Potential Misuse Research Articles

Drug Prescription Practice and Behavior

Counseling has evolved into an essential component of community pharmacy practice. Patient counseling and addressing drug-related problems are the pharmacist's key activities to ensure the safe and effective use of medicines. There are currently no solid theoretical foundations for research on physician prescribing choices. In fact, doctors' drug prescriptions are a complex phenomenon that are influenced by a number of factors. The majority of current studies in the field of drug prescription use an exploratory approach rather than a theoretical one to describe how doctors make decisions. In Libya, a prescription of medications can easily be obtained from community pharmacies without prescription, resulting in potential drug misuse and health hazard. It was stated previously that there was overprescribing of certain categories of drugs written by Libyan physicians which necessitating further improvement. This review aimed to describe the dispensing practice of prescribed medicines in daily community pharmacy practice in Libya, focusing on counseling, and rational prescription based on the World Health Organization prescribing indicators.

Wybrane aspekty prawne ochrony niezakłóconej konkurencji w gospodarce cyfrowej

The article is of research and scientific nature, and its main purpose is to look at selected legal aspects of protection of undistorted competition in the digital economy. The key research question is whether the legal principles for the abuse of a dominant market position should be further developed by the competent competition authorities and courts on a case-by-case basis in regard to digital economy. Competition law’s purpose is to reduce market distortions. In this way, the digital economy must be safeguarded. Otherwise, due to capacity limits in advertising space or just having too much data, there is a possibility of exploitation abuse. The extent to which platform markets have this potential for legal misuse is highly impacted by market development dynamics and platform features (the extent of data access, the type of network effects). As a result, we begin by looking at whether merger control in online markets has been effective enough so far. Then, we discuss the dangers of market power abuse due to a lack of legal enforcement. The article concludes with a summary of the authors’ opinions based on the legal and economic grounds presented. The presented issue has not been analysed comprehensively in the literature on the subject so far, thus gives the opportunity to recommend avenues for future research.

An algorithm to identify gabapentin misuse and/or abuse in administrative claims data

BackgroundDespite gabapentin’s misuse and abuse potential and associated adverse events, few algorithms are available to detect gabapentin misuse and/or abuse in claims data. This study aims to develop an algorithm to identify gabapentin misuse and/or abuse in administrative claims data. MethodsWe developed an algorithm to identify gabapentin misuse and/or abuse over a 12-month period based on input from 21 clinical experts. We implemented the algorithm among 334,128 patients with at least one dispensed prescription of gabapentin between December 1, 2017 and December 1, 2018 in the IBM® MarketScan® Research Databases. We described the characteristics of patients who potentially misused and/or abused gabapentin and assessed factors associated with misuse and/or abuse using logistic regression. ResultsThe algorithm identified 17.6% of patients with gabapentin use who potentially misused and/or abused gabapentin. Factors associated with potential gabapentin misuse and/or abuse included men (adjusted odds ratio (aOR): 1.08; 95% confidence interval (CI): 1.06–1.10), comorbid conditions (e.g., drug and alcohol dependence (aOR: 1.31; 95% CI: 1.24–1.39); bipolar disorder (aOR: 1.34; 95% CI: 1.27–1.41)), and medication use (e.g., opioids (aOR: 1.23; 95% CI: 1.20–1.26), muscle relaxants (aOR: 1.24; 95% CI: 1.21–1.27), or serotonin-norepinephrine reuptake inhibitors (aOR: 1.33; 95% CI: 1.29–1.36)). ConclusionsApproximately one in six patients with gabapentin use potentially misused and/or abused gabapentin in a large commercial claims database. Multiple comorbidities and drug use were associated with gabapentin misuse and/or abuse. Monitoring requirements and individualized safety measures should be put in place for patients at elevated risks of gabapentin misuse and/or abuse.

