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Prescription Drugs (prescription + drug)
Terms modified by Prescription Drugs Selected AbstractsUSE OF PRESCRIPTION DRUGS AMONG FINNISH CENTENARIANSJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2008Maarit J. Korhonen PhD No abstract is available for this article. [source] Understanding the Impacts of the Medicare Modernization Act: Concerns of Congressional StaffTHE JOURNAL OF RURAL HEALTH, Issue 3 2005Keith J. Mueller PhD ABSTRACT: Sweeping changes to the Medicare program embodied in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), including a new prescription drug benefit, changes in payment policies, and reform of the Medicare managed-care program, have major implications for rural health care. The most efficient mechanism for research to affect policy is to provide policy makers with information on issues about which they have voiced concern. The Rural Policy Research Institute's Health Panel conducted 2 focus groups with 16 congressional staff in September 2004 to identify a set of researchable questions concerning the impact of the MMA on rural health care. This paper presents research questions in the following areas that staff identified as having the highest priority: access to health plans and pharmacy services, beneficiary outreach and enrollment, technology capacity, provider payment policy, and demonstration projects. [source] Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription DrugsHEALTH SERVICES RESEARCH, Issue 5p1 2008Julie M. Donohue Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), ,-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15,65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. [source] What Explains the Use of Direct-to-Consumer Advertising of Prescription Drugs?THE JOURNAL OF INDUSTRIAL ECONOMICS, Issue 3 2004Toshiaki Iizuka Following the clarification of advertising regulation in 1997, direct-to-consumer advertising (DTCA) of prescription drugs has skyrocketed in the U.S., creating a controversy over the role of DTCA. Little is known, however, regarding what affects firms' advertising decisions and which drugs have been advertised to consumers. Using brand-level advertising data, I examine the determinants of DTCA of prescription drugs. I find that drugs that are new, of high quality, and for under-treated diseases are more frequently advertised. Furthermore, advertising outlays decrease with competition. These results complement the demand-side evidence that DTCA has a market-expanding effect but little business-stealing effect. [source] Insurance Coverage of Prescription Drugs and the Rural ElderlyTHE JOURNAL OF RURAL HEALTH, Issue 1 2004Curt Mueller PhD ABSTRACT: Context: Rural impacts of a Medicare drug benefit will ultimately depend on the number of elderly who are currently without drug coverage, new demand by those currently without coverage, the nature of the new benefit relative to current benefits, and benefit design. Purpose: To enhance understanding of drug coverage among rural elderly Medicare beneficiaries and their expenditures for pharmaceuticals. Methods: Estimates of the extent of coverage, expenditures, and sources of drugs were obtained using data are from the 1997 Medicare Current Beneficiary Survey and the Pharmacy Verification and Household Components of the 1996 Medical Expenditure Panel Survey. Findings: Three-quarters of the urban elderly had some type of drug coverage in 1997 versus 59% of the elderly in rural areas. Urban residents were more likely to have obtained their drug coverage from an employersponsored supplemental plan, and rural residents were more likely to have self-purchased Medigap drug coverage. Expenditures and use of drugs by Medicare beneficiaries are greater for those with than without coverage, and differences are invariant with respect to geographic location. Coverage under self-purchased supplemental plans appears less generous than under employer-sponsored plans in both rural and urban areas. Rural and urban elderly are more than twice as likely to receive at least 1 prescribed medication through the mail than the general population. Conclusion: A well-designed Medicare drug benefit would be especially beneficial to the rural elderly because relatively more rural elderly currently lack coverage or have less generous coverage than urban beneficiaries. Mail-order distribution may help contain future program expenditures. [source] Prescription drug misuse: Is technology friend or foe?DRUG AND ALCOHOL REVIEW, Issue 1 2009SUZANNE NIELSEN Abstract Introduction and Aims. Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse. Design and Methods. Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring. Results. Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and ,rogue' no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of ,off-label' prescription drug use. Discussion and Conclusions. Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.[Nielsen S, Barratt MJ. Prescription drug misuse: Is technology friend or foe? Drug Alcohol Rev 2009;28:81,86] [source] Prescription drug samples , does this marketing strategy counteract policies for quality use of medicines?JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2003K. E. M. Groves BSc MSc PhD (Cand) Summary Prescription drug samples, as used by the pharmaceutical industry to market their products, are of current interest because of their influence on prescribing, and their potential impact on consumer safety. Very little research has been conducted into the use and misuse of prescription drug samples, and the influence of samples on health policies designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate, with increasing costs and increasing concerns about optimizing use of medicines. This manuscript critically evaluates the research that has been conducted to date about prescription drug samples, discusses the issues raised in the context of traditional marketing theory, and suggests possible alternatives for the future. [source] Prescription drug misuse: Is technology friend or foe?DRUG AND ALCOHOL REVIEW, Issue 1 2009SUZANNE NIELSEN Abstract Introduction and Aims. Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse. Design and Methods. Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring. Results. Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and ,rogue' no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of ,off-label' prescription drug use. Discussion and Conclusions. Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.[Nielsen S, Barratt MJ. Prescription drug misuse: Is technology friend or foe? Drug Alcohol Rev 2009;28:81,86] [source] Prescription Drug Costs for Dually Eligible People in a Medicaid Home- and Community-Based Services ProgramJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2002Victoria L. Phillips Dphil This study examined the prescription drug costs of Medicare beneficiaries participating in a Medicaid home- and community-based services (HCBS) program and discussed possible implications of providing a prescription drug benefit under Medicare. The study examined Medicaid pharmaceutical claims data using two random samples (n = 766) of dually eligible Medicare beneficiaries in a HCBS program from four regions in Georgia. The average total monthly Medicaid prescription drug expenditure was determined. Annual prescription expenditures for this group averaged more than $1,500 per person. Prescription drugs intended for the treatment of cancer and circulatory disorders combined to account for 61% of total program drug expenditures. Multivariate analysis found that drug expenditures were higher for those who died during the observation period, the young-old, Caucasians, and those who self-selected into the program. Higher drug expenditures for the self-selected group, even after frailty adjustments, suggest the presence of adverse selection. Medicare prescription drug benefit proposals that rely on voluntary enrollment may also experience adverse selection from frail, low-income beneficiaries. [source] Unintentional methadone-related overdose death in New Mexico (USA) and implications for surveillance, 1998,2002ADDICTION, Issue 2 2005Nina Shah ABSTRACT Aims To determine death rates from methadone over time, to characterize methadone-related death and to discuss public health surveillance of methadone-related death. Design We analyzed medical examiner data for all unintentional drug overdose deaths in New Mexico, USA, between 1998 and 2002. Measurements Age-adjusted death rates for methadone-related death, logistic regression models for likelihood of methadone-related death among all unintentional drug overdose deaths and bivariate comparisons within methadone-related death. Findings Of 1120 drug overdose deaths during this period, there were 143 (12.8%) methadone-related deaths; the death rate decreased over the time period, averaging 1.6 per 100 000. Of 143 methadone-related deaths, 22.4% were due to methadone alone, 23.8% were due to methadone/prescription drugs (no illicit drugs), 50.3% were due to methadone/illicit drugs and 3.5% were due to methadone/alcohol. These groups were significantly different in demographics, health history and circumstances of death. Of 79 decedents (55.2%) with a known source of methadone, 68 obtained methadone through a physician prescription (31 for methadone maintenance treatment (MMT), 27 for managing pain and 10 had unknown reason for prescription). Conclusions Methadone-related death rates and the proportion of methadone-related death among all drug overdose deaths decreased in New Mexico from 1998 to 2002. It is important for surveillance of methadone-related death to assess multiple drug causes, not just underlying cause. Also, methadone for pain management must be examined alongside MMT and when possible, methadone co-intoxication should be described in the context of other drugs causing death. [source] Prescription drug misuse: Is technology friend or foe?DRUG AND ALCOHOL REVIEW, Issue 1 2009SUZANNE NIELSEN Abstract Introduction and Aims. Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse. Design and Methods. Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring. Results. Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and ,rogue' no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of ,off-label' prescription drug use. Discussion and Conclusions. Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.[Nielsen S, Barratt MJ. Prescription drug misuse: Is technology friend or foe? Drug Alcohol Rev 2009;28:81,86] [source] The abuse potential of the synthetic cannabinoid nabiloneADDICTION, Issue 3 2010Mark A. Ware ABSTRACT Aim Nabilone is a synthetic cannabinoid prescription drug approved in Canada since 1981 to treat chemotherapy-induced nausea and vomiting. In recent years, off-label use of nabilone for chronic pain management has increased, and physicians have begun to express concerns about nabilone becoming a drug of abuse. This study evaluates the evidence for abuse of nabilone, which is currently ill-defined. Study design Scientific literature, popular press and internet databases were searched extensively for evidence of nabilone abuse. Focused interviews with medical professionals and law enforcement agencies across Canada were also conducted. Findings The scientific literature and popular press reviews found very little reference to nabilone abuse. Nabilone is perceived to produce more undesirable side effects, to have a longer onset of action and to be more expensive than smoked cannabis. The internet review revealed rare and isolated instances of recreational use of nabilone. The database review yielded little evidence of nabilone abuse, although nabilone seizures and thefts have occurred in Canada in the past few years, especially in Ontario. Most law enforcement officers reported no instances of nabilone abuse or diversion, and the drug has no known street value. Medical professionals reported that nabilone is not perceived to be a matter of concern with respect to its abuse potential. Conclusions Reports of nabilone abuse are extremely rare. However, follow-up of patients using nabilone for therapeutic purposes is prudent and should include assessment of tolerance and dependence. Prospective studies are also needed to definitively address the issue of nabilone abuse. [source] Prescription drug samples , does this marketing strategy counteract policies for quality use of medicines?JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 4 2003K. E. M. Groves BSc MSc PhD (Cand) Summary Prescription drug samples, as used by the pharmaceutical industry to market their products, are of current interest because of their influence on prescribing, and their potential impact on consumer safety. Very little research has been conducted into the use and misuse of prescription drug samples, and the influence of samples on health policies designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate, with increasing costs and increasing concerns about optimizing use of medicines. This manuscript critically evaluates the research that has been conducted to date about prescription drug samples, discusses the issues raised in the context of traditional marketing theory, and suggests possible alternatives for the future. [source] Synthesis of [11C]celecoxib: a potential PET probe for imaging COX-2 expressionJOURNAL OF LABELLED COMPOUNDS AND RADIOPHARMACEUTICALS, Issue 12 2005Jaya Prabhakaran Abstract [11C]Labeling of celecoxib, a COX-2 selective inhibitor and prescription drug for arthritis and pain has been achieved. The precursor molecule for the radiolabeling was synthesized from 4-bromoacetophenone in 4 steps with 23% overall yield. Stille reaction of N-[bis -(4-methoxyphenyl)phenylmethyl]-4-[5-(4-tributylstannylphenyl)-3-trifluoromethylpyrazol-1-yl]benzenesulfonamide (5) with methyl iodide in presence of catalytic amounts of Pd2(dba)3, tri- o -tolylphosphine, CuCl and excess of K2CO3 in DMF followed by deprotection of the sulfonamide with 20% trifluoroaceticacid yielded 4-(5- p -tolyl-3-trifluoromethylpyrazol-1-yl)benzenesulfonamide or celecoxib (6) in 30% yield. However, under identical conditions, synthesis of [11C]celecoxib ([11C]6) was unsuccessful. Instead, trapping [11C]CH3I in an argon purged solution of catalytic amounts of Pd2(dba)3 and tri- o -tolylphosphine followed by the addition of the precursor 5 in DMF under argon and heating the mixture at 135°C for 4 min resulted in the incorporation of [11C]CH3 group. Removal of the dimethoxytrityl (DMT) with 20% trifluoroacetic acid afforded [11C]celecoxib in 40 min (EOB) and 8±2% yield (EOB) along with a specific activity of 1080±180 Ci/mmol (n=6) (EOB). Copyright © 2005 John Wiley & Sons, Ltd. [source] Prevalence