Undocumented alcoholism and its correlation with tobacco and illegal drug use in advanced cancer patients

BACKGROUND

The objectives of this retrospective study were to determine the frequency of undiagnosed alcoholism among patients with advanced cancer who were referred to palliative care and to explore its correlation with alcoholism, tobacco abuse, and use of illegal drugs.

METHODS

The authors reviewed 665 consecutive charts and identified 598 patients (90%) who completed a screening survey that was designed to identify alcoholism, the Cut Down, Annoyed, Guilty, Eye Opener (CAGE) questionnaire, including 100 consecutive patients who had CAGE-positive and CAGE-negative results. Data on tobacco and illegal drug use, the Edmonton Symptom Assessment Scale, and the morphine equivalent daily dose were collected.

RESULTS

The frequency of CAGE-positive results in this palliative care population was 100 of 598 patients (17%). Only 13 of 100 patients (13%) in that CAGE-positive group had been identified as alcoholics before their palliative care consultation. Compared with CAGE-negative patients, CAGE-positive patients were younger (aged 58.6 years vs 61.3 years; P = .07), predominantly men (68 of 100 patients vs 51 of 100 patients; P = .021), more likely to have a history of tobacco use (86 of 100 patients vs 48 of 100 patients; P < .001), more likely to be actively using nicotine (33 of 100 patients vs 9 of 100 patients; P = .02), and more likely to have a history of illegal recreational drug use (17 of 100 patients vs 1 of 100 patients; P < .001). Pain and dyspnea were worse in patients who had a history of nicotine use. Both CAGE-positive patients and patients who had a history of tobacco use more frequently were receiving strong opioids at the time of their palliative care consultation.

CONCLUSIONS

The current findings suggested that alcoholism is highly prevalent and frequently under diagnosed in patients with advanced cancer. CAGE-positive patients were more likely to have a history of, or to actively engage in, smoking and illegal recreational drug use, placing them at risk for inappropriate opioid escalation and abuse.

Are "social drugs" (tobacco, coffee and chocolate) related to the bipolar spectrum?

BACKGROUND

Across all ages and cultures, mankind has always used substances in order to induce pleasurable sensations or desirable psychophysical states. These substances, notably caffeine, tobacco, alcohol and chocolate, can be labeled 'social drugs'.

METHODS

We analyzed the social drug habits of 562 patients suffering from mood disorders, according to DSM-IV-R criteria (major depressive episode, recurrent depression, bipolar type I and II disorders and depression not otherwise specified). The sample was also divided into bipolar and non-bipolar according to Hypomania Check-list 32 (HCL-32), which proposes a broader concept of hypomania and soft bipolarity, comprising the spectrum of bipolar disorders proper, along with other, "softer" expressions of bipolarity intermediate between bipolar disorder and normality.

RESULTS

Using HCL-32 criteria, but DSM-IV-R criteria, a link was confirmed between bipolar spectrum and substance use including social drugs such as tobacco and coffee.

LIMITATION

Observational correlational study.

CONCLUSION

This study is in support of earlier theoretical formulations within the framework of the Pisa-San Diego collaboration.

Effect of maternal tobacco smoking or exposure to second-hand smoke on the levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine of mother and the first urine of newborn

Tobacco smoking during pregnancy is associated with a variety of negative consequences not only for the mother, but also for the developing fetus. Many studies have shown that carcinogens contained in tobacco smoke permeate across the placenta, and are found in fetus. The aim of the study was to determine the prenatal exposure to tobacco-specific carcinogenic N-nitrosamines on the basis of measurements of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine of smoking and second-hand smoke (SHS) exposed women and in the first urine of their newborns. A questionnaire documenting demographics and socio-economical data, smoking habits and exposure to SHS was completed by 121 delivering women near or at term. Maternal concentrations of cotinine and NNAL were measured in urine of the mother and the first urine of her newborn infant by liquid chromatography tandem mass spectrometry (LC/MS/MS). The mean concentration of cotinine was 439.2 ng/mg creatinine and NNAL concentration in urine of smoking women was 74.0 pg/mg creatinine, and for her newborn 78.6 pg/mg creatinine. Among mothers exposed to SHS, cotinine and NNAL mean concentration were 23.1 ng/mg creatinine, and 26.4 pg/mg creatinine. In newborns of SHS exposed mothers during pregnancy the mean concentration of NNAL was 34.1 pg/mg creatinine, respectively. Active tobacco smoking as well as passive exposure to smoking during pregnancy is an important source of tobacco specific N-nitrosamines to the fetuses as evidenced by increased concentrations of this carcinogen. Determination of NNAL in maternal urine samples can be a useful biomarker of prenatal exposure of newborn to carcinogenic nitrosamines.

