, there's no doubt that we want people to survive. But surviving and being in a persistent vegetative state would not be considered a success by most people. That's why we chose to stratify the results by favorable or unfavorable neurological outcomes," Tobin says. A favorable neurological outcome was defined as good cerebral performance or moderate cerebral disability at hospital discharge, and an unfavorable neurological outcome was defined as coma or vegetative state, brain death or death. The results showed that bystander CPR had a clear effect: Drowning victims in cardiac arrest were three times more likely to have a favorable neurological outcome if bystanders initiated CPR. The study also found that application of an automated external defibrillator (AED) prior to the arrival of emergency services was associated with a worse neurological outcome. Tobin cautions, however, that this finding needs further investigation. "It's difficult to say why AED application prior to EMS arrival portended a worse neurological outcome in this study. Perhaps AED application distracted bystanders from giving good, uninterrupted CPR," Tobin says. "What we do know, though, is that this study adds to a growing body of evidence that bystander CPR improves outcomes in cardiac arrest. It also provides a compelling reason for people to learn this life-saving technique." CPR classes are offered through the American Red Cross, American Heart Association or local fire departments, hospitals and schools, he says. But what if the worst happens and you haven't been trained in CPR? Don't assume you can't help, Tobin says. If you call 911, a dispatcher can teach you CPR during an emergency. "Call 911, do chest compressions at 100 beats per minute and you could save someone's life," Tobin says. ABOUT THE KECK SCHOOL OF MEDICINE OF USC Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has approximately 1,650 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2017, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/three-little-letters-that-could-make-you-a-big-hero-at-the-beach-this-summer-cpr-300458815.html SOURCE Keck School of Medicine of the University of Southern California


News Article | May 16, 2017
Site: www.prnewswire.com

"We have so much to discover about MS, and our traditional methods of studying it are not going fast enough," Pelletier says. "Each incremental finding is like one drop of water in the ocean. If we want to reach the point of individualized therapy for MS, we need a massive amount of data, which is what inspired me to think of a solution that was completely out of the box." myMS app users will be able to monitor how they are doing through validated walking, cognitive and visual tasks, as well as quality of life questionnaires. An interactive dashboard will allow them to view and graph their results over time and compare them to other people. The app will also allow users to upload their brain MRIs and see them in high resolution within the app as well as access genetic information obtained through personal genetics company 23andMe. Pelletier hopes the myMS app will give people with MS a chance to take control of their disease. "Not only will people be able to see how they're doing in real time, but they will also be able to open new lines of communication with their doctors," Pelletier says. "When they see their doctor, they'll be able to open the app and show them how they're doing in their everyday life and not just in the clinic." The pilot study's goals are to discover how willing people are to participate, how often they perform app-related tasks and how likely they are to share their MRI and genetic information. Pelletier is recruiting 200 people nationwide for the study. Participants must have a diagnosis of MS, be 18 years of age or older, have a brain MRI, live in the United States and have a smartphone. No clinical visits will be involved. Participants will be asked to complete six-minute walking tests, cognitive function tests, visual acuity tests and quality of life questions as well as baseline and follow-up surveys through the myMS app. From their home computers, participants will be able to transfer all their MRI scans to the app via a dedicated website. After three months, participants will be offered a free, optional 23andMe genetics kit with reports that meet U.S. Food and Drug Administration standards. Those who choose to use the kit will receive genetic reports containing information related to ancestry, personal traits and a variety of inherited conditions — all of which will appear within the myMS app. "This study is just the beginning for myMS. Our ultimate goal is for the app to go viral so we can collect data from people around the world. It could be a powerful tool to get us closer to personalized medicine and breakthrough discoveries," Pelletier says. More than 2.3 million people have MS worldwide, according to the National Multiple Sclerosis Society. For information about how to participate in the study, click here. ABOUT THE KECK SCHOOL OF MEDICINE OF USC Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has approximately 1,650 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2017, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/unlocking-the-mystery-of-multiple-sclerosis-with-tech-300457710.html SOURCE Keck School of Medicine of the University of Southern California


