Early initiation of alcohol or marijuana use and nonmedical use of prescription drugs

s / Drug and Alcohol Dependence 140 (2014) e2–e85 e77 Methods:We conducted annual surveys of SEPs participating in the North American Syringe Exchange Network (NASEN). Themost recent survey was conducted in Spring 2012, covering 2011 programoperations including budget information and services offered by SEPs. Results: 144 (73%) of 197 programs provided 2011 data. SEPs were active in 117 cities in 32 states, Washington, DC and Puerto Rico. 36.9 million syringes were exchanged, and reported budgets totaled $19.3 million, 84% of which came from local and state governments. SEPs provided many additional services including: male condoms (99%), HIV testing (81%), HCV testing (62%), STD screening (47%), naloxone (47%), and referrals to substance abuse treatment (94%). TheAffordable Care Act (ACA) could provide reimbursement for these additional services. 75% of programs reported experiencing funding problems in 2011 due to budget difficulties, re-instatement of the ban on federal funding of SEPs, and re-allocation of HIV prevention funds away from IDU transmission. Conclusions: While SEPs are currently facing severe financial pressure, US SEPs have been able to maintain syringe distribution along with moderate to high levels of additional supplementary services. The ACA may be the most likely source of needed funding, but billing for individual services would require considerable reorganization of programs. The next few years should provide an important test ofUSpolicies for providinghealthcare topeoplewho use drugs. Financial support: amfAR, The American Foundation for AIDS Research,with support fromTheElton JohnAIDSFoundation (EJAF). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.228 Early initiation of alcohol or marijuana use and nonmedical use of prescription drugs James D. Haddox1, Robert M. Weiler2, L.N. Pealer3, T.E. Barnett3 1 Health Policy, Purdue Pharma L.P., Stamford, CT, United States 2 Hlth. Educ. & Beh., University of Florida, Gainesville, FL, United States 3 Beh. Sci. & Comm. Hlth., University of Florida, Gainesville, FL, United States Aims: Early initiation of use of beverage alcohol (EtOH) or marijuana (MJ) is a predictor of multiple risk behaviors among adolescents, but little is known about whether those behaviors are associatedwith thenonmedicaluseofprescriptiondrugs (NMUPD). If associations exist, that information could inform substance abuse prevention efforts. This study examinedwhether early initiation of alcohol or marijuana use was associated with NMUPD. Methods: Data were collected from a sample of 4178 students in grades 9–12 in five high schools. Logistic regression models adjusted for sex, race/ethnicity, and grade were used to estimate the strength of associations between early initiation of EtOH or MJ use (i.e., before age 15) and the nonmedical use of prescription pain relievers, depressants, and stimulants. Early initiates were compared to students who initiated use of EtOH or MJ at age 15 or older. Results: Data were collected from a sample of 4178 students in grades 9–12 in five high schools. Logistic regression models adjusted for sex, race/ethnicity, and grade were used to estimate the strength of associations between early initiation of EtOH or MJ use (i.e., before age 15) and the nonmedical use of prescription pain relievers, depressants, and stimulants. Early initiates were compared to students who initiated use of EtOH or MJ at age 15 or older. Conclusions: Early initiation of either EtOHorMJ use is strongly associated with NMUPD. The findings underscore the importance of implementing broadly focused substance abuse prevention programs at the middle school level. Financial support: Grant from Purdue Pharma L.P. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.229 Ketamine for treatment-resistant depression: Subjective effects and impact on plasma brain-derived neurotrophic factor Colin N. Haile1,3, J.J. Murrough2, D.V. Iosifescu2, L.C. Chang1, R.K. Al Jurdi1, A. Foulkes1, S. Iqbal1, James J. Mahoney1,3, Richard De La Garza II 1,3, D.S. Charney2, Thomas F. Newton1,3, S.J. Mathew3,1 1 Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States 2 Psychiatry, Mount Sinai School of Medicine, New York, NY, United States 3 MEDVA Medical Center, Houston, TX, United States Aims: Ketamine produces rapid antidepressant effects in patients with treatment resistant depression (TRD) however the magnitude of response varies. Studies suggest ketamine’s antidepressant activitymay relate to peripheral brain-derived neurotrophic factor (BDNF) levels. This study examined if plasma BDNF was associatedwith ketamine’s antidepressant action andwhether levels couldpredict a beneficial outcome. Positive subjective effects were also determined in response to therapeutic doses of ketamine. Methods: Patients (N=22) with TRD received a single IV ketamine (0.5mg/kg, N=15) or midazolam (0.045mg/kg, N=7) infusion over 40min. Depression severity was assessed (40min to 7 days) with the Montgomery-Asberg Depression Rating Scale (MADRS). PlasmaBDNF levelswere determinedwith ELISA. Subjective and dissociative effects were quantified (40min to 24h) using a visual analog scale (0–10) and the CADSS (Clinician Administered Dissociative States Scale). Results: BDNF levels were significantly increased (p<0.05) at 240min in patients that responded to IV ketamine and highly correlated with MADRS scores at 240min (r=−0.700; p=0.007) but not following IV midazolam. Responders with higher plasma BDNF levels following ketamine at 240min had lower MADRS scores (p<0.01) at 7 days compared to non-responders. “HIGH” and “EUPHORIA” subjective ratings did not differ between treatments. CADSS scores were higher at 40min, but not 120min, in patients that received ketamine (p<0.01). Conclusions: Plasma BDNF may be a peripheral biomarker relevant to therapeutic response following IV ketamine therapy. The dose of ketamine efficacious for TRD did not exhibit a high abuse liability profile. Financial support: Supported with resources and the use of facilities at the Michael E. Debakey VA Medical Center, Houston, TX. NIH/NIMH Grant RO1MH081870, UL1TR000067 and NARSAD (SJM). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.230