Biomedical subjects

Eric T Moolchan

Publications and source records attributed to Eric T Moolchan.

At least 37 records · Page 2Linked to original sources

PubMed2005

Differences in risk-taking propensity across inner-city adolescent ever- and never-smokers.

Because adolescent smoking is a significant public health concern, potential value lies in understanding and identifying the psychological factors that distinguish ever- and never-smokers. To that end, we examined the relationship between risk-taking propensity as measured by the Balloon Analogue Risk Task and ever-smoking (i.e., even one puff) versus never-smoking in a sample of 125 predominantly African American high-school adolescents (M = 15.1, SD = 1.5). Results indicated that ever-smokers and never-smokers differed on risk-taking propensity; further risk-taking propensity was related to smoking status above and beyond both demographic variables and a measure of self-reported impulsive sensation seeking. We discuss these results in relation to the potential utility of a multimethod assessment approach (i.e., self-report measures and behavioral tasks) to identify adolescents' risk-taking susceptibilities and engagement in smoking and other risk-taking behaviors.

Adolescent↗

PubMed2005

Recent marijuana blunt smoking impacts carbon monoxide as a measure of adolescent tobacco abstinence.

Adolescent tobacco smokers have a higher prevalence of marijuana (MJ) smoking than adolescents who do not smoke tobacco. As part of an adolescent smoking cessation trial, we examined whether MJ smoking, and specifically "blunt" (gutted cigars filled with MJ) smoking, elevated participants' likelihood of a false indication of cigarette smoking on the basis of breath carbon monoxide (CO) testing. Using clinical data from 37 adolescents (mean age 15.1+/-1.4 years, 78% female) who participated in a smoking-cessation trial in Baltimore between 1999 and 2002, and who on at least one occasion, reported abstinence from tobacco smoking for at least 7 days, we analyzed 146 cigarette-abstinent-visit exhaled CO concentrations classified into blunt occasions (12 participants, 33 visits), nonblunt MJ occasions (seven participants, 20 visits), and non-MJ occasions (27 paricipants, 93 visits). Repeated-measures logistic regression revealed that blunt occasions were associated with CO > or = 8 ppm, compared to nonblunt occasions (p = 0.013). Blunt occasions also tended to be associated with the more youth-appropriate cutoff CO > or = 6 ppm, compared to non-MJ occasions (p =0.054). Blunt smoking impacted the interpretation of measures of exhaled CO for tobacco cessation.

Adolescent↗

PubMed2005

Safety and efficacy of the nicotine patch and gum for the treatment of adolescent tobacco addiction.

OBJECTIVES: To determine the safety and efficacy of the nicotine patch and gum for adolescents who want to quit smoking. DESIGN: Double-blind, double-dummy, randomized, 3-arm trial with a nicotine patch (21 mg), nicotine gum (2 and 4 mg), or a placebo patch and gum; all participants received cognitive-behavioral group therapy. SETTING: Inner-city, outpatient clinic on the East Coast. Subjects. Thirteen- to 17-year-old adolescents who smoked > or =10 cigarettes per day (CPD), scored > or =5 on the Fagerstrom Test of Nicotine Dependence, and were motivated to quit smoking. Intervention. Twelve weeks of nicotine patch or gum therapy with cognitive-behavioral therapy, with a follow-up visit at 6 months (3 months after the end of treatment). MAIN OUTCOME MEASURES: Safety assessed on the basis of adverse event reports for all 3 groups, prolonged abstinence, assessed through self-report and verified with exhaled carbon monoxide (CO) levels of < or =6 ppm, in intent-to-treat analyses, and smoking reduction (CPD and thiocyanate concentrations) among trial completers. RESULTS: A total of 120 participants were randomized (72% white, 70% female; age: 15.2 +/- 1.33 years; smoking: 18.8 +/- 8.56 CPD; Fagerstrom Test of Nicotine Dependence score: 7.04 +/- 1.29) from 1999 to 2003. Participants started smoking at 11.2 +/- 1.98 years of age and had been smoking daily for 2.66 +/- 1.56 years; 75% had at least 1 current psychiatric diagnosis. Mean compliance across groups was higher for the patch (mean: 78.4-82.8%) than for the gum (mean: 38.5-50.7%). Both the patch and gum were well tolerated, and adverse events were similar to those reported in adult trials. Changes in mean saliva cotinine concentrations throughout treatment were not statistically significant. Intent-to-treat analyses of all randomized participants showed CO-confirmed prolonged abstinence rates of 18% for the active-patch group, 6.5% for the active-gum group, and 2.5% for the placebo group; the difference between the active-patch and placebo arms was statistically significant. There was no significant effect of patch versus gum or gum versus placebo on cessation outcomes. Abstinence rates at the 3-month follow-up assessment were sustained but were not significantly associated with treatment group. Mean smoking rates, but not CO or thiocyanate concentrations, decreased significantly in all 3 arms but not as a function of treatment group. CONCLUSIONS: Nicotine patch therapy combined with cognitive-behavioral intervention was effective, compared with placebo, for treatment of tobacco dependence among adolescent smokers. Decreases in the numbers of cigarettes smoked appeared to be offset by compensatory smoking. Additional study of nicotine gum, with enhanced instructional support, is needed to assess its efficacy among adolescent smokers.

