Tag: user_id 13800

Alcohol use was the most common predictor of escalating cannabis vaping among youth and young adults, independent of demographic factors, according to research by UTHealth Houston published this month in the journal Social Science & Medicine. 

Cannabis vaping is the use of electronic cigarette delivery of liquid tetrahydrocannabinol (THC), a concentrated form of cannabis that has been extracted and diluted into a liquid solution.Vaping cannabis has grown in popularity among young people in the U.S., according to the Substance Abuse and Mental Health Services Administration

“A decade ago, 10% of cannabis users vaped it. Now, the number is about 75%, at least for youth and young adults,” said Dale Mantey, PhD, assistant professor of health promotion and behavioral sciences at UTHealth Houston School of Public Health. “That is a major public health concern for many reasons.”

Cannabis vaping in youth and early adulthood can affect cognitive development and performance, including learning, memory, and attention; lead to the onset of chronic pulmonary damage from black market liquid THC products, as well as an increase in dependence on the drug; and result in incarceration due to federal prohibitions, which list cannabis as a Schedule I drug.

In this study, researchers focused on identifying the predictors of behavior of cannabis users and nonusers. The data included middle to high school students in Dallas/Fort Worth, San Antonio, Austin, and Houston. The students were surveyed from 2019 to 2021 and asked two questions: “Have you ever smoked marijuana or liquid THC from an electronic cigarette?” And “During the past 30 days, how many days did you smoke marijuana from an electronic cigarette?” The students were also asked to self-report their racial and ethnic identity, gender, nicotine usage, and alcohol consumption. Researchers also investigated two indicators of mental health among the student population: anxiety and depression.

“If we know what predicts that behavior, those are the things we can try to target for addressing and preventing cannabis vaping among youth,” Mantey said.

At the beginning of the study , 72.7% reported never cannabis vaping, 12.7% reported ever cannabis vaping, and 14.5% reported current cannabis vaping. Through the three-year duration of the study, the risk for cannabis vaping experimentation (never to current) was significantly higher among non-Hispanic Blacks relative to non-Hispanic whites and non-Hispanic other groups. 

Alcohol proved to be a consistent factor in those who had never vaped cannabis to begin or experiment. Researchers referred to alcohol as a “gateway” to cannabis vaping, “The ultimate goal is to delay initiation of substances in youth because the later someone initiates a substance, the less likely they are to become addicted to it,” Mantey said. “Since alcohol was shown to be a strong predictor, we need more comprehensive interventions. When we go into schools and talk about nicotine, vaping, or tobacco prevention, we need to make sure we are incorporating cannabis prevention and alcohol prevention, not just one substance.”

Depression predicted cannabis vaping initiation among Hispanics and non-Hispanic Blacks groups. The authors said more research is needed to understand the impact depression and other mental health problems may have on cannabis vaping among various demographics so public health intervention can target the most at-risk groups.

Additional UTHealth Houston authors included Stephanie L. Clendennen, DrPH, MPH; Baojiang Chen, PhD; Sana Amin, MPH; and Melissa B. Harrell, PhD, MPH.

Media inquiries: 713-500-3030

BYLINE: Dr. Asif Ilyas

The emergence of xylazine in the illicit drug supply marks a new chapter in the ongoing overdose crisis. This veterinary tranquilizer, often mixed with fentanyl, poses significant risks to public health and challenges our existing strategies for combating drug abuse and overdose deaths.

Xylazine, known on the streets as “tranq,” has rapidly spread across the United States. The Drug Enforcement Administration reports that xylazine and fentanyl mixtures have been seized in 48 out of 50 states. In 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine. This widespread presence indicates a growing threat that demands immediate attention.

The dangers of xylazine are multifaceted. When combined with opioids like fentanyl, it increases the risk of fatal overdose. Xylazine can cause dangerous decreases in breathing, heart rate, and blood pressure. Unlike opioid overdoses, xylazine-related overdoses do not respond to naloxone, the standard overdose reversal medication. This complicates emergency response efforts and puts additional strain on our healthcare system.

Moreover, repeated xylazine use is associated with severe skin wounds, including open sores and abscesses. These wounds can lead to tissue death and, in extreme cases, require amputation. The medical community is still grappling with how to treat these xylazine-related injuries effectively.