Examining key factors impact on health science students\u2019 intentions to adopt genetic and pharmacogenomics testing: a comparative path analysis in two different healthcare settings

BackgroundThere is an increasing interest worldwide in investigating healthcare stakeholders’ perceptions and intentions to adopt pharmacogenomics (PGx) into clinical practice. However, the existing inquiries based on well-established theories and models that interpret their intentions to implement PGx are scarce. This study is the first that examines the impact of selected factors on health science students’ intention to adopt genetic testing applications using the technology acceptance model while it compares two different cultural groups: Greeks (Europe; Christian) and Malays (Asia; Muslim).ResultsMalay students were more persuaded about benefits of genomics for drug management compared to their Greek counterparts. However, participants from both countries appear to be particularly convinced about the benefits of genomics on disease management. Moreover, students from both countries considered the potential misuse of genetic information by corporate or government bodies as their most important concern; Greek students appeared to be considerably less worried than Malay about other probable hazards such as the deficient protection of privacy and confidentiality, which could be attributed to their religious background. Participants from both samples expressed very positive attitudes towards genetic research and testing and their favourable intentions to adopt genetic testing for personal use. Exploratory factors analysis and path analysis yielded quite similar results for both samples. Path analysis revealed that the factors of attitudes, concerns, drug management benefits and disease management benefits significantly influenced students’ intentions to adopt genetic testing for personal use, with attitudes being the most inspirational factor with rather high impact, while training did not seem to affect participant’s intentions. The squared multiple correlation of both models was quite satisfactory reaching to 0.55 for the Malaysian sample.ConclusionSimilarities in the results of the two groups along with the relevant validity and reliability tests indicate that the proposed model is a good fit for future studies to interpret stakeholders’ intentions to adopt genetic testing. Therefore, it can provide a promising and reliable basis for future model development to explain the relationships between intentions to adopt genetic testing and its predictors.

Early Posttherapy Opioid Prescription, Potential Misuse, and Substance Use Disorder Among Pediatric Cancer Survivors.

Pediatric cancer survivors often have pain, which may be managed with opioids. We examined the prevalence of opioid prescriptions, potential misuse, and substance use disorders (SUDs) among pediatric cancer survivors during the first year posttherapy. Using MarketScan Commercial Database, we identified 8969 survivors (aged 21 years or younger at diagnosis) who completed cancer therapy in 2009-2018 and remained continuously enrolled for at least 1 year posttherapy and 44 845 age-, sex-, and region-matched enrollees without cancer as a comparison group. Outcomes included opioid prescriptions, any indicator of potential prescription opioid misuse, and SUDs within 1 year posttherapy. Outcomes were compared between survivors and noncancer peers in bivariate and adjusted analyses, stratified by off-therapy age (children: 0-11 years; adolescents: 12-17 years; young adults: 18-28 years). All statistical tests were 2-sided. A higher proportion of survivors than noncancer peers filled opioid prescriptions (children: 12.7% vs 2.0%; adolescents: 22.9% vs 7.7%; young adults: 26.0% vs 11.9%). In models adjusting for sociodemographic factors and health status, survivors remained 74.4%-404.8% more likely than noncancer peer to fill opioid prescriptions (P < .001). The prevalence of potential misuse or SUDs was low, with 1.4% of child, 4.7% of adolescent, and 9.4% of young adult survivors fulfilling at least 1 criterion; however, it was higher than noncancer peers (0.1%, 1.4%, and 4.3%, respectively). In adjusted models, the likelihood of potential misuse among survivors remained at least 2 times higher than that among noncancer peers (P < .001), and the difference in SUDs became nonstatistically significant. Statistically significantly higher rates of opioid prescriptions and potential misuse were found among pediatric cancer survivors within 1 year posttherapy as compared with peers without cancer.

NLX-112, a highly selective 5-HT1A receptor biased agonist, does not exhibit misuse potential in male rats or macaques

NLX-112 (a.k.a. F13640 or befiradol) exhibits nanomolar affinity, exceptional selectivity and biased agonism at serotonin 5-HT1A receptors. NLX-112 displays robust analgesic activity in a number of rodent models of pain, and is currently developed as a treatment for l-DOPA-induced dyskinesia (LID) in Parkinson's disease (PD) patients. Noteworthy, PD patients can suffer from comorbid chronic pain, thus necessitating the use of analgesic drugs, such as opioids, which have potential for misuse. Additionally, dopamine agonists used to treat PD can produce cocaine-like effects in preclinical assays of misuse potential. The present study investigated whether NLX-112 possesses misuse potential of its own using two behavioural assays routinely used for this purpose: intracranial self-stimulation (ICSS) in rats, and cocaine discrimination in macaque monkeys. In rats, low doses of NLX-112 (0.03 and 0.1 mg/kg p.o.) did not alter ICSS frequency-rate curves, while higher doses (0.3 and 1.0 mg/kg) shifted the curve to the right and flattened it, i.e., reduced ICSS. As expected, cocaine (10 mg/kg i.p.) shifted the curve to the left, i.e., facilitated ICSS, but NLX-112 (0.03 and 0.1 mg/kg p.o.) did not further enhance cocaine-induced facilitation of ICSS. In monkeys trained to discriminate cocaine (0.4 mg/kg i.m.) from saline, NLX-112 (0.01–0.1 mg/kg p.o.) did not substitute for cocaine. Taken together, these results suggest that NLX-112, at doses displaying anti-dyskinetic activity in rat, marmoset and macaque models of LID, is free from misuse potential. From a translational perspective, this is a desirable property for a compound destined to be used in PD patients, who can suffer from comorbid chronic pain necessitating the use of potentially misused analgesic drugs.