News Article | May 17, 2017
Site: www.eurekalert.org

WASHINGTON (May 17, 2017) -- A team of investigators led by researchers at Georgetown Lombardi Comprehensive Cancer Center has found that the tumor mutation load, or TML, in a patient's cancer biopsy varied by age and the type of cancer, along with several other factors. Researchers say the findings are some of the most comprehensive analyses of TML to date as they include 14 types of solid tumors. Over 8,000 tissue samples were included in the study making this one of the larger collections of tumors examined for TML. The abstract describing the work was released today. Additional details will be presented at the American Society of Clinical Oncology annual meeting next month in Chicago. TML is a measurement of the number of mutations in DNA. Mutated DNA can be subsequently translated to harmful changes in proteins. Mutated proteins often appear foreign to the immune system and can therefore activate a robust immune response that can be boosted by immunotherapeutic agents. "One of our more interesting findings was the fact that mutation load increased with age in many cancers," says the study's principal investigator, Mohamed E. Salem, M.D., assistant professor of medicine at Georgetown Lombardi. "Older age correlated closely with TML in most of the cancers we examined, but in some cancers, such as bladder cancer, there was no correlation by age, which also makes for an important observation in a difficult to treat type of cancer." Looking for high levels of mutations in tumor may seem to be a contrary way of looking for what therapies might be most effective to fight cancer. Because immunotherapies work by taking the brakes off the immune system, and hence allowing immune-fighting cells to go after cancer cells, the more mutations a cancer cell has may make it appear more alien to the immune-fighting cells and therefore, a more focused object of attack. If a cell's TML is high, an immunotherapy could be more effective and hence Salem's interest in quantifying TML. Tumor mutation load also could be used as a marker to determine which types of cancer and which patients, or subsets of patients, could most benefit from immunotherapy. "We found that, as expected, melanoma had the highest TML as we know clinically that this type of cancer responds best to immunotherapy," says Salem, also a member of Georgetown Lombardi's Ruesch Center for the Cure of GI Cancer. "Indeed, the mean TML for melanoma was nearly double that of the next highest mean, non-small cell lung cancer. In addition, we see that high TML often occurs in tumors lacking well-known cancer-related genes, like BRAF or NRAS genes in melanoma and EGFR or ALK genes in non-small cell lung cancer. This suggests that immune checkpoint inhibitors may be particularly effective in patients who are not candidates for common targeted therapies in these types of cancer." "Our next step is to validate and correlate TML levels with outcomes in patients who have received immunotherapy. We'll look to see if patients had high TML levels before they started therapy and then determine if those with the highest levels had the best clinical outcome, which is what we might expect," he says. "If validation studies prove helpful, they could be very useful in designing clinical trials for many types of cancer," Salem concludes. Co-authors include John Marshall, Michael Atkins, Jimmy J. Hwang, Geoffrey Thomas Gibney, Georgetown Lombardi; Joanne Xiu, Zoran Gatalica, and Nianqing Xiao, Caris Life Sciences; Heinz-Josef Lenz, USC Norris Comprehensive Cancer Center; Philip Agop Philip, Karmanos Cancer Center: Antoinette R. Tan and Derek Raghavan, Levine Cancer Institute; Wafik S. El-Deiry, Fox Chase Cancer Center; and Edward S. Kim and Anthony Frank Shields, Wayne State University. The work was supported by the Ruesch Center for the Cure of GI Cancers. CARIS provided analysis of the tumor samples. Salem and the other co-authors report having no personal financial interests related to the study. Georgetown Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute as a comprehensive cancer center -- the only cancer center of its kind in the Washington, DC area. A part of Georgetown University Medical Center and MedStar Georgetown University Hospital, Georgetown Lombardi seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Connect with Georgetown Lombardi on Facebook (Facebook.com/GeorgetownLombardi) and Twitter (@LombardiCancer). Georgetown University Medical Center (GUMC is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC onFacebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter) and Instagram (@gumedcenter).