As we confront this new crisis, we must learn from our experiences with the opioid epidemic. The rapid spread of xylazine mirrors the trajectory of fentanyl, which began in white powder heroin markets in the Northeast before expanding nationwide. This pattern suggests that xylazine use will likely increase and become more prevalent in the illicit drug supply.

To address this emerging threat, we need a comprehensive, multi-faceted approach. This includes increased awareness, expanded testing capabilities, and the development of targeted treatment strategies. Healthcare providers, first responders, and harm reduction organizations need to be educated about xylazine and its effects to provide appropriate care and interventions.

Research is crucial in understanding xylazine’s impact on the body, its role in the overdose crisis, and potential treatment options. The National Institute on Drug Abuse is supporting studies to explore these areas, but more resources and attention are needed.

Policymakers must also consider the regulatory landscape surrounding xylazine. While it is not currently a controlled substance under federal law, some states have begun to place it on their controlled substances lists. In Pennsylvania, Governor Josh Shapiro signed into law Act 17 of 2024, bipartisan legislation to permanently list Xylazine as a controlled substance.  A balanced approach that restricts illicit use while maintaining legitimate veterinary access is necessary.

It’s one of the reasons we are organizing the symposium “The Next Chapter of the Opioid Epidemic in Pennsylvania: The Xylazine Crisis” and making it free for medical professionals and students. By bringing together state government policymakers, physicians, and surgeons, this event will foster crucial discussions on the current state of the crisis and evidence-based treatment strategies.

As we face this new challenge, collaboration between government agencies, healthcare providers, researchers, and community organizations is essential. We must act swiftly and decisively to prevent xylazine from exacerbating the already devastating impact of the opioid crisis. By learning from past experiences and adapting our approaches, we can work towards mitigating the harm caused by xylazine and protecting public health.

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Dr. Asif Ilyas is President of the Rothman Opioid Foundation in Philadelphia, a Professor of Orthopaedic Surgery at Thomas Jefferson University, and an Associate Dean of Clinical Research at the Drexel University College of Medicine.

Study Identifies Pregnant Women at Risk for Substance Use

STONY BROOK, NY, November 18, 2024 – Use of tobacco, alcohol, cannabis, and illicit drugs is dangerous in pregnancy, increasing risks of stroke, miscarriage, preterm delivery, low birth weight and infant neurodevelopmental problems. Yet according to the 2020 National Survey of Drug Use and Health, more than 20 percent of pregnant women in the United States report using one or more of these substances. Public health experts agree on the need to identify pregnant women who are most vulnerable to using harmful substances. A new study published in the Journal of Addiction Medicine conducted by a team of Stony Brook University researchers used the PROMOTE Prenatal Screener – a unique screening tool for use during pregnancy – to pinpoint vulnerabilities for substance use.

The study, led by Heidi Preis, MSW, PhD, Assistant Professor of Research in the Department of Obstetrics, Gynecology and Reproductive Medicine in the Renaissance School of Medicine (RSOM), focused on vulnerabilities for tobacco, cannabis, or alcohol use in pregnancy.

“When patients complete the PROMOTE at the start of their prenatal care, their health care providers can identify any psychological, social, or other needs and determine whether a particular patient is likely to use harmful substances during pregnancy,” explains Preis, who also has academic affiliations and collaborates with Stony Brook’s Program in Public Health and Department of Psychology. “This way a patient’s needs can be addressed very early and she can be referred for counseling, treatment, or resources, and this reduces harms for both mother and child.”

Preis and colleagues developed the PROMOTE with a grant from the National Institutes of Health’s National Institute on Drug Abuse (NIDA). Prior to its creation, a comprehensive yet concise screening tool to detect psychosocial and substance use risk was not available in prenatal care settings. The PROMOTE includes 18 core items that address vulnerabilities in areas such as education, financial stability, living conditions, partner and family stress and support, exposure to violence, and mental health.

For their current study, the team reviewed medical charts of 1,842 patients who completed the PROMOTE during their first prenatal visit to a New York State health system outpatient clinic.  They found that 188 patients (10.2%) used at least one substance during pregnancy, including 132 (7.2%) tobacco, 50 (2.7%) cannabis, and 45 (2.4%) alcohol. Patients with limited education were most likely to use tobacco during pregnancy, single and unpartnered patients were most likely to use cannabis, and those who experienced a major stressful life event were most likely to use alcohol during pregnancy. Other vulnerabilities were also associated with harmful substance use.