Measurements of hydrocortisone and cortisone for longitudinal profiling of equine plasma by liquid chromatography-tandem mass spectrometry.

The conventional detection of exogenous drugs in equine doping samples has been used for confirmation and subsequent prosecution of participants responsible. In recent years, alternative methods using indirect detection have been investigated due to the expanding number of pharmaceutical agents available with the potential of misuse. The monitoring of endogenous biomarkers such as hydrocortisone (HC) has been studied in equine urine with an international threshold of 1 μg/ml established; however, there is no current threshold for equine plasma. The aim of this research was to investigate plasma concentrations of HC and cortisone (C) in race day samples compared to an administration of Triamcinolone Acetonide (TACA). The reference population (n = 1150) provided HC (6 to 145 ng/ml) and C (0.7 to 13 ng/ml) levels to derive the HC to C ratio (HC/C). Population reference limits (PRLs) were proposed for HC/C values at 0.2 (lower) and 61 (upper). Administration of TACA resulted in down‐regulation of HC/C values below the estimated PRLs for up to 96 h post‐administration. This indirect detection period was longer than the detection of TACA for 72 h. The use of individual reference limits (IRLs) for HC/C values was investigated to support the Equine Biological Passport (EBP), an intelligence model developed by Racing NSW for longitudinal monitoring of biomarkers.

Novel Psychoactive Substances: The Razor's Edge between Therapeutical Potential and Psychoactive Recreational Misuse.

Background: Novel psychoactive substances (NPS) are compounds of natural and synthetic origin, similar to traditional drugs of abuse. NPS are involved in a contemporary trend whose origin lies in a thinner balance between legitimate therapeutic drug research and legislative control. The contemporary NPS trend resulted from the replacement of MDMA by synthetic cathinones in ‘ecstasy’ during the 2000s. The most common NPS are synthetic cannabinoids and synthetic cathinones. Interestingly, during the last 50 years, these two classes of NPS have been the object of scientific research for a set of health conditions. Methods: Searches were conducted in the online database PubMed using boolean equations. Results: Synthetic cannabinoids displayed protective and therapeutic effects for inflammatory, neurodegenerative and oncologic pathologies, activating the immune system and reducing inflammation. Synthetic cathinones act similarly to amphetamine-type stimulants and can be used for depression and chronic fatigue. Conclusions: Despite the scientific advances in this field of research, pharmacological application of NPS is being jeopardized by fatalities associated with their recreational use. This review addresses the scientific achievements of these two classes of NPS and the toxicological data, ending with a reflection on Illicit and NPS control frames.

Non-parenteral Ketamine for Depression: A Practical Discussion on Addiction Potential and Recommendations for Judicious Prescribing.

Intravenous (IV) ketamine is increasingly used off-label at subanesthetic doses for its rapid antidepressant effect, and intranasal (IN) esketamine has been recently approved in several countries for treating depression. The clinical utility of these treatments is limited by a paucity of publicly funded IV ketamine and IN esketamine programs and cost barriers to private treatment programs, as well as the drug cost for IN esketamine itself, which makes generic ketamine alternatives an attractive option. Though evidence is limited, use of non-parenteral racemic ketamine formulations (oral, sublingual, and IN) may offer more realistic access in less rigidly supervised settings, both for acute and maintenance treatment in select cases. However, the psychiatric literature has repeatedly cautioned on the addictive potential of ketamine and raised caution for both less supervised and longer-term use of ketamine. To date, these concerns have not been discussed in view of available evidence, nor have they been discussed within a broader clinical context. This paper examines the available relevant literature and suggests that ketamine misuse risks appear not dissimilar to those of other well-established and commonly prescribed agents with abuse potential, such as stimulants or benzodiazepines. As such, ketamine prescribing should be considered in a similar risk/benefit context to balance patient access and need for treatment with concern for potential substance misuse. Our consortium of mood disorder specialists with significant ketamine prescribing experience considers prescribing of non-parenteral ketamine a reasonable clinical treatment option in select cases of treatment-resistant depression. This paper outlines where this may be appropriate and makes practical recommendations for clinicians in judicious prescribing of non-parenteral ketamine.