LOS ANGELES - New research from the Keck School of Medicine of the University of Southern California (USC) shows new promise in the fight against one of the most lethal forms of cancer. Studies in mice with a mutation present in 90 percent of pancreatic cancer patients (the KRAS mutation) indicate that expressing only half the amount of the glucose-regulated protein GRP78 is enough to halt the earliest stage of pancreatic cancer development. The study, funded in part by the National Institutes of Health, suggests that because the protein is required for "switching" healthy pancreatic cells that produce enzymes to digest food into potentially cancerous cells, reducing the amount of this protein delays pancreatic cancer development and prolongs survival. The study, published online on May 16 in the Proceedings of the National Academy of Sciences, is the first to establish the pivotal role of the protein in pancreatic cancer. "Cancer cells are addicted to high levels of GRP78 for cancer development and growth. Our hope is that partially reducing or inactivating the protein by therapeutic agents could one day be an effective complementary therapy for pancreatic cancer and other cancers, while sparing other healthy organs," said Amy Lee, PhD, professor of biochemistry and molecular medicine at the Keck School and the Judy and Larry Freeman Chair in Basic Science Research at the USC Norris Comprehensive Cancer Center. Lee, who was the first scientist to clone human GRP78, has since dedicated much of her research to investigating the protein's role in cancer progression and treatment. For her scientific contributions, Lee was honored by a MERIT award from the National Cancer Institute and elected as Fellow of the American Association for the Advancement of Science. "As developing drugs directly targeting the KRAS genetic mutation has been challenging, we are thrilled these findings indicate that we can attack KRAS-driven pancreatic cancer through an entirely new method," Lee said. GRP78 is a stress-inducible protein that folds newly synthesized proteins and performs quality control in the endoplasmic reticulum (an essential component of human cells). During stress, a fraction of GRP78 is shipped out to the cell surface to perform additional growth and survival functions. Cancer cells, particularly those that survive treatment, typically undergo more stress than healthy cells, resulting in increased levels of GRP78 to help the cancer cells survive, grow and develop therapeutic resistance. A number of studies across cancer types have shown a relationship between highly elevated levels of the protein and increased risk for cancer recurrence or decreased survival. With GRP78 emerging as an attractive anti-cancer target, there is active development of potential treatments that can inhibit GRP78 activity or expression, including some that are in early-phase clinical trials with promising results. Certain food and herbs, including green tea and soy, contain natural compounds that can suppress the protein, Lee said. Patients and physicians alike are eager for more effective treatments for pancreatic cancer, as it is among the deadliest forms of cancer. According to the American Cancer Society, more than 53,600 people will be diagnosed with pancreatic cancer this year, and more than 43,000 people will die from the disease. The five-year survival rate for early stage pancreatic cancer is only 12 percent, compared to 100 percent for breast cancer and prostate cancer and 92 percent for colon cancer. "Translating any basic science discovery into clinical practice is a long process that requires substantial resources," Lee said. "But given the notorious difficulties of treating KRAS-mutation related cancers, particularly in a disease as devastating as pancreatic cancer, this research provides hope and a novel approach. I am excited to put our theories to test in the clinical setting." Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has more than 1,500 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2017, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu. This press release references support by the National Institutes of Health under award numbers R21 CA179273 ($393,911 over two years), R01 CA027607 ($1,748,391 over five years) and R01 CA133117 ($1,968,744 over five years). Research was conducted at facilities supported by awards P30 CA014089 ($30,711,039 over five years) and P30 DK048522 ($5,934,825 over five years). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The research above was also supported by the Julia Stearns Dockweiler Foundation in the amount of $85,000.


LOS ANGELES - Jay R. Lieberman, MD, chair and professor of orthopedic surgery at the Keck School of Medicine of the University of Southern California has received a five-year, $2.2 million grant from the National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases to research gene therapy to enhance repair of extensive bone injuries. Examples of these types of injuries include fractures with extensive bone loss, non-healing fractures, failed spinal fusion and revision of total joint replacement. Lieberman will genetically manipulate human bone marrow cells to overproduce bone morphogenetic protein (BMP), a protein that spurs progenitor cells to produce bone. "There are a number of bone injuries that are very difficult to repair and lack satisfactory solutions," Lieberman says. "My goal with this grant is to determine whether genetically modifying human bone marrow cells to overproduce BMP will help heal large bone defects in an animal model and, ultimately, provide a better alternative for repairs in humans." Lieberman's study will determine the efficacy and safety of the gene therapy as well as establish a cellular dose of the genetically manipulated cells that can be scaled up for potential use in humans. An abstract of the grant, 2R01AR057076-06A1, is available on the NIH RePORTER website. Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has approximately 1,650 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2017, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu. This press release references support by the National Institutes of Health under award number 2R01AR057076-06A1 ($2,284,028 over five years). One hundred percent of the project's funding will be federally funded.