Their study results highlight the value of using a well-developed screening tool to gain a better understanding of the life context of pregnant patients and identify those who are most vulnerable or might be struggling with substance use. Preis stresses that addressing their needs has great potential to improve the health and well-being of pregnant women and their children.

Co-authors and collaborators on the PROMOTE project include: Marci Lobel, PhD, Department of Psychology and Department of Obstetrics, Gynecology and Reproductive Medicine; Cassandra Heiselman, DO, Department of Obstetrics, Gynecology and Reproductive Medicine; Ayesha Azeem, RSOM student and first author of the publication; David Garry, MD, Department of Obstetrics, Gynecology and Reproductive Medicine.

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SUMMARY POINTS

• Race influences the treatments of opioid use disorders.
• There is an opioid crisis and a health disparities crisis.
• Racial equity should include increasing access for treatment, funding harm reduction programs and expanding community-based services such as employment, housing, and recovery support for those with opioid use disorder. 

ANALYSIS

Background

The United States listed the opioid crisis as a public health emergency (1). Concurrently, the United States has a racial health disparities crisis that is evident as patients from various races receive different health care treatments (2). The opioid crisis has impacted all racial groups, with incidence rates of 11.9, 9.3%, and 9.6% in the White, Black, and Hispanic populations, respectively(3). 

Multiple studies have listed that racial disparities in pain treatment are associated with lower opioid use in minority patients during the beginning of liberalized opioid use in clinical settings (4). Disparities in pain treatment usually involve decreased access to medication by the patients, and biases in pain assessment and management by healthcare providers; and differential workers compensation for pain-related claims (5). A meta-analysis utilizing data from  1989-2011 found that Hispanic and Black patients had a 22% and 30% lower rate of obtaining an opioid prescription compared to white patients, respectively (5). In 2010, due to better regulation of opioid prescriptions, heroin use and other synthetically produced opioids increased, leading to a crisis of opioid related deaths (6).

Opioid Use Disorder (OUD) is the chronic use of opioids that leads to habitual drug seeking and includes reduced self-control, participation in risky behavior and social impairments (7). Although treatment for OUD, discrimination continues to affect the care provided to the minority population (7). It is known that treatment for OUD can reduce the overdose rate, increase patient involvement in addiction programs when discharged and decrease overall health care utilization (8). Unfortunately, communities that have a higher number of Black and Hispanic residents have reduced health care resources that can provide the recommended interventions for OUD. When controlling for factors such as overdose burden, socioeconomic status and hospital risk factors; minority communities are still less likely to have access to essential harm reduction services(8). 

FIGURE 1: U.S Drug Overdose death rate 

[SEE ARTICLE from the CDC]

Analysis

Only 20% of patients with OUD get treatment despite the studied benefits such as reduced risk of mortality (10). Research has shown that racial minorities are less likely to obtain treatment for OUD from health care providers when compared to white counterparts(8). In 2019, Black and Hispanic with diagnosed OUD were 30% less likely than White patients to be offered treatment (11). 

There have been numerous public strategies taken to improve opioid misuse. Unfortunately, public health campaigns primarily focus on White communities and ultimately decreased the rate of OUD and opioid related death for White patients alone rather than the combination with minority patients (12). As a result of minority patients receiving less community support and resources for OUD, individuals resort to self-medicating with fentanyl and heroin which increases opioid misuse within these populations (12). In 2019, opioid related mortality rates decreased by 0.3% in White patients but increased by 20% in Black patients (13). 

A quantitative analysis on the intersection of race and opioid use disorder treatment observed how race influences treatment for OUD. This study used patient information from the Treatment Episode Data Set Discharges (TEDS-D), a nationwide study utilizing data of patients discharged from substance use disorder (SUD) treatment programs (14). The dataset includes information on treatment episodes and admissions to SUD treatment programs including programs in public and privately owned facilities. TEDS-D also included information from institutions such as state prisons. The study only used information from patients with a DSM-IV diagnosis of OUD between 2013 to 2017. From this data, researchers observed that being a minority is linked with a reduced chance of being referred to treatment by a healthcare worker. Data also showed that compared to their White counterparts, minority patients had a reduced likelihood of receiving appropriate OUD medication as part of the treatment plan. This study, as with many others, concluded that change is required to address this problem. This study primarily focused on policymakers and how to implement these findings to create interventions for OUD that acknowledge race. Public health interventions could help to address the discrepancies in treatment gaps that this study identified.