and Patterns of Alcohol Consumption and Health-Risk Behaviors Among High School Students in ThailandALCOHOLISM, Issue 12 2009Sawitri Assanangkornchai Background:, Underage drinking is a significant social and public health problem in Thailand. We report the prevalence and patterns of alcohol consumption and associated health-risk behaviors using data from a 2007,2008 national school survey. Method: A cross-sectional survey using a self-administered questionnaire was conducted among 50,033 high school and vocational college students from 201 schools in 40 provinces between December 2007 and February 2008. Results: The prevalence rates of past-year drinking, past-30-day binge drinking, and drinking until intoxication were 25.5, 9.5, and 17.3% in boys and 14.5, 3.7, and 7.2% in girls, respectively. Higher school levels, lower grades, living with someone other than their own parents, and having family members with substance or alcohol problems were significantly associated with all kinds of drinking. Binge drinkers were significantly more likely to have drinking consequences, e.g., driving after drinking, nausea and vomiting, and having a hangover than were nonbinge drinkers. The rates of other behavior and emotional problems were 2.5 to 6.7 times as likely in drinkers as nondrinkers, including smoking (35.1% vs. 4.9%), prescription drug misuse (17.7% vs. 6.7%), illicit substance use (17.8% vs. 2.4%), carrying a weapon (6.5% vs. 1.8%), feeling depressed (23.2% vs. 10.9%), suicidal attempt (10.5% vs. 3.8%), and sexual intercourse (30.5% vs. 5.7%). Conclusion: Alcohol consumption is a serious problem among adolescents in Thailand and is strongly associated with various health-risk behaviors. Effective age- and gender-specific interventions should be implemented to discourage underage drinking and associated adverse health and social consequences. [source] Prevalence and Characteristics of Chronic Pain in Patients Admitted to an Outpatient Drug and Alcohol Treatment ProgramPAIN MEDICINE, Issue 7 2008Robert Sheu MD ABSTRACT Objectives., To evaluate the prevalence, characteristics, and correlates of chronic pain in a population of predominantly employed, alcoholic patients attending an outpatient drug and alcohol treatment program. Methods., A pain survey was administered to 79 patients attending an outpatient drug and alcohol treatment program situated in a suburban community outside of New York City. Chronic severe pain was defined as pain that 1) had persisted for at least 6 months; and 2) was either moderate to severe in intensity or significantly interfered with daily activities. Results., Seventy-six percent of patients experienced pain during the past week. Chronic severe pain was experienced by 29.1% of patients. High levels of pain interference with physical and psychosocial functioning were reported by 26.1%. Patients with chronic severe pain were more likely to have significant comorbidity, to cite physical pain as the impetus for alcohol or drug abuse, to have abused a prescription drug or used an illicit drug to treat pain during the prior 3 months, and to have used illicitly obtained opioids. Only 13% of patients with chronic severe pain were currently receiving pain treatment and 72% expressed interest in receiving treatment. Discussion., Chronic severe pain was prevalent in this predominantly employed, alcoholic population attending an outpatient drug and alcohol treatment program. Pain was associated with significant functional impairment, medical and psychiatric comorbidities, and abuse behaviors. Few patients accessed adequate pain treatment. Efforts should be made to better address the pain problems in this patient population. [source] The role of traumatic event history in non-medical use of prescription drugs among a nationally representative sample of US adolescentsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 1 2010Jenna L. McCauley Background:, Building on previous research with adolescents that examined demographic variables and other forms of substance abuse in relation to non-medical use of prescription drugs (NMUPD), the current study examined potentially traumatic events, depression, posttraumatic stress disorder (PTSD), other substance use, and delinquent behavior as potential correlates of past-year non-medical use of prescription drugs. Method:, A nationally representative sample of 3,614 non-institutionalized, civilian, English-speaking adolescents (aged 12,17 years) residing in households with a telephone was selected. Demographic characteristics, traumatic event history, mental health, and substance abuse variables were assessed. NMUPD was assessed by asking if, in the past year, participants had used a prescription drug in a non-medical manner. Multivariable logistic regressions were conducted for each theoretically derived predictor set. Significant predictors from each set were then entered into a final multivariable