Menthol's potential effects on nicotine dependence: a tobacco industry perspective

OBJECTIVE

To examine what the tobacco industry knows about the potential effects menthol may have on nicotine dependence.

METHODS

A snowball strategy was used to systematically search the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu/) between 22 February and 29 April, 2010. Of the approximately 11 million documents available in the Legacy Tobacco Documents Library, the iterative searches returned tens of thousands of results. We qualitatively analysed a final collection of 309 documents relevant the effects of menthol on nicotine dependence.

RESULTS

The tobacco industry knows that menthol overrides the harsh taste of tobacco and alleviates nicotine's irritating effects, synergistically interacts with nicotine, stimulates the trigeminal nerve to elicit a 'liking' response for a tobacco product, and makes low tar, low nicotine tobacco products more acceptable to smokers than non-mentholated low delivery products.

CONCLUSION

Menthol is not only used in cigarettes as a flavour additive; tobacco companies know that menthol also has sensory effects and interacts with nicotine to produce tobacco products that are easier to smoke, thereby making it easier to expose smokers, especially those who are new and uninitiated, to the addictive power of nicotine.

Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence.

METHODS

Analyses were done for the subsample of lifetime nicotine (n=15,918), alcohol (n=28,907), cannabis (n=7389) or cocaine (n=2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence.

RESULTS

The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed.

CONCLUSIONS

Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.

The effect of some ganglionic stimulants and blocking drugs on acetylcholine release from the mammalian neuromuscular junction

The effect of nicotine, dimethylphenylpiperazinium (DMPP), hexamethonium and pempidine on release of acetylcholine from the guinea-pig phrenic nerve diaphragm preparation has been investigated. Neither nicotine nor DMPP, 2 × 10−5, modified acetylcholine release from the hemidiaphragms at rest or indirectly stimulated at 50/sec: therefore their neuromuscular blocking action has only a postjunctional origin. Hexamethonium, 4 × 10−4, significantly reduced the output of transmitter from preparations stimulated at 50/sec at 38°. It did not affect the release of acetylcholine from hemidiaphragms at rest or the acetylcholine content of the muscle. The presynaptic effect of hexamethonium is probably related to its linkage with “receptors” present on the surface of the nerve endings. Pempidine, 1 × 10−4, diminished the release of acetylcholine from the preparations at rest or stimulated either at 50 or at 6/sec. The effect was related to the frequency and to the temperature. Moreover, the drug reduced the acetylcholine content of the muscle. This effect may be the result of non-specific metabolic inhibition or of an impairment of choline transport system.

[Protective effect of allicin on human periodontal ligament cells with nicotine-induced oxidative damage]

OBJECTIVE

To explore the protective effect of allicin on nicotine-induced oxidative damage to human periodontal ligament cells (HPDLCs).

METHODS

(1) Establish nicotine-induced oxidative damage model on HPDLCs. Use water-soluble tetrazolium (WST) colorimetric method to find out the nicotine concentration (X) that could inhibit HPDLCs' growth for the following experiments. (2) HPDLCs of the fifth passage were divided into 5 groups: The control group, the nicotine group and the nicotine+allicin groups(the concentration of allicin was 15, 30, and 60 microg x mL(-1) respectively). Different kinds of culture media were added. Similarly, use WST colorimetric method to choose the allicin concentration (Y) that could significantly improve the survival rate of HPDLCs. (3) HPDLCs were divided into 3 groups: The control group, the nicotine group, the nicotine+allicin group and different media were added. The glutathion (GSH) concentrations in HPDLCs were determined in 1, 4, 8, 12 and 24h respectively.