Discussion

Additional studies are needed to develop more efficacious strategies to address race for OUD. Across multiple studies, it is noted that areas with more economic instability and distress reported higher drug use. There are other factors discussed such as income, housing instability, transportation, insurance, biases, and mistrust in the healthcare system that influence access to treatment. Interventions in the local, state, and national policy levels are critical to tackle these issues. 

Interventions such as linkage and retention in care while not criminalizing patients with OUD and access to treatment and harm reduction services are beneficial in minority communities. Ultimately, intervention and prevention strategies must include evidence based and culturally receptive tools that use social determinants of health to reduce biases surrounding treatment. These tools include culturally targeted campaigns and hiring community prevention liaisons or ambassadors to assist with decreasing mistrust and increasing accessibility to treatment and reduction services. Opioid misuse is preventable. Integrating efforts with an emphasis on childhood experiences that increase the risk for OUD, as well as applying trauma-informed care, is essential for improving minority communities that have been affected by years of discriminatory policies. 

Newswise — University of Maryland School of Medicine Researchers Identify Neurobiological Changes Leading to Increase Release of the Brain Chemical Dopamine and Its Target Neurons Linked to Addiction-Like Behavior 

With the increased legalization of recreational cannabis, as many as 1 in 5 pregnant women in the U.S. are now using the drug to help with morning sickness, lower back pain or anxiety. Evidence has been growing, however, to suggest that tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis, poses risks to the developing fetus by impacting brain development. Now a new study finds that this could increase the risk of addiction to opioids later in life.  

The preclinical animal study, led by researchers at the University of Maryland School of Medicine, was published in the journal Science Advances. It found that prenatal exposure to THC causes a rewiring of the fetal brain.  THC caused certain brain cells, called dopamine neurons, to respond in a hyperactive way, causing a heightened increase in dopamine release.  This was accompanied by heightened neuronal responsiveness to cues associated with rewards like a light turning on to indicate that food or an opioid drug was available.

“Doctors are contending with an explosion of cannabis use, and the THC content has quadrupled from what it was a generation ago,” said study corresponding author Joseph Cheer, PhD, a Professor of Neurobiology and Psychiatry at the University of Maryland School of Medicine. “It demonstrates the enduring consequences that prenatal cannabis exposure exerts on the brain’s reward system, which ultimately results in a neurobiological vulnerability to opioid drugs.”

The American College of Obstetricians and Gynecologists recommends that doctors counsel patients on concerns about potential adverse health consequences of continued use of cannabis during pregnancy. Dr. Cheer and others doing research on THC exposure during pregnancy are racing to learn more about the health consequences on developing fetuses to help doctors better counsel their patients on the drug’s effects.

To conduct this new study, he and his colleagues found that fetuses exposed to a moderately low dose of THC (equivalent to their mothers smoking one to two joints per day) developed changes in how their reward system functioned, causing them to develop an at-risk phenotype for opioid seeking. Animals previously exposed to THC in utero display a dramatically increased motivation to press a lever that would deliver a dose of opioid drugs compared to those that were not previously exposed to THC. 

When THC-exposed animals reached early adulthood, they were more likely to show enhanced opioid-seeking and were more likely to relapse upon opioid-associated environmental cues compared to those animals who were not exposed to THC in the womb. They were also more likely to develop persistent addiction-like behaviors.

In a follow-up experiment, the researchers implanted tiny sensors in the animals’ brains and measured heightened dopamine release, accompanied by activity in neurons that over-represented opioid-related cues, in the rats exhibiting strong addiction-like behaviors.

“These observations support the hypothesis of a hypersensitized ‘wanting’ system that develops in the brain after exposure to THC during prenatal development,“  said Dr. Cheer. “Interestingly, we found that this opioid-seeking phenotype occurs significantly more in males compared to females, and we are currently performing research with our colleagues at UMSOM, to determine why this is the case.” 

Dr. Cheer’s previous work published in the journal Nature Neuroscience found prenatal exposure to THC makes the brain’s dopamine neurons hyperactive, which may contribute to an increased risk of psychiatric disorders like schizophrenia. His work has been independently verified by three independent laboratories throughout the world.