A Call for Data on the Principal Pipeline

In this policy forum commentary, we call for improved national and state-level data collection and access relevant to the principal pipeline. We focus specifically on how access to quality data can inform, has informed, and is critical to policy and practice across three segments of the principal pipeline—principal preparation, licensure, and labor markets—as well as the essential issue of diversity itself and across each pipeline segment. We also outline and explain the types of data collection, storage, and access that would enable more informed and relevant principal pipeline research, policy, and preparation. We then call for action at the state and the federal levels, including reauthorization of the Higher Education Act to expand Title II educator data collection to include principal preparation programs as it does teacher preparation programs. Finally, we conclude with cautions against potential data misuse.

Examination of multiple drug arrests reported to the Maine Diversion Alert Program.

Much of the responsibility for the increasing drug overdoses in the US has been attributed to opioids but most opioid overdoses also involve another drug. The objective of this study was to identify the drugs involved in polysubstance arrests. The substances that were more likely to be found in conjunction with other substances, using the drug arrests reported to Maine's Diversion Alert Program (DAP) were examined. Single and multiple drug arrests were quantified (N = 9,216). Multiple drug arrest percentages were compared to single drug arrest percentages to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug to identify over (MSR > 1) and under-representation (MSR < 1). Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were for opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous psychoactive prescription substances (e.g. clonidine, gabapentin, cyclobenzaprine, hydroxyzine) had the highest (1.51) MSR of any drug family. Conversely, stimulants (0.63), opioids (0.42), and hallucinogens (0.35) were significantly underrepresented in polysubstance arrests. Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR. Bath-salts (0.34), methamphetamine (0.44), and oxycodone (0.54) had the lowest MSR. The misuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance. In addition, common prescription drugs with less appreciated misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require greater attention for their ability to enhance the effects of other drugs.

Pramipexole treatment attenuates mechanical hypersensitivity in male rats experiencing chronic inflammatory pain

Opioids are commonly prescribed for pain despite growing evidence of their low efficacy in the treatment of chronic inflammatory pain and the high potential for misuse. There is a clear need to investigate non-opioid alternatives for the treatment of pain. In the present study, we tested the hypothesis that acute and repeated dopamine agonist treatment would attenuate mechanical hypersensitivity in male Long-Evans rats experiencing chronic inflammatory pain. We used two clinically available therapeutics, l-DOPA (precursor of dopamine biosynthesis) and pramipexole (dopamine D2/3 receptor agonist), to examine the functional role of dopamine signaling on mechanical hypersensitivity using an animal model of chronic inflammatory pain (complete Freund's adjuvant, CFA). We found that both acute and repeated pramipexole treatment attenuated hyperalgesia-like behavior in CFA-treated animals but exhibited no analgesic effects in control animals. In contrast, there was no effect of acute or repeated l-DOPA treatment on mechanical hypersensitivity in either CFA- or saline-treated animals. Notably, we discovered some extended effects of l-DOPA and pramipexole on decreasing pain-like behavior at three days and one week post-drug treatment. We also examined the effects of pramipexole treatment on glutamatergic and presynaptic signaling in pain- and reward-related brain regions including the nucleus accumbens (NAc), dorsal striatum (DS), ventral tegmental area (VTA), cingulate cortex (CC), central amygdala (CeA), and periaqueductal gray (PAG). We found that pramipexole treatment decreased AMPA receptor phosphorylation (pGluR1845) in the NAc and DS but increased pGluR1845 in the CC and CeA. A marker of presynaptic vesicle release, pSynapsin, was also increased in the DS, VTA, CC, CeA, and PAG following pramipexole treatment. Interestingly, pramipexole increased pSynapsin in the NAc of saline-treated animals, but not CFA-treated animals, suggesting blunted presynaptic vesicle release in the NAc of CFA-treated animals following pramipexole treatment. To examine the functional implications of impaired presynaptic signaling in the NAc of CFA animals, we used ex vivo electrophysiology to examine the effects of pramipexole treatment on the intrinsic excitability of NAc neurons in CFA- and saline-treated animals. We found that pramipexole treatment reduced NAc intrinsic excitability in saline-treated animals but produced no change in NAc intrinsic excitability in CFA-treated animals. These findings indicate alterations in dopamine D2/3 receptor signaling in the NAc of animals with a history of chronic pain in association with the anti-hyperalgesic effects of pramipexole treatment.