logistic regression to determine significant predictors of past-year NMUPD. Results:, NMUPD was endorsed by 6.7% of the sample (n = 242). The final multivariable model showed that lifetime history of delinquent behavior, other forms of substance use/abuse, history of witnessed violence, and lifetime history of PTSD were significantly associated with increased likelihood of NMUPD. Conclusions: Risk reduction efforts targeting NMUPD among adolescents who have witnessed significant violence, endorsed abuse of other substances and delinquent behavior, and/or endorsed PTSD are warranted. Interventions for adolescents with history of violence exposure or PTSD, or those adjudicated for delinquent behavior, should include treatment or prevention modules that specifically address NMUPD. [source] Continued occurrence of Accutane® -exposed pregnancies ,BIRTH DEFECTS RESEARCH, Issue 3 2001M.A. Honein Background Accutane® a teratogenic prescription drug licensed to treat severe, recalcitrant nodular acne. First-trimester pregnancy exposure can cause major birth defects. The manufacturer began a Pregnancy Prevention Program (PPP) in 1988; however, exposed pregnancies continue to occur. In 1996, the manufacturer began a direct-to-consumer advertising campaign, raising concerns of more exposed pregnancies. Methods We examined trends in Accutane use by reproductive-aged women. We also interviewed a series of 14 women in California who had recent Accutane-exposed pregnancies to identify opportunities for prevention. Results The estimated number of Accutane prescriptions for reproductive-aged women has more than doubled in the past 10 years; it is the most widely used teratogenic drug in the United States, with approximately 2.5 per 1,000 reproductive-aged women exposed to Accutane in 1999. One-half of the women interviewed reported seeing an advertisement for prescription acne treatment before taking Accutane. Eight of the 14 women used no contraception at the time of the exposed pregnancy; 13 of the 14 women did not use two forms of contraception. Four of the 14 women did not have pregnancy tests before starting Accutane. None reported seeing all PPP components, and four saw only the information on the pill packet. These 14 pregnancies resulted in four live infants who had no apparent birth defects, one live-born infant with multiple defects, four spontaneous abortions, and five induced abortions. Conclusions The increase in Accutane use observed among females may be exacerbated by advertising. Physicians and patients must use more caution with teratogenic prescription drugs. Teratology 64:142,147, 2001. Published 2001 Wiley-Liss, Inc. [source] Prescription drug misuse: Is technology friend or foe?DRUG AND ALCOHOL REVIEW, Issue 1 2009SUZANNE NIELSEN Abstract Introduction and Aims. Prescription drug misuse and related harms have been increasing considerably over the past decade. At the same time, there has also been rapid growth in the use of online and Internet technologies. Thus, it is important that we understand the role online and Internet technologies play in prescription drug misuse. Design and Methods. Published work addressing the role of technology in prescription drug misuse is explored. Topics include: Internet supply, online monitoring of prescription drug use trends and electronic prescription monitoring. Results. Little is known about the prevalence of acquiring prescription drugs from online pharmacies. Prescription drugs are easily accessible through vendor websites, and ,rogue' no-prescription websites have proven difficult to control. There has so far been limited application of real-time monitoring to prevent overuse of prescription medications. Online monitoring of drug use trends may also prove to be a useful and timely source of information about new methods of ,off-label' prescription drug use. Discussion and Conclusions. Technology has the potential to play a more prominent role in facilitating drug acquisition, while also enhancing the monitoring and prevention of prescription drug misuse. As technology becomes more ubiquitous in everyday life, the continued investigation of its relationship with prescription drug misuse becomes even more important.