8 results on '"David H. Epstein"'
Search Results
2. Kratom use as more than a 'self-treatment'
- Author
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Kirsten E. Smith, Kelly E. Dunn, Jeffrey M. Rogers, Oliver Grundmann, Christopher R. McCurdy, Albert Garcia-Romeu, Destiny Schriefer, Marc T. Swogger, and David H. Epstein
- Subjects
Psychiatry and Mental health ,Clinical Psychology ,Medicine (miscellaneous) - Published
- 2022
- Full Text
- View/download PDF
Catalog
3. Kava (
- Author
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Salma, Pont-Fernandez, Marina, Kheyfets, Jeffrey M, Rogers, Kirsten E, Smith, and David H, Epstein
- Published
- 2022
4. When an obscurity becomes trend: social-media descriptions of tianeptine use and associated atypical drug use
- Author
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Justin C. Strickland, David H. Epstein, Jeffery M Rogers, and Kirsten E. Smith
- Subjects
medicine.medical_specialty ,Thiazepines ,media_common.quotation_subject ,Receptors, Opioid, mu ,Medicine (miscellaneous) ,Context (language use) ,Drug Users ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,medicine ,Humans ,Tianeptine ,Psychiatry ,media_common ,Addiction ,Cognition ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,Opioid ,Antidepressant ,Psychology ,Social Media ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Background: Originally believed to be an atypical antidepressant acting at serotonin transporters, tianeptine is now known to also be an atypical agonist at mu-opioid receptors. Its nonmedical use may be increasing amidst the broader context of novel drug and supplement use. Objectives: To analyze social-media text from current, former, and prospective tianeptine users for better understanding of their conceptualizations of tianeptine, motives for and patterns of use, and reported benefits and harms. Methods: Reddit posts were obtained and thematically coded; additional quantitative analyses were conducted. Results: A total of 210 posts mentioning tianeptine were made between 2012 and 2020. Eighteen thematic categories were identified, 10 of which were consistent with expected themes. Two independent raters coded all text, generating 1,382 unique codes, of which 1,090 were concordant (78.9% interrater agreement). Tianeptine use was frequently associated with use of other drugs, particularly kratom, phenibut, and racetams. People conceptualized and variously used tianeptine as an opioid, antidepressant, and “nootropic” (cognitive enhancer). Between 2014 and 2020, mentions of positive effects decreased, while mentions of adverse effects and withdrawal increased. Motivations for use included substitution or withdrawal mitigation for other drugs (especially opioids) and for kratom itself; self-treatment for psychiatric symptoms; and improvement of quality of life, mood, or performance. Descriptions of tolerance, withdrawal, and addiction were evident. Intravenous use was rare and strongly discouraged, with detrimental effects described. Conclusion: Tianeptine is recognized as an opioid (though not only an opioid) in online communities. Posts describe benefits, acute risks, and patterns of co-use that warrant greater clinical attention. more...
- Published
- 2021
5. Using ecological momentary assessment to examine the relationship between craving and affect with opioid use in a clinical trial of clonidine as an adjunct medication to buprenorphine treatment
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Jia-Ling Lin, Karran A. Phillips, Kenzie L. Preston, Landhing M. Moran, William J. Kowalczyk, Udi E. Ghitza, Jeremiah W. Bertz, Massoud Vahabzadeh, and David H. Epstein
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Adult ,Male ,Ecological Momentary Assessment ,Narcotic Antagonists ,Medicine (miscellaneous) ,Craving ,Placebo ,Article ,Clonidine ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,mental disorders ,Adrenergic alpha-2 Receptor Agonists ,Opiate Substitution Treatment ,Humans ,Medicine ,business.industry ,Ecology ,Opioid use disorder ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,Buprenorphine ,030227 psychiatry ,Clinical trial ,Affect ,Psychiatry and Mental health ,Clinical Psychology ,Mood ,Opioid ,Linear Models ,Drug Therapy, Combination ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
BACKGROUND: In a recent clinical trial (NCT00295308), we demonstrated that clonidine decreased the association between opioid craving and moderate levels of stress and affect in patients receiving buprenorphine-based opioid agonist therapy. OBJECTIVES: To examine the relationship between illicit opioid use and craving and affect during the evaluation of clonidine as an adjunct medication in buprenorphine treatment for opioid use disorder. Secondarily, to examine whether those relationships are driven by within- or between-participant factors. METHODS: This was a secondary data analysis from our original trial. Participants (N = 108, female: n = 23, male n =85) receiving buprenorphine were randomized to receive adjunct clonidine or placebo. Participants used portable electronic devices to rate stress, mood, and craving via ecological momentary assessment (EMA) four times randomly each day. To associate the EMA data with illicit opioid use, each EMA report was linked to participants’ next urine drug screen (thrice weekly). We used generalized linear mixed models to examine the interaction between treatment group and illicit opioid use, as well as to decompose the analysis into within- and between-participant effects. RESULTS: Craving for opioids and cocaine was increased when participants were using illicit opioids; this effect was greater in the clonidine group. For affect, mood was poorer during periods preceding opioid-positive urines than opioid-negative urines for clonidine-treated participants, whereas there was no difference for placebo participants. CONCLUSION. This secondary analysis provides evidence that illicit opioid use was linked to stronger negative affect and craving in participants maintained on clonidine in opioid agonist therapy. more...