Along with his colleague Mary Kay Lobo, PhD, Professor of Neurobiology at UMSOM, Dr. Cheer serves as the co-director of the Center for Substance Use in Pregnancy, which is part of UMSOM’s Kahlert Institute for Addiction Medicine. The two are working with a team of researchers to investigate the enduring effects of drug and alcohol exposure in the womb.

“We need to more fully understand the enduring effects of THC exposure in the womb and whether we can reverse some of the deleterious effects through CRISPR-based gene therapies or repurposed drugs,” said UMSOM Dean Mark T. Gladwin, MD, who is the John Z. and Akiko K. Bowers Distinguished Professor and vice president for medical affairs at the University of Maryland, Baltimore. “We also need to provide better advice to pregnant patients, many of whom are using cannabis to help control anxiety because they think this drug is safer for their baby than traditional anti-anxiety medications.”  

The study was funded by the National Institute on Drug Abuse (Grant: R01 DA022340)  (Grant: K99 DA060209).  UMSOM faculty member Miguel A. Lujan, PhD, a research associate in Neurobiology, was the first author of the paper. 

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has more than $500 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2023, the UM School of Medicine is ranked #10 among the 92 public medical schools in the U.S., and in the top 16 percent (#32) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

Newswise — Pennsylvania legislators and top medical experts will come together to address the growing xylazine crisis at an upcoming free symposium. The event, titled “The Next Chapter of the Opioid Epidemic in Pennsylvania: The Xylazine Crisis,” will be held on November 23, 2024, at the Bluemle Life Science Building at Jefferson Med in Philadelphia.

State Representative Rick Krajewski (D, Philadelphia), Subcommittee Chair on Health Care for the House Health Committee (Majority), and State Representative Mary Jo Daley (D, Montgomery), House Democratic Chair of the Women’s Health Caucus, will be among the key speakers at the symposium. Their participation underscores the importance of this issue at the state level and the need for collaborative efforts between policymakers and healthcare professionals.

The symposium, organized by the Rothman Orthopaedic Institute Foundation for Opioid Research & Education, will run from 8:30 am to 12:30 pm and is open to all medical professionals and students across Pennsylvania. This no-cost event offers a unique opportunity to gain critical insights into the xylazine crisis from legislative and medical perspectives.

In addition to the legislators, the symposium will feature presentations from a diverse group of medical experts. Daniel (Danny) Teixeira da Silva, MD, MSHP, Medical Director of the Division of Substance Use Prevention and Harm Reduction at the Philadelphia Health Department, will bring valuable insights from the public health sector.

The event comes at a crucial time as Pennsylvania grapples with the increasing impact of xylazine, a veterinary tranquilizer that has infiltrated the state’s illicit drug supply. Xylazine, commonly known as “tranq,” is a veterinary tranquilizer that has been found in illicit drug supplies, often mixed with fentanyl without users’ knowledge. The drug can cause dangerous decreases in breathing, heart rate, and blood pressure and is not affected by traditional overdose reversal medications.  Repeated xylazine use is associated with skin wounds, including open sores and abscesses.

The symposium will cover topics such as understanding the xylazine crisis, public policy related to xylazine, and medical and surgical management of xylazine-related issues. Sessions include Bioethical Considerations of Surgical Management, Harm Reduction Strategies for Xylazine Exposure, Surgical Management Strategies (Debridement), Surgical Management Strategies (Flap), Surgical Management Strategies (Wound Care), and an Inpatient Addiction Medicine Strategy. Several sessions on public policy and Xylazine will also be held.

The event’s chairpersons are Dr. Asif Ilyas, President of the Rothman Opioid Foundation and Professor of Orthopaedic Surgery at Drexel University College of Medicine, and Dr. Katherine Woozely, Head of Orthopaedic Hand and Nerve Surgery and Associate Professor of Orthopaedic Surgery at Cooper Medical School of Rowan University.

The program will feature presentations from experts in various fields, including toxicology, addiction medicine, orthopaedic surgery, plastic surgery, and family medicine.  Speakers include Rachel Haroz, MD, Head of Toxicology and Addiction Medicine and Associate Professor of Emergency Medicine at Cooper Medical School of Rowan University; Andrew Miller, Assistant Professor of Orthopaedic Surgery at Thomas Jefferson University; Lisa Rae, MD, Associate Professor of Surgery at Temple University School of Medicine; Mark Solarz, MD, Associate Professor of Orthopaedic Surgery at Thomas Jefferson University;  Rick Tosti, MD, Assistant Program Director of Hand Surgery and Associate Professor of Orthopaedic Surgery at Thomas Jefferson University; Lara Weinstein, MD; Program Director of Addiction Medicine and Professor of Family Medicine at Thomas Jefferson University; and Jason Wink, MD, Assistant Professor of Plastic Surgery at the University of Pennsylvania School of Medicine; and Erum Ilyas, MD, Associate Professor and the interim academic chair of the provisional Department of Dermatology at Drexel University. Jonathan Bigley of the government relations firm Bigley & Blikle will lead a panel discussion Q&A. 