Reconsidering harm in psychiatric manuals within an explicationist framework.

The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority.

ML-Based Classification of Device Environment Using Wi-Fi and Cellular Signal Measurements

Future spectrum sharing rules very likely will be based on device environment: indoors or outdoors. For example, the 6 GHz rules created different power regimes for unlicensed devices to protect incumbents: “indoor” devices, subject to lower transmit powers but not required to access an Automatic Frequency Control database to obtain permission to use a channel, and “outdoor” devices, allowed to transmit at higher power but required to do so to determine channel availability. However, since there are no reliable means of determining if a wireless device is indoors or outdoors, other restrictions were mandated: reduced power for client devices and indoor access points that cannot be battery powered, have detachable antennas or be weatherized. These constraints lead to sub-optimal spectrum usage and potential for misuse. Hence, there is a need for robust identification of device environments to enable spectrum sharing. In this paper we study automatic indoor/outdoor classification based on the radio frequency (RF) environment experienced by a device. Using a custom Android app, we first create a labeled data set of a number of parameters of Wi-Fi and cellular signals in various indoor and outdoor environments, and then evaluate the classification performance of various machine learning (ML) models on this data set. We find that tree-based ensemble ML models can achieve greater than 99% test accuracy and F1-Score, thus allowing devices to self-identify their environment and adapt their transmit power accordingly.

NUDGE, SHOVE, BUDGE, SLUDGE AND ADMINISTRATIVE BURDEN: Terminological Demarcation and Practical Implications

In this paper, the authors provide a precise terminological demarcation of the following behavioral concepts: “nudge”, “shove”, and “budge”. Based on these concepts and three defined criteria (freedom/coercion, internalities/externalities, and behavioral insights), the authors explain various behavioral public policies and their practical implications: 1) the behavioral public policy of libertarian-paternalistic orientation (the “nudge policy”); 2) the policy of coercive paternalism; and 3) the behavioral regulation of externalities. Then, the authors provide a terminological distinction between the concept of “sludge” and “nudge”, and discuss their potential misuses. Finally, based on the level of “frictions”, the authors distinguish between the concepts of “administrative burden” and “sludge”, as well as the types of public policies that are recommended for their reduction, particularly “sludge audits”. The conclusion is that all these public policies are very close, slightly different in terms of the subject matter of regulation and the intensity of encroachment on the freedoms of individuals, but that they all have a common root in behavioral insights.

Suočavanje sa izazovima bioloških pretnji i biološkog oružja u 21. veku

Biological warfare has attracted people since the earliest times. During the Cold War, bio-weapons were part of the arsenal of both world superpowers. The Convention prohibiting the production, storage, transfer and use of potential biological weapons (BWC) was signed 50 years ago. The question arises how sincere the signatory states were in its implementation. The rapid development of molecular biology has raised awareness about its potential misuse in terms of creating new and more dangerous bio-weapons, as well as the question of ethics in biomedical research. The anthrax campaign in the USA represents a turning point after which the use of weapons of mass destruction (WMD), including biological ones, has become part of the narrative that accompanies each war conflict. Epidemics and pandemics of avian and swine flu, Zika virus, SARS, MERS and COVID-19, as well as their implications, have proved the significance of a multidisciplinary approach to the study of microorganisms, their epidemiological, microbiological, genetic and antigenic characteristics, methods of their diagnosis, prevention and treatment, not only from the biomedical, but also from the security aspect. Perhaps the 50th anniversary is the right time to ask why the International Expert Body for controlling the implementation of the BTWC provisions has not been constituted yet.

Linaclotide utilization and potential for off-label use and misuse in three European countries.