RESULTS

0.8 mg x mL(-1) nicotine could inhibit the HPDLCs survival rate significantly (77% of the control, P < 0.05). But 60 microg x mL(-1) allicin could prevent the inhibition effects evidently, improving the survival rate to 112% of that of the nicotine group (P < 0.05) and reaching the survival rate level of control group (P > 0.05). The GSH concentrations of nicotine+allicin group were higher than that of the nicotine group always (P < 0.05) and by 82% at 8 h after culture, but had no difference with that of the control group (P > 0.05).

CONCLUSION

60 microg x mL(-1) allicin can protect the HPDLCs against oxidative damage induced by nicotine.

Proteome analysis of the left ventricle in the vitamin D₃ and nicotine-induced rat vascular calcification model

Vitamin D₃ and nicotine (VDN) serve as an animal model of arterial calcification. The vascular calcification induced by the VDN model is always accompanied by compensatory left ventricular (LV) hypertrophy and impaired cardiac performance. To determine the possible mechanisms that are responsible for the effects of VDN on the LV, a 2-DE based proteomics approach was used to evaluate the changes in protein expression of the left ventricle in VDN rats, to our knowledge, for the first time. We identified sixteen proteins that were markedly altered and involved in mitochondrial function, heat shock protein activity, myocyte cytoskeleton composition and enzyme activity for energy metabolism. We describe, for the first time, a novel pathway (NDPK) that is involved in LV hypertrophy and enzyme activities of three of the sixteen clinical identified proteins: lactate dehydrogenase (LDH), SOD [Mn] and GST.

Nicotine competes with a visual stimulus for control of conditioned responding

Environmental stimuli that co-occur with tobacco use come to evoke drug-related conditioned responses (CRs) that appear involved in continued use of nicotine-containing products. In rats, nicotine can serve as a conditional stimulus (CS) for non-drug unconditioned stimuli (USs), prompting the question of whether the nicotine CS can compete with, or overshadow, a non-drug environmental stimulus for control of a CR. In Experiment 1, male Sprague-Dawley rats were assigned to a group [0, 0.01, 0.03, 0.045, or 0.06 mg nicotine (base)/kg/infusion]. During each session, there were 10 intravenous infusions followed by a 30-second houselight to form a compound CS. At light offset there was 4-second access to sucrose. For Experiment 2, groups were nicotine (0.03 mg/kg/infusion) + light compound paired, nicotine + light compound unpaired, nicotine paired and light unpaired, and nicotine unpaired and light paired. Paired stimuli were presented with sucrose similar to Experiment 1. Unpaired stimuli were temporally separated from sucrose. Following acquisition, tests of nicotine and light alone were conducted by intermixing non-reinforced trails into training sessions. Nicotine dose-dependently overshadowed the light CS as shown by reduced light control of conditioned responding with higher doses. The nicotine, light, and nicotine + light compound had to be paired with sucrose to evoke a CR. These results demonstrate nicotine overshadows an exteroceptive visual stimulus. Because exteroceptive stimuli are often the focus of cue-exposure therapy, such competition may help begin to explain the marginal effectiveness of these therapies.

Limitations in the characterisation of cigarette products using different machine smoking regimes

It is recognised that no single machine smoking regime can represent the different behaviours of individual human smokers. It has been argued that the current ISO standard regime provides machine yields that are somewhat low for certain cigarette designs compared to human intake. Various cigarette machine smoking regimes have been proposed as options for regulatory use to provide data that reflect "average" or "maximum" yields as related to human intake. Some public health representatives have proposed that the intense regime mandated for testing in Canada with 100% of the ventilation holes in the cigarette filter blocked, should be used for product characterisation and that it is not necessary that it should reflect general human smoking behaviour. We believe that this is a flawed approach because our studies and those of other workers demonstrate that the conditions generated in the cigarette when using this intense machine smoking regime are extreme in comparison to the conditions found for regimes based more realistically on human smoking. In this paper, we provide data to show that smokers modify their smoking intensity over the course of smoking in response to changes in draw resistance, smoke concentrations and smoke temperatures. We compare changes in and interactions between these parameters during puffing when smoking cigarettes of different designs. Cigarettes were smoked using various machine smoking regimes previously proposed for smoke testing as well as a regime based on human smoking data from an 'in-house' study. Puffing parameters were derived from this study to represent the 'average smoker' under laboratory conditions and equivalent to the 90th percentile when the studied smokers smoked under natural conditions. Biomarker data from human uptake studies have shown that ventilation is an effective cigarette design tool to reduce total smoke constituent uptake in humans so demonstrating that any blocking of filter ventilation is far from 100%. Likewise, this current work also shows how smokers modify their smoking behaviour in ways not well reflected by the 100% ventilation blocking regime. It seems logical that any machine smoking regime chosen for future product regulation should reflect these findings for it to have valid public health relevance. In addition, it seems misguided to discourage product design features, such as ventilation, which clearly can provide products with reduced human smoke exposure, just to maintain the dogma, counter to the scientific evidence, that there must be a regulatory regime with 100% ventilation blocking.