[Nielsen S, Barratt MJ. Prescription drug misuse: Is technology friend or foe? Drug Alcohol Rev 2009;28:81,86] [source] Vaccines, Viagra, and Vioxx: medicines, markets, and money,when life-saving meets life-style,DRUG DEVELOPMENT RESEARCH, Issue 2 2005David J. Triggle Abstract In this Commentary, life-style drugs will be termed as "those drugs for which there is a definable and real, but limited, therapeutic need, but a need that has been significantly stimulated by the cycle of pharmaceutical company advertising and pressure and public demand." The key to the continuing expansion of the life-style drug market is a progressive narrowing of the definition of "normal" coupled with campaigns launched by the pharmaceutical industry that persuade both patients and clinicians that a major and treatable disease does exist and that drug treatment, rather than acceptance of hair loss or occasional lack of sexual interest, and so on, is both necessary and appropriate. The expansion of the market for prescription drugs in this manner is now an integral part of the business model of the pharmaceutical industry. For society, the expanding role of these drugs, particularly those directed at "desires rather than diseases," raises ethical issues of our increasing obsession with a medically directed quest for perfection, and financial issues of the cost of this quest on the health care system and its priorities. For the pharmaceutical industry, there are questions of whether its role is life-saving or life-styling for a Huxleyan "Brave New World." Drug Dev Res 64:90,98, 2005. © 2005 Wiley-Liss, Inc. [source] LC-MS: a powerful tool in workplace drug testingDRUG TESTING AND ANALYSIS, Issue 3 2009E. Gallardo Abstract Workplace drug testing is a well-established application of forensic toxicology and it aims to reduce workplace accidents caused by affected workers. Several classes of abused substances may be involved, such as alcohol, amphetamines, cannabis, cocaine, opiates and also prescription drugs, such as benzodiazepines. The use of alternative biological specimens such as hair, oral fluid or sweat in workplace drug testing presents several advantages over urinalysis,mainly the fact that sample collection can be performed easily without infringing on the examinee's privacy, so the subject is more likely to perform the test. However, drugs are usually present in these alternative specimens at low concentrations and the amount of sample available for analysis is small. The use of highly sensitive techniques is therefore necessary. In fact, the successful interface of liquid chromatography with mass spectrometry (LC-MS) has brought a new light into bioanalytical and forensic sciences as it allows the detection of drugs and metabolites at concentrations that are difficult to analyse using the more commonly adopted GC-MS based techniques. This paper will discuss the importance of LC-MS in supporting workplace drug-testing programmes. The combination of LC-MS with innovative instrumentation such as triple quadrupoles, ion traps and time-of-flight mass spectrometers will also be focused. Copyright © 2009 John Wiley & Sons, Ltd. [source] Individual, partner and relationship factors associated with non-medical use of prescription drugsADDICTION, Issue 8 2010Gregory G. Homish ABSTRACT Aims The objective of the current report was to examine individual, partner and relationship factors (e.g. relationship satisfaction) associated with the non-medical use of prescription drugs (NMUPD) in a community sample of married adults. Design The current report used two waves of data from an ongoing study of couples who were recruited at the time they applied for their marriage license and are now in the 10th year of follow-up. Logistic regression models examined the relation between individual, partner and relationship factors and NMUPD. Participants This report is based on 273 couples. Measurements Participants completed questionnaires that assessed prescription drug use, alcohol use, other substance use, depression, marital satisfaction and socio-demographic factors. Findings Among wives, there was evidence that a partner's prescription drug use and relationship factors were associated with increased risk for NMUPD. There was some evidence suggesting that it was the increased access or availability, and not the partner's use per se, that was related to the NMUPD. These results persisted after controlling for other illicit drug use, heavy drinking, depressive symptomatology and socio-demographic factors. Among men, neither partner use nor relationship factors were associated with NMUPD after considering the impact of individual-level risk factors. Conclusion Prevention and intervention efforts directed at reducing the risk for NMUPD should consider the influence of partner and relationship factors in addition to individual-level risk factors. [source] HOW DID THE 2003 PRESCRIPTION DRUG RE-IMPORTATION BILL PASS THE HOUSE?ECONOMICS & POLITICS, Issue 1 2006OMER GOKCEKUS We examine the major interest groups in the debate over allowing the re-importation of prescription drugs by utilizing a logit model and instrumental variables. Consistent with political support approach, the evidence suggests that Representatives are maximizing their electoral prospects: contributions from pharmaceutical manufacturers shrink the probability of voting for the bill; and Representatives are sensitive to their constituencies , employees of pharmaceutical manufacturing and senior citizens. Representatives' gender and ideology regarding free trade and subsidies are also determining factors. However, the decision was, by and