Introduction:Linaclotide is approved for adults with moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C). Linaclotide is not indicated for weight loss or for patients with inflammatory bowel disease (IBD); it is contraindicated in patients with mechanical bowel obstruction (MBO). Some patients with obesity or eating disorders (ED) may use linaclotide off-label for weight loss or as a laxative.Objectives:To describe the use of linaclotide in clinical practice, including patients with potential for off-label use or misuse.Methods:Post-authorization safety study conducted in three databases from the linaclotide launch date to 2017: the Clinical Practice Research Datalink in the United Kingdom (UK), the Information System for Research in Primary Care database in Spain and the linked Patient, Prescription and Causes of Death Registries in Sweden. Cohorts of patients were identified as having IBS using diagnostic and treatment codes; IBS subtypes were identified using symptoms and treatment codes; patients with obesity, ED, MBO, and IBD were identified using diagnostic codes or body mass index.Results:There were 1319, 1981, and 5081 linaclotide users from the United Kingdom, Spain, and Sweden with a median age of 45, 57, and 51 years, respectively; most were females. In the United Kingdom, Spain, and Sweden, respectively: 59.0%, 60.3%, and 31.3% of linaclotide users had an IBS diagnosis recorded, and among those, 68.8%, 61.3%, and 92.7% were classified as IBS-C. The proportions of linaclotide users considered at risk for potential off-label use for weight loss or as a laxative were 17.1%, 29.7%, and 1.7%, and the proportions of users considered at risk of misuse due to a history of MBO or IBD were 3.5%, 4.6%, and 5.7% in the United Kingdom, Spain, and Sweden, respectively.Conclusions:Potential linaclotide off-label use and misuse appears limited, as evidenced by the small sizes of the patient subgroups at risk for off-label use and misuse.

Predictors of Pain Reliever Misuse Among Respondents of the United States 2017 National Survey on Drug Use and Health.

The risk factors for potential opioid misuse and abuse in patients receiving long-term opioid pain treatment have been a topic of interest in research for many years. There are differences among patients who receive long-term opioid pain treatment. These differences may or may not lead to opioid misuse. This study analyzes the different characteristics and predictors of prescription pain reliever misuse among respondents of the United States 2017 National Survey on Drug Use and Health. It examines the relationships of age, gender, income, perception of risk and availability of heroin, past substance use and alcohol use, the source of the pain relievers, and motivation to misuse pain relievers to pain reliever misuse and if these variables significantly predict pain reliever misuse. Data used in this study were analyzed through sequential multiple linear regression analyses. The significant positive predictors of prescription pain reliever misuse were being 26 or older, perceiving heroin as easily obtainable, and past methamphetamine use. The significant negative predictors of prescription pain reliever misuse were being 12 to 25 years old, perceiving heroin as a great risk, past alcohol use, and obtaining pain relievers from a friend or relative. The goal of this study was to increase the amount of knowledge regarding predictors of prescription opioid misuse to identify those who are at risk and decrease prescription opioid misuse and overdose rates in the United States.

Autogenous vaccines in aquaculture: Tool to combat resistance of bacteria to antibiotics?

New technological progress and increased demands for fish as a source of animal protein are driving significant growth of aquaculture production. Intensification of production increases the severity and frequency of infectious disease outbreaks, and so requires significant effort to prevent and control disease. Because of the global crisis of bacterial resistance to antibiotics, the use of antibiotics in aquaculture is increasingly subjected to strict control and regulatory measures, leading to potential misuse. The lack of availability of approved veterinary medical products for use in aquaculture, combined with the risk of drug resistance development and antibiotic residues in fish flesh or water, support the development of preventive actions, including vaccines. However, the diversity of species and aquaculture production methods, including epidemiological units and their links, results in economic challenges for commercial vaccine development and authorization. As a possible response to the increasing demand for less antibiotic use in fish farms, and to the expenses associated with novel veterinary product development, there is a need for increased use of safe and effective autogenous vaccines in aquaculture. Regulatory processes for autogenous vaccine production, approval and application should recognize the specificities of epidemiological units and their links in aquatic animal production facilities. The joint efforts of regulatory authorities, producers, and veterinary services to follow veterinary biosecurity principles, including risk analysis, surveillance, and selection/prioritization of pathogens, are essential to provide maximum safety and efficacy of autogenous vaccines as disease prevention and control tools within larger areas, such as compartments and zones, and allow for reductions in antibiotic use.

Voluntary Registries: Filling the Critical Information Gap in First Response to Mental Health Crises.

We argue that voluntary mental health registries integrated into the 9-1-1 system, where patients and caregivers can establish a repository of this information, will help fill this information gap by enabling first responders to quickly understand the context of a call for service with a mental health component, and to make better informed decisions. Despite valid concerns about privacy, stigma, and the potential misuse of protected health information, such registries, if carefully designed and administered, can improve the health outcomes of 9-1-1 calls for service involving mental health-related crises.