Interested participants can register for the symposium at https://www.rothmanopioid.org/. While the symposium will not grant CME credit, it offers a valuable opportunity for medical professionals and students to gain insights into the emerging xylazine crisis and its impact on public health in Pennsylvania.

About the Rothman Institute Foundation for Opioid Research and Education.

The Rothman Orthopaedic Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use – respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies while working to mitigate opioid abuse and addiction. https://www.rothmanopioid.org/

Newswise — PLYMOUTH MEETING, PA [November 13, 2024] — The National Comprehensive Cancer Network^® (NCCN^®)—an alliance of leading cancer centers—today announced the publication of a new patient guideline designed to provide critical support and guidance for individuals with cancer who are seeking to quit smoking. Continued smoking elevates the risk of developing additional cancers, reduces the effectiveness of treatment, exacerbates treatment side effects, and is associated with shorter survival. The new NCCN Guidelines for Patients^®: Quitting Smoking explains how to best use the tools that exist to help anyone quit for good. While focused on smoking cessation strategies in people with cancer, the information is also useful for smokers who do not have a cancer diagnosis.

“For every patient with cancer who is smoking at diagnosis or anytime during their cancer journey, quitting is absolutely possible. Quitting earlier is better, but any time helps,” said Peter G. Shields, MD, of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute. Dr. Shields serves as Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Smoking Cessation, which develops evidence-based, expert consensus-driven recommendations intended for care providers. “By empowering patients with the same information that doctors use, we aim to make quitting smoking a more achievable goal, even for those who have struggled in the past. Smoking cessation requires the active work of both the patient and the health care provider. These patient guidelines are so critical for closing that loop for best success.”

The NCCN Guidelines for Patients: Quitting Smoking offers a fresh perspective and renewed hope for those who have previously tried to quit smoking without success and those who want to quit but haven’t yet taken initial steps. The book takes an encouraging, judgement-free approach, recognizing that slips and lapses are common and that a combination of therapies, rather than a one-size-fits-all solution, is often the key to success. It features multiple evidence-based options, including details on nicotine replacement therapy (NRTs), behavior therapy, and non-nicotine medicines.

The NCCN Guidelines for Patients: Quitting Smoking are available to view or download for free online at NCCN.org/patientguidelines or via the NCCN Patient Guides for Cancer App, thanks to funding from the NCCN Foundation^®. Printed versions are available for a nominal fee at Amazon.com. A Spanish version will also be publishing soon.

“People with cancer understand the critical importance of quitting smoking, but the addiction is powerful. These NCCN Guidelines for Patients are designed to engage patients actively in their own care, turning smoking cessation into a collaborative, two-way conversation between patient and caregivers and their care team,” added Dr. Shields. “They offer easy-to-understand tools and support needed to make this challenging journey a success.”

“People with cancer have more than enough stress in their lives,” noted Patrick Delaney, Executive Director of the NCCN Foundation. “They and their doctors are engaged first and foremost with addressing the cancer itself. We hope this new patient guideline can be an added resource that empowers people to recognize they have options when it comes to quitting smoking, even while they may be focused on other medical treatments.”

The full library of NCCN Guidelines for Patients includes more than 70 free books providing people with cancer and their loved ones with easy-to-understand information about prevention, screening, diagnosis, treatment, and supportive care for nearly every type of cancer. They have received numerous awards over the years and are widely recognized as a trustworthy source for free health information online.

Other supportive care topics covered by the NCCN Guidelines for Patients include how to manage fatigue, distress, or nausea and vomiting during cancer treatment. Visit NCCN.org/patients to view all of the books and other informational offerings in multiple languages.

To help support NCCN patient guidelines, patient webinars, and other free resources for people with cancer and their caregivers, visit NCCN.org/foundation.

