Acute Hyperkinetic Syndrome Due to Ephedrone Abuse

Objectives: A new form of manganese poisoning is related to the intravenous use of self-prepared methcathinone hydrochloride (ephedrone). Manganese encephalopathy typically manifests as a levodopa-resistant parkinsonism. Main Points: A 32-year-old drug-addicted man with acute gait disturbances after the ephedrone injections was presented. Choreic movements, severe postural instability, and “cock-walk” gait were observed. Magnetic resonance imaging T1 images showed high signal intensity of white matter in the basal ganglia and pituitary gland, and T2 images showed decreased signal mostly of globus pallidus with decreased N-acetylaspartate and choline levels in MR spectroscopy. Conclusions: The unusual pattern of MR imaging may explain the unusual clinical symptoms with dominant hyperkinetic syndrome.

Mobile Phone Use Patterns and Preferences in Safety Net Office-Based Buprenorphine Patients

Background: Integrating mobile phone technologies in addiction treatment is of increasing importance and may optimize patient engagement with their care and enhance the delivery of existing treatment strategies. Few studies have evaluated mobile phone and text message (TM) use patterns in persons enrolled in addiction treatment, and none have assessed the use in safety net, office-based buprenorphine practices. Methods: A 28-item, quantitative and qualitative semistructured survey was administered to opiate-dependent adults in an urban, publicly funded, office-based buprenorphine program. Survey domains included demographic characteristics, mobile phone and TM use patterns, and preferences pertaining to their recovery. Results: Surveyors approached 73 of the 155 eligible subjects (47%); 71 respondents completed the survey. Nearly all participants reported mobile phone ownership (93%) and TM use (93%), and most reported “very much” or “somewhat” comfort sending TM (79%). Text message contact with 12-step group sponsors, friends, family members, and counselors was also described (32%). Nearly all preferred having their providers' mobile phone number (94%), and alerting the clinic via TM in the event of a potential relapse to receive both supportive TM and a phone call from their buprenorphine provider was also well received (62%). Conclusions: Mobile phone and TM use patterns and preferences among this sample of office-based buprenorphine participants highlight the potential of adopting patient-centered mobile phone–based interventions in this treatment setting.

Opioid Use in Pregnant Women and the Increase in Neonatal Abstinence Syndrome: What Is the Cost?

Objectives: To investigate the length of stay for observation and treatment of neonatal abstinence syndrome (NAS), as well as the hospital costs associated with the medical care of affected newborns. Methods: A retrospective chart review was conducted at Shands Hospital at the University of Florida, Gainesville, Florida. Data were collected for newborns diagnosed with NAS, including their hospital length of stay and the associated hospital charges, from December 1, 2008, to November 30, 2011. Results: One hundred-sixty eligible newborns were included in the study. During the 3-year study period, hospital charges related to the diagnosis and treatment of NAS increased from $1.1 million per year to $1.8 million per year. Compared with the cost of caring for newborns without the risk of NAS, an additional $4.1 million was spent in the medical care of these newborns. Conclusions: The costs associated with treating newborns with NAS are exponentially higher than the costs associated with newborns not affected with NAS. The societal costs associated with treatment of newborns with NAS, as well as infant symptomatology experienced with NAS, can be reduced by encouraging physicians to be proactive in screening for drug use, urging women who use chronic opioids to actively engage in family planning and contraception, and encouraging pregnant women who use opioids to seek substance treatment.

Real-World Effectiveness of Varenicline Versus Nicotine Replacement Therapy in Patients With and Without Psychiatric Disorders

Objective: To compare the effectiveness and safety of varenicline with nicotine replacement therapy (NRT) among smokers with or without psychiatric disorders attending a storefront smoking cessation clinic in an urban addiction and mental health academic health science center. Methods: A retrospective chart review was conducted to compare treatment outcomes, demographics, and clinical characteristics for adult smokers prescribed varenicline (n = 98) or NRT (n = 98) between 2007 and 2010. Subjects were matched 1:1 on age, sex, and year of initial assessment. Results: End-of-treatment quit rates were almost twice as high among those prescribed varenicline (33.7%) versus NRT (18.4%) (RR = 1.83, 95% CI = 1.11-3.03, P = 0.02). After adjusting for several baseline and treatment characteristics, varenicline was still significantly more effective than NRT (ARR = 1.71, 95% CI = 1.05-2.79, P = 0.03). History of psychiatric disorder (excluding substance use disorders) and treatment duration were also independent predictors of end-of-treatment quit rates. Nausea was more commonly reported among those using varenicline (13.3% vs 3.1%, P = 0.009). No single neuropsychiatric adverse effect significantly differed between groups; however, overall reporting of any neuropsychiatric effect was somewhat higher in the varenicline group (31.6% vs 20.4%, P = 0.07). There was one incident of suicidal ideation in each medication group. Conclusions: Varenicline seems to be more effective than NRT and as safe in real-world settings among patients with and without a history of psychiatric disorder.