large, a partisan one: party affiliation was the most important factor in passing the bill. [source] Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patientsADDICTION, Issue 1 2009Anne Zahradnik ABSTRACT Aims Dependence on or problematic use of prescription drugs (PD) is estimated to be between 1 and 2% in the general population. In contrast, the proportion of substance-specific treatment in PD use disorders at 0.5% is comparatively low. With an estimated prevalence of 4.7%, PD-specific disorders are widespread in general hospitals compared to the general population. Brief intervention delivered in general hospitals might be useful to promote discontinuation or reduction of problematic prescription drug use. Design A randomized, controlled clinical trial. Setting Internal, surgical and gynaecological wards of a general and a university hospital. Participants One hundred and twenty-six patients fulfilling criteria for either regular use of PD (more than 60 days within the last 3 months) or dependence on or abuse of PD, respectively, were allocated randomly to two conditions. Intervention Subjects received two counselling sessions based on Motivational Interviewing plus an individualized written feedback (intervention group, IG) or a booklet on health behaviour (control group, CG). Measurements The outcome was measured as reduction (>25%) and discontinuation of PD intake in terms of defined daily dosages (DDD). Findings After 3 months, more participants in the IG reduced their DDD compared to the participants in the CG (51.8% versus 30%; ,2 = 6.17; P = 0.017). In the IG 17.9%, in the CG 8.6% discontinued use of PD (,2 = 2.42; P = 0.17). Conclusions Brief intervention based on Motivational Interviewing is effective in reducing PD intake in non-treatment-seeking patients. [source] Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, CanadaHEALTH ECONOMICS, Issue 9 2005Paul Contoyannis Abstract The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a ,rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between ,0.12 and ,0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes. Copyright © 2005 John Wiley & Sons, Ltd. [source] Effect of an Expenditure Cap on Low-Income Seniors' Drug Use and Spending in a State Pharmacy Assistance ProgramHEALTH SERVICES RESEARCH, Issue 3 2009Christine E. Bishop Objective. To estimate the impact of a soft cap (a ceiling on utilization beyond which insured enrollees pay a higher copayment) on low-income elders' use of prescription drugs. Data Sources and Setting. Claims and enrollment files for the first year ( June 2002 through May 2003) of the Illinois SeniorCare program, a state pharmacy assistance program, and Medicare claims and enrollment files, 2001 through 2003. SeniorCare enrolled non-Medicaid-eligible elders with income less than 200 percent of Federal Poverty Level. Minimal copays increased by 20 percent of prescription cost when enrollee expenditures reached $1,750. Research Design. Models were estimated for three dependent variables: enrollees' average monthly utilization (number of prescriptions), spending, and the proportion of drugs that were generic rather than brand. Observations included all program enrollees who exceeded the cap and covered two periods, before and after the cap was exceeded. Principle Findings. On average, enrollees exceeding the cap reduced the number of drugs they purchased by 14 percent, monthly expenditures decreased by 19 percent, and the proportion generic increased by 4 percent, all significant at p<.01. Impacts were greater for enrollees with greater initial spending, for enrollees without one of five chronic illness diagnoses in the previous calendar year, and for enrollees with lower income. Conclusions. Near-poor elders enrolled in plans with caps or coverage gaps, including Part D plans, may face sharp declines in utilization when they exceed these thresholds. [source] Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription DrugsHEALTH SERVICES RESEARCH, Issue 5p1 2008Julie M. Donohue Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), ,-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15,65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. [source] Factors Affecting Plan Choice and Unmet Need among Supplemental Security Income Eligible Children with DisabilitiesHEALTH SERVICES RESEARCH, Issue 5p1 2005Jean M. Mitchell Objective. To evaluate factors affecting plan choice (partially capitated managed care [MC] option versus the fee-for-service [FFS] system) and unmet needs for health care services among children who qualified for supplemental security income (SSI) because of a disability. Data Sources. We conducted telephone interviews during the summer and fall of 2002 with a random sample of close to 1,088 caregivers of SSI eligible children who resided in the District of Columbia. Research Design. We employed a two-step procedure where