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Tremonti C, Celemajer DS, Marel C, Mills K, Foo S, Wilson J, Slade T, Teesson M, Haber P. Low Risk of Cardiac Complications during Long-Term Follow-Up of Opioid Dependence. J Addict Med 2024:01271255-990000000-00330. [PMID: 38941157 DOI: 10.1097/adm.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
OBJECTIVES To prospectively assess rates of QT prolongation, arrhythmia, syncope, and sudden cardiac death (SCD) in a cohort of people with heroin dependence. METHODS To estimate rates of QT prolongation, arrhythmia, and syncope, a subcohort (n = 130) from the Australian Treatment Outcomes Study, a prospective longitudinal cohort study of 615 people with heroin dependence, underwent medical history, venepuncture, and ECG at the 18- to 20-year follow-up.To estimate rates of SCD, probabilistic matching for the entire cohort was undertaken with the Australian Institute of Health and Welfare National Death Index. Deaths were classified into suicide, accidental overdose, trauma, unknown, and disease, which were then further subclassified by probability of SCD. SCD rate was the number of possible or probable SCDs divided by total patient years from the cohort. RESULTS From the subcohort, 4 participants (3%) met the criteria for QT prolongation; 3 were prescribed methadone. Seven participants (5%) reported history of arrhythmia, including 2 transferred from methadone to buprenorphine. Thirty participants (23%) reported a previous syncopal event-14 diagnosed as nonarrhythmic syncope and 13 not investigated. In the previous 12 months, 66 participants (51%) reported heroin use; 55 participants (42%) were prescribed methadone. No participant had QTc greater than 500 milliseconds.There were 3 possible SCDs, translating to an estimated SCD rate of 0.29 (CI: 0.05, 0.8) events per 1000 patient years. More cohort members died of overdose (n = 50), suicide (n = 11), and hepatitis C (n = 4). CONCLUSIONS Low rates of QT prolongation, arrhythmia, syncope, and SCD in the cohort despite high rates of heroin use and methadone treatment.
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Affiliation(s)
- Chris Tremonti
- From the Alcohol and Drug Services, St Vincent's Hospital, Sydney, Australia (CT); Drug and Alcohol Department RPA Hospital, Sydney, Australia (CT); Faculty of Medicine and Health, University of Sydney (CT, DSC); Department of Cardiology, RPA Hospital (DS); Heart Research Institute (DSC); University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW, Australia (CM, KM, JW, TS, MT); Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (SF); Department of Cardiology, North Shore Hospital, Auckland, New Zealand (SF); Macquarie University (TS); Black Dog Institute (TS); and Drug Health Services RPA Hospital, Faculty of Health and Medicine University of Sydney, Sydney, Australia (PH)
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Wilson J, Mills KL, Sunderland M, Freeman TP, Teesson M, Haber PS, Marel C. The Long-Term Relationship Between Cannabis and Heroin Use: An 18- to 20-year Follow-Up of the Australian Treatment Outcome Study (ATOS). Am J Psychiatry 2024; 181:135-143. [PMID: 38018142 DOI: 10.1176/appi.ajp.20230088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Cannabis use is common among individuals with opioid use disorder, but it remains unclear whether cannabis use is associated with an increase or a reduction in illicit opioid use. To overcome limitations identified in previous longitudinal studies with limited follow-ups, the authors examined a within-person reciprocal relationship between cannabis and heroin use at several follow-ups over 18 to 20 years. METHODS The Australian Treatment Outcome Study (ATOS) recruited 615 people with heroin dependence in 2001 and 2002 and reinterviewed them at 3, 12, 24, and 36 months as well as 11 and 18-20 years after baseline. Heroin and cannabis use were assessed at each time point using the Opiate Treatment Index. A random-intercept cross-lagged panel model analysis was conducted to identify within-person relationships between cannabis use and heroin use at subsequent follow-ups. RESULTS After accounting for a range of demographic variables, other substance use, and mental and physical health measures, an increase in cannabis use 24 months after baseline was significantly associated with an increase in heroin use at 36 months (estimate=0.21, SE=0.10). Additionally, an increase in heroin use at 3 months and 24 months was significantly associated with a decrease in cannabis use at 12 months (estimate=-0.27, SE=0.09) and 36 months (estimate=-0.22, SE=0.08). All other cross-lagged associations were not significant. CONCLUSIONS Although there was some evidence of a significant relationship between cannabis and heroin use at earlier follow-ups, this was sparse and inconsistent across time points. Overall, there was insufficient evidence to suggest a unidirectional or bidirectional relationship between the use of these substances.
