Concurrent Paper Session I

Early Changes in Irritability Predict Longer-Term Abstinence from Drug Use in Adults With Stimulant Use Disorder: Findings From the Stride Study

Summary
Adults with stimulant use disorder experience significant improvement in irritability with treatment and have a higher likelihood of staying abstinent during longer term follow-up.

Methods
Participants included adults with stimulant use disorder from nine residential addiction treatment programs who were randomized to augmentation of usual care with dosed exercise or health education intervention and had irritability measurements (5-item irritability domain of Concise Associated Symptom Tracking scale) at baseline and week-2 (n=278). Percent of days abstinent from stimulant use during acute (baseline-to-week-12) and continuation (week-12-to-week-36) phases were estimated with a novel algorithm that incorporated self-reported Timeline Follow Back stimulant use and urine drug screen data. Linear regression analyses evaluated whether baseline-to-week-2 reductions in irritability predicted percent of days abstinent from stimulant use over the subsequent 34 weeks.

Results
Irritability improved significantly from baseline-to-week-2 (mean reduction = 1.13; sd = 4.20). However, the two treatment arms did not differ in changes in irritability (F=0.04, df=2, 576, p=0.96). Greater baseline-to-week-2 reduction in irritability was associated with higher percent of days abstinent from week-2-to-week-12 (β=0.89, SE=0.43, p=0.038) and from week-12-to-week-36 (β=1.44, SE=0.59, p=0.016) even after controlling for baseline-to-week-2 changes in depression, baseline irritability and depression, age, sex, race, ethnicity, and treatment arm.

Conclusion
Adults with stimulant use disorder experience significant improvement in irritability with treatment. Early improvements in irritability are associated with higher likelihood of staying abstinent during longer-term follow-up. Therefore, systematic assessment of irritability may prognosticate clinical course in adults with stimulant use disorder.

Scientific Significance
These findings are scientifically important since systematic assessment of irritability may prognosticate clinical course in adults with stimulant use disorder and may inform novel therapeutic approaches.

Learning Objectives

Irritability is an often overlooked though qualitatively and quantitatively important risk factor to analyze in patients with stimulant use disorder.
Findings from the STRIDE study show that adults with stimulant use disorder experience significant improvement in irritability with treatment.
Findings from the STRIDE study also suggest early changes in irritability predict longer-term abstinence from drug use in adults with Stimulant Use Disorder.

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing

Keywords

Substance Use Disorder Treatment
Depression
Substance Use Disorders
Stimulant Use Disorder
Stimulants

Presenter

Kimberlyn Baig-Ward, MD, PhD

Dr. Baig-Ward is a Texas native and is originally from College Station, TX. She attended Texas A&M University and graduated with multiple honors including magna cum laude with a B.S. in Molecular and Cell Biology and a B.S. in Biomedical Science with a minor in Art and Architectural History. She went on receive a post-baccalaureate intramural research training award (IRTA) at the National Institutes of Health (NIH ) Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in Bethesda, MD. After this, she went on to an individual Graduate Partnership Program acceptance at the NIH and Virginia Commonwealth University School of Medicine where she earned both an M.D. and a Ph.D. in Biochemistry. Dr. Baig-Ward also conducted post-doctoral research at Johns Hopkins University School of Medicine. Dr. Baig-Ward is currently a psychiatry resident at UT Southwestern Medical Center in Dallas, TX.

Co-Authors: Manish Jha, Kimberlyn Baig-Ward, Steven Shoptaw, Abu Minhajuddin, Sidarth Wakhlu, Madhukar Trivedi

Carfentanil, a Highly Potent Opioid Responding to High Doses of Naloxone, What Can Help?

Summary
Carfenatil use is emerging as a new era of heroin use in the USA. Cenfeatil use is of most concern among opioid use disorder patients due to being 10,000 times more potent than morphine and 100 times more potent than Fentanyl [1]. Carfenatil looks like table salt and due to its high affinity for mu receptors, small doses can cause toxicity even in accidental exposures in first responders, doctors and border control agents [1,2].