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- 2018
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6. Sex differences in daily life stress and craving in opioid-dependent patients
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Landhing M. Moran, William J. Kowalczyk, Karran A. Phillips, Mustapha Mezghanni, Kenzie L. Preston, Jia-Ling Lin, Massoud Vahabzadeh, and David H. Epstein
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Adult ,Male ,Cue induced craving ,Ecological Momentary Assessment ,Medicine (miscellaneous) ,Craving ,behavioral disciplines and activities ,Article ,03 medical and health sciences ,Cocaine-Related Disorders ,0302 clinical medicine ,Sex Factors ,mental disorders ,Outpatients ,Opiate Substitution Treatment ,Medicine ,Humans ,Drug craving ,Life stress ,business.industry ,digestive, oral, and skin physiology ,Opioid dependent ,Middle Aged ,Opioid-Related Disorders ,030227 psychiatry ,Analgesics, Opioid ,Psychiatry and Mental health ,Clinical Psychology ,Affect ,behavior and behavior mechanisms ,Female ,Smartphone ,medicine.symptom ,Cues ,business ,psychological phenomena and processes ,030217 neurology & neurosurgery ,Stress, Psychological ,Clinical psychology - Abstract
Responses to stress and drug craving differ between men and women. Differences in the momentary experience of stress in relation to craving are less well-understood.Using ecological momentary assessment (EMA), we examined sex differences in real-time in two areas: (1) causes and contexts associated with stress, and (2) the extent to which stress and drug cues are associated with craving.Outpatients on opioid-agonist treatment (135 males, 47 females) reported stress, craving, and behavior on smartphones for 16 weeks. They initiated an entry each time they felt more stressed than usual (stress event) and made randomly prompted entries 3 times/day. In stress-event entries, they identified the causes and context (location, activity, companions), and rated stress and craving severity.The causes reported for stress events did not differ significantly by sex. Women reported arguing and being in a store more often during stress events, and men reported working more often during stress events, compared to base rates (assessed via random prompts). Women showed a greater increase in opioid craving as a function of stress (p 0.0001) and had higher stress ratings in the presence of both stress and drug cues relative to men (p 0.01). Similar effects were found for cocaine craving in men (p 0.0001).EMA methods provide evidence based on real-time activities and moods that opioid-dependent men and women experience similar contexts and causes for stress but differ in stress- and cue-induced craving. These findings support sex-based tailoring of treatment, but because not all participants conformed to the overall pattern of sex differences, any such tailoring should also consider person-level differences. more...
- Published
- 2018
7. Serum Cortisol Secretion During Heroin Abstinence Is Elevated Only Nocturnally
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Jing Li, Lin Lu, Su Xia Li, Thomas R. Kosten, Xiang Yang Zhang, and David H. Epstein
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Adult ,Male ,Hypothalamo-Hypophyseal System ,medicine.medical_specialty ,Time Factors ,Hydrocortisone ,medicine.drug_class ,media_common.quotation_subject ,Radioimmunoassay ,Pituitary-Adrenal System ,Medicine (miscellaneous) ,Article ,Heroin ,Internal medicine ,medicine ,Humans ,Circadian rhythm ,media_common ,Heroin Dependence ,Diurnal temperature variation ,Abstinence ,Circadian Rhythm ,Substance Withdrawal Syndrome ,Psychiatry and Mental health ,Clinical Psychology ,Endocrinology ,Case-Control Studies ,Corticosteroid ,Psychology ,Glucocorticoid ,medicine.drug - Abstract
Several studies indicate abnormalities in the hypothalamic-pituitary-adrenal axis (HPA) during acute opiate withdrawal, but protracted withdrawal has gotten less study. The current study further characterized the 24-hour time course of plasma cortisol levels in heroin-dependent individuals who were abstinent for 10–15 days, which is beyond the 5 days of acute withdrawal, compared to demographically matched healthy controls using samples collected every 3 hours over 24 hours and assessed with radioimmunoassay (RIA). The abstinent heroin-dependent participants had significantly higher plasma cortisol levels nocturnally suggesting a loss of diurnal variation in these heroin subjects. more...
- Published
- 2008
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8. A meta-analysis of retention in methadone maintenance by dose and dosing strategy
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Jie Shi, Lin Lu, Zhimin Liu, Cun Du, Yanping Bao, and David H. Epstein
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Methadone maintenance ,Substance-Related Disorders ,Medicine (miscellaneous) ,Placebo ,Article ,law.invention ,Randomized controlled trial ,law ,medicine ,Odds Ratio ,Humans ,Dosing ,Randomized Controlled Trials as Topic ,Dose-Response Relationship, Drug ,business.industry ,Odds ratio ,Confidence interval ,Psychiatry and Mental health ,Clinical Psychology ,Anesthesia ,Meta-analysis ,Patient Compliance ,Regression Analysis ,business ,Methadone ,medicine.drug - Abstract
To estimate, via meta-analysis, the influence of different methadone dose ranges and dosing strategies on retention rates in methadone maintenance treatment (MMT).A systematic literature search identified 18 randomized controlled trials (RCTs) evaluating methadone dose and retention. Retention was defined as the percentage of patients remaining in treatment at a specified time point. After initial univariate analyses of retention by Pearson chi-squares, we used multilevel logistic regression to calculate summary odds ratios (ORs) and 95% confidence intervals for the effects of methadone dose (above or below 60 mg/day), flexible vs. fixed dosing strategy, and duration of follow-up.The total number of opioid-dependent participants in the 18 studies was 2831, with 1797 in MMT and 1034 receiving alternative mediations or placebo. Each variable significantly predicted retention with the other variables controlled for. Retention was greater with methadone dosesor = 60 than with doses60 (OR: 1.74, 95% CI: 1.43-2.11). Similarly, retention was greater with flexible-dose strategies than with fixed-dose strategies (OR: 1.72, 95% CI: 1.41-2.11).Higher doses of methadone and individualization of doses are each independently associated with better retention in MMT. more...
- Published
- 2009
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