# # #

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients^® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation^®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

About the NCCN Foundation

The NCCN Foundation empowers people with cancer and their caregivers by delivering unbiased expert guidance from the world’s leading cancer experts through the library of NCCN Guidelines for Patients® and other patient education resources. The NCCN Foundation is also committed to advancing cancer treatment by funding the nation’s promising young investigators at the forefront of cancer research. For more information about the NCCN Foundation, visit nccnfoundation.org.

Newswise — Online e-cigarette retailers are not consistently adhering to laws aimed at preventing the sale of vaping products to minors, including regulations on age verification, shipping methods and flavor restrictions, report researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego.

In a study published online on Nov. 11, 2024 in JAMA, researchers asked 16 people to purchase flavored vape products online and have them delivered to their homes in the County of San Diego, then analyzed the results of these attempted purchases. Of 156 attempted transactions 73% were processed and 67% were delivered.

As of March 21, 2024, sale restrictions on flavored tobacco have been enacted in eight U.S. states and 392 cities or counties, but some of these do not cover e-commerce. For example, the 2022 California Senate Bill (SB) 793 prohibited the sale of flavored tobacco products but left e-commerce restrictions ambiguous.

Due to the ambiguity in California law, the researchers aimed to test differences in compliance with local tobacco e-commerce ordinances. Eight buyers were from the City of San Diego, where an ordinance restricts the sale of flavored tobacco products, including online sales. The other eight were from other County of San Diego communities, which do not have the same restrictions. Delivery did not differ significantly between buyers in these two jurisdictions.

In addition to violations of flavor restrictions, the online purchases violated the Preventing Online Sales of E-Cigarettes to Children Act, a federal law prohibiting the use of the United States Postal Service (USPS) to ship vaping products and requires both age verification and scanning identifications upon delivery.

“There are longstanding surveillance systems in place that help implement laws at brick-and-mortar stores, but we do not have a system in place for online retailers,” said Eric Leas, Ph.D., M.P.H., an assistant professor at the Herbert Wertheim School of Public Health and Human Longevity Science. “The results of this study highlight the need for greater oversight and enforcement of online tobacco retailers.”

Key findings include:

• 1% of buyers had their IDs scanned
• 81% of deliveries were made via the USPS
• 9% arrived via couriers with policies restricting shipping tobacco, including: 4.0% via UPS, 3.0% via FedEx 3.0% and 1.8% via DHL
• 78% of buyers reported no interaction with delivery personnel
• 15% of buyers spoke with delivery personnel but did not have their IDs checked
• 6% of buyers had their IDs checked but not scanned

“Online sales of e-cigarettes are the largest and fastest growing sector of the tobacco. We need to evaluate tobacco retail policies and ensure they cover e-commerce and monitor the market to improve implementation,” said Leas, who is also director of the Tobacco E-commerce Lab.

In a 2023 study published in Tobacco Control, Leas reported that following the implementation of SB-793, online shopping queries were 194% higher than expected for cigarettes and 162% higher than expected for vape products.

As a result, to strengthen state tobacco oversight programs, including online sales of flavored tobacco products, California lawmakers recently approved SB-1230, citing Leas’ Tobacco Control study. The law will go into effect on Jan. 1, 2025.

“This research is piloting a system for monitoring online compliance that local health departments could mimic as a routine surveillance system to strengthen the implementation of public health laws designed to reduce the sale of tobacco products to minors,” said Leas.

Co-authors include: Raquel M. Harati, Shannon E. Ellis, Nora Satybaldiyeva, and Tomas Mejorado, all of UC San Diego; Gustavo Benitez, California State University San Marcos; and Lisa Henriksen, Stanford University.

This research was funded, in part, by the California Tobacco Related Disease Research Program (T32IP4684).

Disclosures: The authors do not have any conflicts of interest to report.

DOI: 10.1001/jama.2024.21597

Contact:
Stacy A. Anderson                    
Mount Sinai Press Office                    
347-346-3390                    
[email protected]                          

Mount Sinai Awarded Nearly $7 Million From National Institutes of Health to Create New York Coalition to Recruit for Highly Diverse Health Database 
Health System to serve as a lead site for the All of Us research program

(New York, NY – November 11, 2024) – The Mount Sinai Health System has been awarded nearly $7 million from the National Institutes of Health (NIH) to create and lead a New York coalition to contribute to one of the most diverse health databases in history, ultimately informing and guiding individualized treatment and care for a variety of diseases and health conditions. Mount Sinai will also work to increase the number of participants from various demographics, regions, and stages of opioid use disorder to address the public health crisis of rising overdose deaths.