Administration, Cutaneous↗

PubMed2004

Performance characteristics of the Cozart RapiScan Oral Fluid Drug Testing System for opiates in comparison to ELISA and GC/MS following controlled codeine administration.

Oral fluid is an interesting alternative matrix for drug testing in many environments, including law enforcement, workplace drug testing, and drug treatment facilities. Performance characteristics of the FDA-cleared, qualitative, Cozart RapiScan Opiate Oral Fluid Drug Testing System (Opiate Cozart RapiScan System or Opiate CRS) were compared to the semi-quantitative Cozart Microplate EIA Opiate Oral Fluid Kit (Opiate ELISA) and to gas chromatography/mass spectrometry (GC/MS). The following oral fluid opiate cutoffs were evaluated: the GC/MS limit of quantification (LOQ) of 2.5 mg/l; 15 microg/l currently used for oral fluid testing in the United Kingdom (UK); 30 microg/l (Opiate CRS cutoff); and 40 microg/l, the proposed Substance Abuse and Mental Health Services Administration (SAMHSA) cutoff. Subjects provided informed consent to participate in this IRB-approved research and resided on the closed research ward throughout the study. Three oral codeine doses of 60 mg/70 kg were administered over a 7-day period. After a 3-week break, subjects received three doses of 120 mg/70 kg within 7 days. Oral fluid specimens (N = 1273) were analyzed for codeine (COD), norcodeine (NCOD), morphine (MOR) and normorphine (NMOR) by GC/MS with an LOQ of 2.5 microg/l for all analytes. MOR and NMOR were not detected in any sample; 26.5% of the specimens were positive for COD and 13.7% for NCOD. Opiate CRS uses a preset, qualitative cutoff of 10 microg/l; this is equivalent to 30 microg/l in undiluted oral fluid as the oral fluid collection process involves a 1:3 dilution with buffer. Sensitivity, specificity, and efficiency of Opiate CRS compared to Opiate ELISA were 98.6, 98.1, and 98.2% at a 30 microg/l cutoff and 99.0, 96.2, and 96.6% at a 40 microg/l cutoff. Compared to the much lower GC/MS LOQ of 2.5 microg/l, sensitivity, specificity and efficiency were 66.8, 99.3 and 90.7%. Increasing the GC/MS cutoff to the current UK level yielded performance characteristics of 81.5% (sensitivity), 99.3% (specificity), and 95.4% (efficiency). Using a GC/MS cutoff identical to the preset Opiate CRS cutoff yielded sensitivity, specificity, and efficiency of 88.5, 99.2, and 97.5%, respectively. At the proposed SAMSHA confirmation cutoff of 40 microg/l, sensitivity increased with little change in specificity and efficiency (91.3% sensitivity, 98.9% specificity, and 97.5% efficiency). Oral fluid is a suitable matrix for detecting drugs of abuse. Opiate CRS, with a 30 microg/l cutoff, is sufficiently sensitive, specific and efficient for oral fluid opiate analysis, performing similarly to Opiate ELISA at the same cutoff, and having performance characteristics >91% when compared to GC/MS at the proposed SAMHSA cutoff.

Analgesics, Opioid↗

PubMed2004

History of marijuana use and tobacco smoking topography in tobacco-dependent adolescents.