News Article | May 8, 2017
Site: www.eurekalert.org

Drug users born in the 1980s and 1990s are turning to injection drug more quickly than previous generations, a USC-led study suggests The prescription opioid epidemic is shrinking the time it used to take drug users to progress to drug injection, a new Keck School of Medicine of USC-led study suggests. The study may predict the next national public health threat related to prescription painkiller abuse, said Ricky Bluthenthal, lead author of the study and a professor of preventive medicine at the Keck School of Medicine. "The prescription opioid epidemic is creating a heroin epidemic, which will create an injection drug use epidemic," Bluthenthal said. "We've seen the first two. Now we're waiting to see the last emerge on the national level. I predict we'll see an uptick in injection-related diseases over the next couple of years." The study, published in April in the journal Drug and Alcohol Dependence, is based on 776 drug users in Los Angeles and San Francisco. Participants born in the 1980s or 1990s, on average, took six years to escalate from first illicit drug use to first drug injection. The average for participants born in the 1970s was nine years. "The more rapid transition to injection is an impact of the prescription opioid-to-heroin use phenomenon," Bluthenthal said. "Heroin is most efficiently used via injection as compared to other formerly popular drugs such as crack cocaine or even cocaine." Injection-related diseases can include HIV, which affects more than 1.2 million Americans, and hepatitis C, which affected an estimated 3.9 million Americans in 2014, according to the Centers for Disease Control and Prevention. People who inject drugs also are at elevated risk for sexually transmitted infections, abscesses and soft-tissue infections, mental health disorders, drug overdose and dying young, the study stated. Researchers found that the first drug injected changed in tandem with national drug use trends. In general, however, heroin and prescription opiate pills were the most common first drug injected. Drug users born in the 1980s and 1990s moved quicker from initial illicit drug use to syringe use than those born in the '70s. In California, 2,014 deaths were attributed to opioid-related poisoning or overdose, according to the state's Department of Public Health. Nationwide, the rate of overdose deaths involving opioids -- more than 165,000 deaths -- has nearly quadrupled since 1999, according to the U.S. Department of Health and Human Services. On an average day in America, some 3,900 people begin nonmedical use of prescription opioids, creating more than $55 billion in health and social costs each year. Prescription opioids are the current drug of choice and has been for nearly two decades, Bluthenthal said. Heroin was popular in the 1970s, crack cocaine in the 1980s and marijuana in the 1990s. For the past 20 years, people who inject drugs were considered an aging population. Long-acting opioid-based medications became available in the 1990s, Bluthenthal said. Once use of prescription opioid pain relievers and heroin skyrocketed, however, the downward trend changed, he noted. In the study, researchers divided the 776 individuals into birth cohorts: those born before the 1960s, in the 1960s, 1970s and 1980s or later. All participants had injected in the last month. About 33 percent were white, 30 percent were African-American and 25 percent were Latino. The adult participants completed a survey that asked if they had ever used a list of drugs, including crack cocaine, methamphetamine, speed, heroin, tranquilizers, nonmedical use of prescription opioids and buprenorphine. They reported when they first used that drug, the first time they injected and what drug they injected. More than half had injected heroin, powder cocaine and methamphetamine. More than 30 percent reported they had injected crack cocaine and opioid painkillers. Longer time until first injection was associated with drug treatment prior to first injection. This fact suggests that drug interventions may help keep drug users away from the needle. "We need to get ahead of a possible drug injection epidemic," Bluthenthal said. "What works for Latinos in East Los Angeles might not work for people in West Virginia. We need to come up with prevention activities responsive to specific cultures, generations and locales to combat the move to drug injection." USC researchers from multiple disciplines, including the USC Schaeffer Center for Health Policy and Economics, are trying to solve the intractable problem of unnecessary drug prescriptions. Previous USC-led research found that a "nudge" reduces doctors' unnecessary antibiotic prescriptions. Researchers ranked and shared a list of physicians most likely to give an unnecessary prescription and used pop-up boxes that required physicians to justify their pharmacy order. Interventions such as these potentially can prevent unnecessary opioid prescriptions and the negative effects that result from painkiller addiction. Bluthenthal is collecting more data from younger people using opioids to better understand the drug behaviors associated with younger generations. The research was supported by the National Institute on Drug Abuse and the National Cancer Institute via nearly $1.7 million in awards. Founded in 1885, the Keck School of Medicine of USC is among the nation's leaders in innovative patient care, scientific discovery, education, and community service. It is part of Keck Medicine of USC, the University of Southern California's medical enterprise, one of only two university-owned academic medical centers in the Los Angeles area. This includes the Keck Medical Center of USC, composed of the Keck Hospital of USC and the USC Norris Cancer Hospital. The two world-class, USC-owned hospitals are staffed by more than 500 physicians who are faculty at the Keck School. The school today has approximately 1,650 full-time faculty members and voluntary faculty of more than 2,400 physicians. These faculty direct the education of approximately 700 medical students and 1,000 students pursuing graduate and post-graduate degrees. The school trains more than 900 resident physicians in more than 50 specialty or subspecialty programs and is the largest educator of physicians practicing in Southern California. Together, the school's faculty and residents serve more than 1.5 million patients each year at Keck Hospital of USC and USC Norris Cancer Hospital, as well as USC-affiliated hospitals Children's Hospital Los Angeles and Los Angeles County + USC Medical Center. Keck School faculty also conduct research and teach at several research centers and institutes, including the USC Norris Comprehensive Cancer Center, the Zilkha Neurogenetic Institute, the Eli and Edythe Broad Center for Stem Cell Research and Regenerative Medicine at USC, the USC Cardiovascular Thoracic Institute, the USC Roski Eye Institute and the USC Institute of Urology. In 2016, U.S. News & World Report ranked Keck School of Medicine among the Top 40 medical schools in the country. For more information, go to keck.usc.edu.

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