The New York coalition will include academic medical centers and community partners with expertise in engaging, recruiting, and retaining participants often underrepresented in biomedical research in New York City—one of the most ethnically and culturally diverse enclaves in the world. Along with Mount Sinai, the group of collaborators includes Weill Cornell Medicine, New York City Health + Hospitals, the Institute for Family Health, and NYU Langone. The New York coalition will try to recruit more than 7,000 new participants across the tri-state area to join the NIH’s All of Us Research Program in the first year.

“This multi-institutional effort will fill a gap to significantly increase recruitment of participants in an area of the country with rich diversity,” said Principal Investigator Monica Kraft, MD, the Murray M. Rosenberg Professor of Medicine and Chair of the Department of Medicine at Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai. “Our partnership encompasses dozens of hospitals and medical practices, longstanding collaborations, senior research investigators, and seasoned staff with experience in recruiting diverse populations. We will work closely with the All of Us consortium and key stakeholders, assess the impact of our activities, identify best practices, and share both our expertise and discoveries along the way. We look forward to continuing to build on our strong and robust IT, data science, clinical, data collection, and electronic health record infrastructures.”

The coalition will join the other All of Us regional hubs to also enroll 3,300 new participants with opioid use disorder, an epidemic that has affected thousands across the United States through increasing opioid use, addiction, and overdose deaths. The crisis has most recently involved a rise of synthetic opioids like fentanyl, which are significantly more potent and deadly than heroin and prescription opioids. There are distinct racial disparities among those with opioid use disorder, according to the Centers for Disease Control and Prevention: although opioid use is more common among white Americans, Black adults and teens experienced a steeper increase in the rate of fatal opioid overdoses than whites during the last decade.

Three Icahn Mount Sinai leaders join Dr. Kraft as Principal Investigators for the New York coalition: Bruce D. Gelb, MD, Dean for Child Health Research, the Gogel Family Professor and Director of The Mindich Child Health and Development Institute, and Director of the Center for Molecular Cardiology; Carol R. Horowitz, MD, MPH, Dean for Gender Equity in Science and Medicine, Director of the Institute for Health Equity Research, and Professor of Medicine, and Population Health Science and Policy; and Girish N. Nadkarni, MD, MPH, Irene and Dr. Arthur M. Fishberg Professor of Medicine, Director of The Charles Bronfman Institute of Personalized Medicine, and System Chief of the Division of Data-Driven and Digital Medicine.

“Our participation in the All of Us Research Program is a significant step towards revolutionizing health care through the power of multimodal data,” said Dr. Nadkarni. “This grant will enable us to harness cutting-edge technologies and integrate vast amounts of health information to uncover new insights and accelerate the development of personalized treatments. The world can leverage this comprehensive dataset to identify novel biomarkers, predict disease progression, and ultimately enhance clinical outcomes.”

Dr. Horowitz added: “Mount Sinai has a longstanding and deep commitment to health equity. Working in close partnership with expert clinicians, patients, and community advocates, we will ensure that our New York neighbors from more disadvantaged backgrounds and who have experienced health disparities are among the first to benefit from the advances in science and medicine that stem from All of Us.”

The investigators will harness insights from trusted networks and communities of ongoing research they currently lead, including The Charles Bronfman Institute for Personalized Medicine’s BioMe BioBank program, which supports rapid analysis from electronic medical information; the Mount Sinai Million Health Discoveries Program, which aims to carry out genetic sequencing of 1 million Mount Sinai patients within the next five years; and the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, which is examining the long-term effects of COVID-19.

The All of Us Research Program was created in 2015 to reflect the diversity of the United States and its territories, with a focus on precision medicine, or development of individualized plans for disease prevention and treatment. The national effort includes gathering data from 1 million or more diverse people, including those who are LGBTQ+ or Indigenous, with the goal of accelerating medical research and health breakthroughs. The comprehensive dataset is housed on a secure cloud-based platform and participating researchers can access information from surveys, genomic analyses, electronic health records, physical measurements, and wearables to study a range of factors that influence health and disease, including the environment, lifestyle, and genes. To date, more than 800,000 people have enrolled in the program.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report’s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.

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