Adolescent tobacco smokers have higher rates of marijuana (MJ) use than nonsmokers. Because MJ smoking typically involves deeper inhalation and longer breathholding than tobacco smoking, we hypothesized greater puff volume, longer puff duration and puff interval, and higher puff velocity during tobacco smoking among (1) MJ-using teens; (2) teens whose onset of MJ smoking occurred before tobacco (MBT). One hundred and three tobacco-dependent adolescents presented for smoking cessation treatment (66.0% female, 71.0% European American, mean age 15.3+/-1.25 years) smoked one cigarette of their own brand in the laboratory prior to study entry. Topography and associated physiological measures among current recreational (<5 days in a 14-day period) MJ users (n=25), current heavy (>/=5 days in a 14-day period) MJ users (n=22) and current non-MJ-smoking teens (n=56) were compared. There were no differences in tobacco smoking topography or physiological measures by recent MJ-smoking history or by order of substance initiation. Significantly more African American than European American adolescent smokers reported MJ use before tobacco. Our findings in adolescent smokers are consistent with results from adult studies in which history of MJ smoking was not associated with changes in tobacco smoking topography.

Adolescent↗

PubMed2004

Time spent with friends who smoke and quit attempts among teen smokers.

Social interactions, as well as pharmacological effects, can reinforce smoking behavior in adolescents and pose challenges to smoking cessation. We hypothesized that time spent with friends who smoke would be inversely related to both the number and duration of previous quit attempts for teens receiving smoking cessation treatment. Demographic- and smoking-related data were collected from 98 adolescent smokers enrolled in an accruing smoking cessation study (68% female, 70% Caucasian, mean age 15.3 years). Among smokers who had at least one quit attempt, time spent with friends who smoke was inversely associated with the number of prior quit attempts (chi(2)=9.55, P=.0085) but not with their duration, suggesting a potential relationship between an adolescent's affiliation with smoking peers, smoking identity, and fewer quit attempts.

Adolescent↗

PubMed2004

Tobacco smoking trajectory and associated ethnic differences among adolescent smokers seeking cessation treatment.

PURPOSE: To examine smoking trajectories in a clinical sample of adolescent smokers seeking cessation treatment, including: (a) smoking onset (initial, daily) and time intervals from initial to daily smoking and from daily smoking to treatment request, (b) associations between current level of tobacco dependence and smoking history, and (c) differences in smoking trajectory between African-American and non-African-American youth. METHODS: Four hundred and thirty-two adolescent smokers (aged 13-17 years, 61.8% female, 32% African-American) responding to various media advertisement completed a telephone interview as part of pre-eligibility screening for a smoking cessation trial. Smoking trajectory data included age at onset of initial and daily smoking, intervals between those time points, and cigarettes smoked per day (CPD). Tobacco dependence was assessed using the Fagerström Test for Nicotine Dependence (FTND). Data were analyzed using regression models and multiple analyses of covariance. RESULTS: Initial smoking occurred at a mean age of less than 12 years and daily smoking at age 13 years. Earlier onset of daily smoking was associated with higher FTND scores and longer duration from daily smoking to treatment request. For the entire sample, the time interval from initial to daily smoking was 1.14 years. When the sample was divided into early (before age 14 years) and later (at or after age 14 years) initiators, early initiators showed a slower progression from initial to daily smoking compared with late initiators (16 months vs. 6 months). Compared with non-African-American teen smokers, African-American youth reported a 1-year delay in onset of both initial and daily smoking. CONCLUSIONS: Early age of daily smoking and short time interval from initial to daily smoking highlight a brief window of opportunity to prevent the development of tobacco addiction and its consequences. Ethnic differences in smoking trajectory uncovered in this report call for ethnically tailored interventions to reduce youth smoking.

Adolescent↗

PubMed2004

Smoking topography and trajectory of asthmatic adolescents requesting cessation treatment.