we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias associated with plan choice. We included the selectivity correction, the dummy variable indicating plan choice and other exogenous regressors in the second stage equations predicting unmet need. The dependent variables in the second stage equations include: (1) having an unmet need for any service or equipment; (2) having an unmet need for physician or hospital services; (3) having an unmet need for medical equipment; (4) having an unmet need for prescription drugs; (5) having an unmet need for dental care. Principal Findings. More disabled children (those with birth defects, chronic conditions, and/or more limitations in activities of daily living) were more likely to enroll in FFS. Children of caregivers with some college education were more likely to opt for FFS, whereas children from higher income households were more prone to enroll in the partially capitated MC plan. Children in FFS were 9.9 percentage points more likely than children enrolled in partially capitated MC to experience an unmet need for any type of health care services (p<.01), while FFS children were 4.5 percentage points more likely than partially capitated MC enrollees to incur a medical equipment unmet need (p<.05). FFS children were also more likely than partially capitated MC enrollees to experience unmet needs for prescription drugs and dental care, however these differences were only marginally significant. Conclusions. We speculate that the case management services available under the MC option, low Medicaid FFS reimbursements and provider availability account for some of the differences in unmet need that exist between partially capitated MC and FFS enrollees. [source] Determinants of HMO Formulary Adoption DecisionsHEALTH SERVICES RESEARCH, Issue 1p1 2003David Dranove Objective. To identify economic and organizational characteristics that affect the likelihood that health maintenance organizations (HMOs) include new drugs on their formularies. Data Sources. We administered an original survey to directors of pharmacy at 75 HMOs, of which 41 returned usable responses. We obtained drug-specific data from an industry trade journal. Study Design. We performed multivariate logistic regression analysis, adjusting for fixed-drug effects and random-HMO effects. We used factor analysis to limit the number of predictors. Data Collection Methods. We held initial focus groups to help with survey design. We administered the survey in two waves. We asked respondents to report on seven popular new drugs, and to describe a variety of HMO organizational characteristics. Principal Findings. Several HMO organizational characteristics, including nonprofit status, the incentives facing the director of the pharmacy, size and make-up of the pharmacy and therapeutics committee, and relationships with drugs makers, all affect formulary adoption. Conclusions. There are many organizational factors that may cause HMOs to make different formulary adoption decisions for certain prescription drugs. [source] Potential for Alcohol and Prescription Drug Interactions in Older PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Kristine E. Pringle PhD Objectives: To examine the patterns and prevalence of concomitant alcohol and alcohol-interactive (AI) drug use in older people. Design: Cross-sectional analysis of survey and prescription claims data. Setting: The Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PA-PACE) program, a state-funded program providing prescription benefits to older people with low to moderate incomes. Participants: A total of 83,321 PA-PACE cardholders (age range 65,106) who were using any prescription medications at the time of survey completion. Measurements: All AI drugs were identified using a database of medication warning labels obtained from First DataBank. Prescription drug claims were used to characterize AI drug exposure according to therapeutic class of prescription drug use. A mail survey of PA-PACE cardholders was used to examine alcohol use, as well as sociodemographic and health factors associated with concomitant use of alcohol and AI drugs. Results: Seventy-seven percent of all prescription drug users were exposed to AI medications, with significant variation in exposure and concomitant alcohol use according to therapeutic class. Overall, 19% of AI drug users reported concomitant alcohol use, compared with 26% of non-AI drug users (P<.001). Multinomial logistic regression analyses showed that certain groups of older people, including younger older people, men, and those with higher educational levels, were at greater risk for concomitant exposure to alcohol and AI drugs. Conclusion: Many older people use alcohol in combination with AI prescription drugs. Clinicians should warn every patient who is prescribed an AI drug about alcohol,drug interactions, especially those at high risk for concomitant exposure. [source] | ||||||||||||||||||||||