A brief review of pharmacotherapeutic treatment options in smoking cessation: bupropion versus varenicline

PURPOSE

The purpose of this article is to compare the efficacy of two prominent medications utilized in smoking cessation: bupropion and varenicline.

DATA SOURCES

Comprehensive review of the literature on bupropion and varenicline including randomized control trials, government reports, journal reviews, and pharmaceutical inserts.

CONCLUSIONS

In all studies comparing varenicline to bupropion and/or placebo, varenicline yielded a greater cessation rate at both 3 and 12 months. Additionally, varenicline 1 mg indicated an increased potential for long-term cessation success when compared with varenicline 0.5 mg. When compared with only placebo, bupropion demonstrated a higher efficacy for cessation both at 3 and 12 months.

IMPLICATIONS FOR PRACTICE

Only 6% of the 20 million smokers who attempt to quit will succeed in long term. Clinicians must assess their patient's willingness to quit and educate them about cessation options. Knowing the efficacy of various treatment options for patients will potentially increase their success at quitting smoking. Understanding the treatment options available, allows for clinicians to provide the best possible method for smoking cessation for their patient population.

Educating smokers about their cigarettes and nicotine medications

The objective of this study was to test the efficacy of specially designed educational materials to correct misperceptions held by smokers about nicotine, nicotine medications, low tar cigarettes, filters and product ingredients. To accomplish this, 682 New York State Smokers' Quitline callers were randomized to one of two groups: control group received counseling, nicotine patches and quit smoking guide; and experimental group received counseling, nicotine patches, quit guide, plus information about cigarette characteristics mailed in a brand-tailored box. Participants were contacted 1 month later to assess knowledge about cigarettes and actions taken to alter smoking behavior. The results found that respondents in the experimental condition were more likely to report using and sharing the test materials with others compared with the control condition. Overall mean knowledge scores for the experimental group were slightly higher compared with those who received the standard materials. Knowledge of cigarette ingredients was not related to quit attempts or quitting smoking. This study found that the experimental materials were better recalled and contributed to higher levels of knowledge about specific cigarette design features; however, this did not translate into changes in smoking behavior.

[Nicotine affects biological properties of the human osteosarcoma cell line MG63]

OBJECTIVE

To evaluate the effect of nicotine on cell proliferation.

METHODS

The cells were cultured with DMEM medium containing 10% fetal bovine serum with 0, 1 x 10(-4) mol x L(-1), and 1 x 10(-3) mol x L(-1) nicotine for up to 3, 5, 7, 10, 14 days. The cell proliferation was evaluated by MTT. The alkaline phosphatase (ALP) activity was estimated by PNPP. The expression of collagen type I (COL1) and osteocalcin (OCN) were estimated by reverse transcription-polymerase chain reaction (RT-PCR).

RESULTS

Nicotine suppressed the cell proliferation. ALP activity increased to peak on 10 days in control and 1 x 10(-4) mol x L(-1) nicotine. COL1 expression increased to peak on 10 days in control and 1 x 10(-4) mol x L(-1) nicotine, but there was decreased to the minimum on 10 days and increased on 14 days in 1 x 10(-3) mol x L(-1) nicotine. OCN expression increased to peak on 10 days in control, and increased in 1 x 10(-4) mol x L(-1) nicontine from 3 days to 14 days, but there wasn't significant change in 1 x 10(-3) mol x L(-1) nicontine.

CONCLUSION

Nicotine suppresses osteogenesis through a decrease in ALP and COL1 production by osteoblasts.