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Affiliation(s)
- Jack Wilson
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Katherine L Mills
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Matthew Sunderland
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Tom P Freeman
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Paul S Haber
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
| | - Christina Marel
- Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia (Wilson, Mills, Sunderland, Teesson, Marel); Addiction and Mental Health Group, University of Bath, Bath, U.K. (Freeman); Sydney Medical School, University of Sydney, Sydney, Australia (Haber); Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia (Haber)
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Marel C, Wilson J, Darke S, Ross J, Slade T, Haber PS, Haasnoot K, Visontay R, Keaveny M, Tremonti C, Mills KL, Teesson M. Patterns and Predictors of Heroin Use, Remission, and Psychiatric Health Among People with Heroin Dependence: Key Findings from the 18-20-Year Follow-Up of the Australian Treatment Outcome Study (ATOS). Int J Ment Health Addict 2023:1-18. [PMID: 36688114 PMCID: PMC9847452 DOI: 10.1007/s11469-022-01006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
This study aimed to investigate the long-term patterns and predictors of heroin use, dependence, and psychiatric health over 18-20 years among a cohort of Australians with heroin dependence, using a prospective longitudinal cohort study conducted in Sydney, Australia. The original cohort consisted of 615 participants, who were followed up at 3 months and 1, 2, 3, 11, and 18-20 years post-baseline; 401 (65.2%) were re-interviewed at 18-20 years. The Australian Treatment Outcome Study structured interview with established psychometric properties was administered to participants at each follow-up, addressing demographics, treatment and drug use history, overdose, crime, and physical and mental health. Overall, 96.7% completed at least one follow-up interview. At 18-20 years, 109 participants (17.7%) were deceased. Past-month heroin use decreased significantly over the study period (from 98.7 to 24.4%), with one in four using heroin at 18-20 years. Just under half were receiving treatment. Reductions in heroin use were accompanied by reductions in heroin dependence, other substance use, needle sharing, injection-related health, overdose, crime, and improvements in general physical and mental health. Major depression and borderline personality disorder (BPD) were consistently associated with poorer outcome. At 18-20 years, there is strong evidence that clinically significant levels of improvement can be maintained over the long term. The mortality rate over 18-20 years was devastating, with over one in six participants deceased. More sustained and targeted efforts are needed in relation to major depression and BPD to ensure evidence-based treatments are delivered to people with heroin dependence. Supplementary Information The online version contains supplementary material available at 10.1007/s11469-022-01006-6.
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Affiliation(s)
- Christina Marel
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Jack Wilson
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW Australia
| | - Joanne Ross
- National Drug and Alcohol Research Centre, UNSW Australia, Kensington, NSW Australia
| | - Tim Slade
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Paul S. Haber
- University of Sydney Addiction Medicine, Royal Prince Alfred Hospital, Camperdown, NSW Australia
- Sydney Local Health District Drug Health Services, Camperdown, NSW Australia
| | - Katherine Haasnoot
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Rachel Visontay
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Madeleine Keaveny
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Chris Tremonti
- Sydney Local Health District Drug Health Services, Camperdown, NSW Australia
| | - Katherine L. Mills
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
| | - Maree Teesson
- University of Sydney Matilda Centre for Research in Mental Health and Substance Use, Sydney, NSW Australia
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The role of eIF2 phosphorylation in cell and organismal physiology: new roles for well-known actors. Biochem J 2022; 479:1059-1082. [PMID: 35604373 DOI: 10.1042/bcj20220068] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/06/2023]
Abstract
Control of protein synthesis (mRNA translation) plays key roles in shaping the proteome and in many physiological, including homeostatic, responses. One long-known translational control mechanism involves phosphorylation of initiation factor, eIF2, which is catalysed by any one of four protein kinases, which are generally activated in response to stresses. They form a key arm of the integrated stress response (ISR). Phosphorylated eIF2 inhibits eIF2B (the protein that promotes exchange of eIF2-bound GDP for GTP) and thus impairs general protein synthesis. However, this mechanism actually promotes translation of certain mRNAs by virtue of specific features they possess. Recent work has uncovered many previously unknown features of this regulatory system. Several studies have yielded crucial insights into the structure and control of eIF2, including that eIF2B is regulated by several metabolites. Recent studies also reveal that control of eIF2 and the ISR helps determine organismal lifespan and surprising roles in sensing mitochondrial stresses and in controlling the mammalian target of rapamycin (mTOR). The latter effect involves an unexpected role for one of the eIF2 kinases, HRI. Phosphoproteomic analysis identified new substrates for another eIF2 kinase, Gcn2, which senses the availability of amino acids. Several genetic disorders arise from mutations in genes for eIF2α kinases or eIF2B (i.e. vanishing white matter disease, VWM and microcephaly, epileptic seizures, microcephaly, hypogenitalism, diabetes and obesity, MEHMO). Furthermore, the eIF2-mediated ISR plays roles in cognitive decline associated with Alzheimer's disease. New findings suggest potential therapeutic value in interfering with the ISR in certain settings, including VWM, for example by using compounds that promote eIF2B activity.
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Hutchison M, Aldalur A, Maisto SA, Chiang A, Abar B, Stecker T, Conner KR. Alcohol Use During COVID-19 in Adults with Severe Untreated AUD. ALCOHOLISM TREATMENT QUARTERLY 2022; 40:299-310. [PMID: 35937159 PMCID: PMC9355046 DOI: 10.1080/07347324.2022.2060156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Evidence demonstrating increased alcohol use during COVID-19 comes from low- to moderate-alcohol use samples and has yet to use adults with severe but untreated AUD. Using a community sample of adults with severe AUD, this exploratory, cross-sectional study examined associations of COVID-19 alcohol use. Participants were recruited for a phase-II RCT. Only baseline measures, completed prior to randomization, were analyzed in the present study. Key variables were alcohol consumption, COVID-19-related worries and experiences, and qualitative responses of 1) alcohol use and 2) positive changes during COVID-19. 176 pariticpants recruited since COVID-19 were on average 41.4 years old, 49.1% female, and 79% White. Participants drank alcohol nearly 23 of the past 30 days, consumed 7 standard drinks per drinking day, and nearly 90% reported increased alcohol use. More heavy episodic drinking was reported in the first six-months of COVID-19 and more COVID-related concerns in the most recent six-months. Participants reported drinking increased due to "more time on their hands", but the pandemic also "strengthened relationships". Results affirm an increase in alcohol use during COVID-19 in adults with severe, untreated AUD. Findings underscore the need to understand how alcohol use and pandemic-related circumstances may influence one another for adults with severe AUD.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Aileen Aldalur
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Stephen A. Maisto
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Andrew Chiang
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kenneth R. Conner
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA
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