BACKGROUND: Teenage smokers cite health concerns as their primary motivators for tobacco smoking cessation. Smoke exposure aggravates the clinical course of asthma, yet few reports have examined the association between asthma and smoking topography and trajectory. METHODS: Before their enrollment in a smoking cessation trial, we assessed the smoking topography (i.e., puff volume, maximum puff velocity, puff duration, and interpuff interval) and smoking trajectory (i.e., age of first cigarette, age of daily smoking, time to treatment request, and prior quit attempts) in 30 self-reported asthmatic and 92 nonasthmatic tobacco-dependent teenagers (mean age, 15.2 +/- 1.3 years, 28.7% African-American). Approximately one-half of asthmatics used prescribed medications for their asthma. RESULTS: There was no significant difference in smoking topography or smoking trajectory variables between asthmatic and nonasthmatic adolescents, nor between medicated and nonmedicated asthma subgroups. CONCLUSIONS: Although tobacco smoking exacerbates asthmatic symptoms, these data suggest that age of smoking initiation, as well as smoking topography characteristics in asthmatic adolescents, does not differ from those of adolescents without asthma. These findings highlight the need for more effective health counseling of asthmatic youth regarding the physical and behavioral effects of smoking.

Adolescent↗

PubMed2004

Quit attempts among African American teenage smokers seeking treatment: gender differences.

BACKGROUND: African Americans experience disproportionate smoking-related mortality. Because established smoking during youth predisposes to adult smoking and serious health consequences, characterizing ethnic differences in adolescent smokers' self-quit attempts may inform ethnic-specific approaches to youth smoking cessation. METHODS: African American and European American teenage smokers applying to a teenage smoking cessation study (2000-2003) provided smoking-related data, including characteristics of previous cessation attempts and prior use of nicotine replacement therapy (NRT). Tobacco dependence was assessed using the Fagerstrom Test of Nicotine Dependence (FTND). RESULTS: Of 980 (15.5 +/- 1.3 years, 41.8% African American, 59.9% female) participants, African Americans boys were significantly less likely than European American boys to report a prior quit attempt (OR = 0.35, 95% CI 0.17-0.73, P = 0.0049) or to have used NRT (OR = 0.60, 95% CI 0.36-0.998, P = 0.049) after adjusting for years smoked and FTND score. African American girls were more likely to report a prior request for cessation treatment than European American girls after adjusting for FTND and years smoked (OR = 2.19, 95% CI 1.37-3.48, P = 0.001). CONCLUSIONS: While increasing education and outreach to African American boys and enhancing access to formal cessation programs for African American girls who smoke may be beneficial, our findings warrant extension to non-treatment-seeking teenage smokers.

Adolescent↗

PubMed2004

Quantitative comparisons between a nicotine delivery device (Eclipse) and conventional cigarette smoking.

In 1997, R. J. Reynolds introduced Eclipse, a nicotine delivery device (NDD) purported to deliver lower levels of smoke than conventional cigarettes. This NDD uses a carbon fuel element to vaporize the nicotine in the rod; the user then inhales the nicotine vapor. In the present study, the effects of this NDD on smoking topography; substance delivery factors; and physiological, subjective, and biochemical markers of smoking were compared with commercial cigarettes (referred to as Own Brand). All smoking occurred ad lib with the cigarette or NDD hand-held (conventional) or held in a topography mouthpiece. A total of 10 adults (seven males) smoked on five occasions: NDD conventional, NDD topography, Own Brand conventional, Own Brand topography (twice). Sessions were separated by at least 24 hr. Measures were taken before and 2, 5, 10, 15, 30, and 60 min after smoking. The NDD took longer to smoke (366 s vs. 292 s), required more puffs (14.8 vs. 10.8), and caused a larger increase in exhaled carbon monoxide (CO; 7.3 ppm vs. 4.2 ppm) than Own Brand. However, venous plasma nicotine boost was significantly larger 2 min after smoking Own Brand as compared with the NDD (16.4 ng/ml vs. 10.7 ng/ml). Puff volume (90.7 ml vs. 63.0 ml) and puff velocity (81.6 ml/s vs. 58.2 ml/s) were greater after the NDD than Own Brand, whereas inter-puff interval and puff duration were similar. Subjects rated the NDD as less satisfying (5.2 vs. 9.8), less rewarding (9.5 vs. 14.3), and more aversive (5.0 vs. 3.1) than their own brand. The results of this study indicate that this NDD exposes the user to significant quantities of nicotine, CO, and possibly other harmful components of tobacco smoke. The findings further validate the use of a topography device as an effective instrument to quantify smoke exposure.

