Biological Drug Screening Research Articles

Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa

BackgroundWomen in South Africa who use alcohol and other drugs face multiple barriers to HIV care. These barriers make it difficult for women to progress through each step in the HIV treatment cascade from diagnosis to treatment initiation and adherence. This paper examines correlates of HIV status, newly diagnosed HIV status, and use of antiretroviral therapy (ART).MethodsOutreach workers recruited sexually active Black African women who used substances in Pretoria as part of a U.S. National Institutes of Health-funded geographically clustered randomized trial examining the effect of an intervention to reduce alcohol and drug use as well as sexual risk behaviors. To address the question of interest in the current investigation, cross-sectional baseline data were used. At study enrollment, all participants (N = 641) completed an interview, and underwent rapid HIV testing and biological drug screening. Those who tested positive for HIV and were eligible for ART were asked about their barriers to initiating or adhering to ART. Bivariate and multivariable logistic regression analyses were conducted to determine correlates of HIV status, newly diagnosed HIV, and ART use.ResultsAt enrollment, 55% of participants tested positive for HIV, and 36% of these women were newly diagnosed. In multivariable analyses of the entire sample, women who had completed 10th grade were less likely to be living with HIV (OR 0.69; CI 0.48, 0.99) and those from the inner city were more likely to be living with HIV (OR 1.83; CI 1.26, 2.67). Among HIV-positive participants, women were less likely to be newly diagnosed if they had ever been in substance abuse treatment (OR 0.15; CI 0.03, 0.69) or used a condom at last sex (OR 0.58; CI 0.34, 0.98) and more likely to be newly diagnosed if they were physically assaulted in the past year (OR 1.97; CI 1.01, 3.84). Among women eligible for ART, fewer were likely to be on treatment (by self-report) if they had a positive urine test for opiates or cocaine (OR 0.27; CI 0.09, 0.80).ConclusionsThese results, although cross-sectional, provide some guidance for provincial authorities to address barriers to HIV care for sexually active, substance-using vulnerable women in Pretoria. Targeting the inner city with prevention campaigns, expanding and improving substance abuse treatment programs, linking clients with simultaneous HIV testing and treatment, and targeting women who have experienced sexual assault and violence may help the government achieve the UNAIDS 90-90-90 treatment target.Clinical Trials.gov NCT01497405 registered on December 1, 2011.

Opioid Prescribing Laws and Emergency Department Guidelines for Chronic Non-Cancer Pain in Washington State.

Rising mortality rates, increased opioid prescription abuse, and a perceived need to provide practitioners with structured guidance in opioid prescribing have prompted the Washington State Legislature to establish new legal standards of practice regarding chronic non-cancer pain management. Clinicians are required to conduct a detailed physical examination and health history prior to treatment. Risk assessments for abuse and detailed periodic reviews of treatment are required at least every 6 months. Those considered "high risk" or who have significant psychiatric comorbidities will be required to sign and follow a written agreement or pain contract, obtain their pain prescriptions from a single provider, and submit to biological drug screening. Unless an exemption exists, patients prescribed > 120 mg of morphine-equivalents daily, considered severe pain nonresponders, necessitating dosage escalation, diagnosed with multifaceted mental health-related comorbidities, demonstrating diagnostic ambiguity, and/or requiring significant treatment individualization are referred to a pain specialist. Episodic care settings should refrain from supplying opioids to chronic pain patients whenever possible. The ER is for Emergencies coalition instituted the Seven Best Practices program throughout the state to reduce unnecessary visits, coordinate prescribing practice, reduce Medicaid expenditures, and improve overall patient care. The state reported approximately $33.65 million in savings in 2013 through the use of these practices and converting Medicaid participants from fee-for-service to managed care plans. Similar legislation to complement clinical practice guidelines is expected to be enacted in other states. It is vital that practitioners comprehend the new guidelines and make appropriate adjustments in their opioid prescribing habits.

Effectiveness of Treatment for Adolescent Substance Use: Is Biological Drug Testing Sufficient?

The purpose of this study was to compare the relative effectiveness of three treatment modalities for adolescent substance use: biological drug screening (BDS), Motivational Enhancement Therapy-Cognitive Behavioral Therapy (MET/CBT5), and BDS combined with MET/CBT5, relative to no treatment. This study comprised 5,186 adolescents (70% male) enrolled in substance use treatment and tracked through the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment's database (BDS = 1,110; MET/CBT5 = 784; BDS combined with MET/CBT5 = 2,539; no treatment = 753). Outcomes of interest were substance use frequency and severity of substance use problems at 3, 6, and 12 months, as measured by the Global Appraisal of Individual Needs survey. Propensity score weighting was used to adjust for pretreatment covariate imbalances between groups. Weighted generalized linear models were used to estimate the impact of treatment on outcomes at 3, 6, and 12 months. BDS, alone or in combination with MET/CBT5, was associated with improved substance use and substance problems outcomes. Relative to youth reporting no treatment services, the BDS group reported significantly lower substance use at all visits, with the observed difference increasing over time. BDS alone was associated with significantly fewer substance problems than bds combined with met/cbt5 at all visits and significantly lower use at 12 months. Our results demonstrate significant improvement on substance use outcomes associated with BDS and offer preliminary evidence that BDS, particularly standalone BDS, may be an effective form of drug treatment for adolescents. Further work, including randomized studies, should explore the optimal format of administering BDS to adolescents to achieve maximum effectiveness.

Estimating the causal effects of cumulative treatment episodes for adolescents using marginal structural models and inverse probability of treatment weighting

BackgroundSubstance use treatment is rarely a one-time event for individuals with substance use disorders. Sustained reductions in substance use and its related symptoms may result from multiple treatment episodes. MethodsWe use a marginal structural model with inverse-probability-of-treatment weighting to estimate the causal effects of cumulative treatment experiences over a period of 9 months on drug use at the end of 1-year among 2870 adolescents receiving care in community-based treatment settings. During the 9 months, adolescents move in and out of outpatient and residential treatment with periods where they only receive biological drug screening (BDS) or no treatment at all. The use of inverse-probability-of-treatment weighting reduces confounding bias due to observed baseline and time-varying measures over the course of follow-up; weights were estimated using generalized boosted models. ResultsEach additional period of treatment (representing at least one day, 1 session, or 1 BDS during the 90 day period between follow-up visits) yielded reductions in average substance use frequency at 1-year relative to no treatment during the 90-day period. For residential treatment it was a 16% decrease (95% CI=−27%, −7%), for outpatient treatment it was a 9% decrease (95% CI=−18%, −0%), and for BDS (with no additional outpatient or residential treatment) it was an 11% decrease (95% CI=−20%, −3%). ConclusionsUsing robust statistical methods, we find promising (albeit preliminary) evidence that additional periods of outpatient and residential treatment, as well as biological drug screening, lead to reductions in substance use outcomes at one year.

Automated techniques in biotechnology

During the past decade, the technological revolution in microelectronics and software has led to the introduction of numerous automated tools. The necessity to unveil the vast amount of information that lies hidden in biological samples has driven the development of a huge variety of commercially available equipment. Automation efforts are currently concentrated in areas such as clinical analysis, chemical analysis and biological drug screening. Increasing knowledge of the capabilities of automation in the laboratory, as well as the availability of more and better equipment/software systems, is revolutionizing our concept of automation; currently, automated processes are under development not only for the replacement of traditionally manual procedures, but also for novel specifically designed procedures. The introduction of new work planners, expert systems, data-handling software, automation hardware (e.g., robots), conveyor systems and micro-machinery testifies to the integral role of automated processes in the biotechnology laboratory of the future.