Methods
Literature search was conducted using relevant MeSH terms in PubMed, PubMed Central, Medline, and Cochran databases. We identified all published relevant articles from inception until June 12th, 2022 and found 18 articles. Out of these 18 articles, 11 were relevant to the topic.

Results
Carfentanil poisoning has been associated with potential lethality and this came to the attention of the world in late october 2002 when it was used in Moscow during the rescue operation in a terrorist attack. With Naloxone not available for hours, 15 percent of the hostages died[5]. Bardsley et al, presented two cases of carfentanil in 2019 where one patient received 12 mg of naloxone and the other received 10 mg of naloxone to be successfully resuscitated [6]. There are risks with high doses of naloxone but it outweighs its benefit in reversing the respiratory depression without the need of intubation, a procedure with well documented risks [6].Thus emergency personnels should be educated on the carfentanil toxicity and use of high dose of naloxone when needed [6]. Another pilot study on two patients coming to the emergency department also showed similar results. [7]

Conclusion
A public health investigation in West Virginia in 2016 of a case of opioid outbreak showed that 16 out of 20 cases were treated with repeated naloxone doses successfully showing the highly potent opioid and fentanyl analog [8]. There should be increased awareness of the highly potent opioids poisoning and its reversal using high naloxone doses. Naloxone kits should be made easily accessible considering the high use in treatment of Carfentanil toxicity [7]. NARCAN Nasal Spray is used for immediate administration as emergency therapy where opioid poisoning is suspected [9]. One regular nasal spray kit contains 4 mg of naloxone hydrochloride in 0.1 mL[9]. We recommend researching safety of high dose narcan kits with 8-12 mg of narcan reserved for these cases or making multiple kits of narcan available to first responders to ensure the reversal of carfentanil toxicity.

Scientific Significance
Carfentanil is among the most potent opioids and can cause toxicity at a low dose. This puts the doctors, first responders and others at risk of poisoning [10]. The carfentanil poisoning is reversed using high doses of naloxone which are not associated with the low blood concentration of carfentanil [7].

Learning Objectives

There should be increased awareness of the highly potent opioids poisoning and its reversal using high naloxone doses.
NARCAN Nasal Spray is used for immediate administration as emergency therapy where opioid poisoning is suspected [9]. One regular nasal spray kit contains 4 mg of naloxone hydrochloride in 0.1 mL[9].
We recommend researching safety of high dose narcan kits with 8-12 mg of narcan reserved for these cases or making multiple kits of narcan available to first responders to ensure the reversal of carfentanil toxicity.

State Requirement Topic Category

Addiction- Substance Use Disorders: Identifying, Diagnosing, Treating, and/or Managing
Opioids and other Controlled Substances: Use and Abuse, Prescribing, Dispensing, and/or Administering

Keywords

Merdication for Addiction Treatment
Opioid Use Disorder
Naloxone

Presenter
Sahar Ashraf, MD

I am Sahar Ashraf. I am lead clinical research manager/rater at Northpointe psychiatry and North texas psychiatric associates. I am also working as research scholar at International psychiatry scholars collaboartion with Dr. Shailesh Jain, Texas Tech, Midland, Texas. I worked on this abstract with Dr. Nauman Ashraf who has been working at Ozark Center since 2013 treating patients with mental illness and co-morbid substance use disorder. I am very excited to have him as mentor for this paper.

Co-Authors: Sahar Ashraf, Nauman Ashraf

Summary


Availability:	On-Demand


Cost:	FREE


Credit Offered:	0.75 CME Credit 0.75 Other Professionals Credit

Create Account

	The content on this site is intended solely to inform and educate medical professionals. This site shall not be used for medical advice and is not a substitute for the advice or treatment of a qualified medical professional.		400 Massasoit Avenue Suite 307 East Providence, RI 02914 cmecpd@aaap.org	About Advocacy Membership Fellowship Education and Resources Training Events