Adult↗

PubMed2004

Adolescent menthol smokers: will they be a harder target for cessation?

Menthol smoking may influence the development of tobacco addiction and related health consequences, yet limited data on menthol smoking by youth are available. We assessed usual brand menthol preference by Baltimore-area teenage smokers applying to a smoking cessation study between September 1999 and December 2002. Of a biethnic (Black and White) sample of 593 youths (mean age=15.5+/-1.4 years, 51% female, 45% African American), the overwhelming majority (93%) were menthol smokers. Menthol preference rates were highest among African American girls and lowest among White boys. Overall, a statistically significant association was found between ethnicity and menthol preference, chi2 (df=1)=19.4, p<.001. This association also was observed separately for girls, chi2 (df=1)=9.21, p=.0024, and for boys, chi2 (df=1)=9.59, p=.0020. Menthol smoking did not vary with age in either ethnic group. These findings of overwhelming menthol preference in a treatment-seeking sample of adolescents warrant further research on the developmental trajectory, cessation, and health-related impact of menthol smoking by youth.

Administration, Inhalation↗

PubMed2004

Urinary pharmacokinetics of 11-nor-9-carboxy-delta9-tetrahydrocannabinol after controlled oral delta9-tetrahydrocannabinol administration.

Understanding the pharmacokinetics of orally administered cannabinoids is vitally important for optimizing therapeutic usage and to determine the impact of positive tests on drug detection programs. In this study, gas chromatography-mass spectrometry (limit of quantitation = 2.5 ng/mL) was used to monitor the excretion of total 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in 4381 urine voids collected from seven participants throughout a controlled clinical study of multiple oral doses of THC. The National Institute on Drug Abuse Institutional Review Board approved the study and each participant provided informed consent. Seven participants received 0, 0.39, 0.47, 7.5, and 14.8 mg THC/day for five days in this double blind, placebo-controlled, randomized protocol conducted on a closed research ward. No significant differences (P </= 0.05) were observed in mean time of maximum excretion rate, mean maximum excretion rate, and mean terminal elimination half-life (t(1/2)) between the four THC doses, with ranges of 67.4 to 94.9 h, 0.9 to 16.3 micro g/h, and 44.2 to 64.0 h, respectively. Mean apparent elimination t(1/2) of 24.1 +/- 7.8 and 21.1 +/- 4.3 h for the 7.5 and 14.8 mg/day doses, respectively, were calculated from the excretion rate curve prior to the last urine sample with a THCCOOH concentration >/= 15 ng/mL. An average of only 2.9 +/- 1.6%, 2.5 +/- 2.7%, 1.5 +/- 1.4%, and 0.6 +/- 0.5% of the THC in the 0.39, 0.47, 7.5, and 14.8 mg/day doses, respectively, was excreted as THCCOOH in the urine over each 14-day dosing session. This study demonstrated that the terminal urinary elimination t(1/2) of THCCOOH following oral administration was approximately two to three days for doses ranging from 0.39 to 14.8 mg/d. These data also demonstrate that the apparent urinary elimination t(1/2) of THCCOOH prior to reaching a 15 ng/mL concentration is significantly shorter than the terminal urinary elimination t(1/2). These controlled drug administration data should assist in the interpretation of urine cannabinoid results and provide clinicians with valuable information for future pharmacological studies.

Administration, Oral↗

PubMed2004

Urinary pharmacokinetics of methamphetamine and its metabolite, amphetamine following controlled oral administration to humans.

Methamphetamine is widely abused for its euphoric effects. Our objectives were to characterize the urinary pharmacokinetics of methamphetamine and amphetamine after controlled methamphetamine administration to humans and to improve the interpretation of urine drug test results. Participants (n = 8) received 4 daily 10-mg (low) oral doses of sustained-release (d)-methamphetamine hydrochloride within 7 days. After 4 weeks, 5 participants received 4 daily 20-mg (high) oral doses. All urine specimens were collected during the study. Methamphetamine and amphetamine were measured by GC-MS/PCI. Maximum excretion rates ranged from 403 to 4919 microg/h for methamphetamine and 59 to 735 microg/h for amphetamine with no relationship between dose and excretion rate. The mean molar percentage of dose in the urine as total methamphetamine and amphetamine were 57.5 +/- 21.7% (low dose) and 40.9 +/- 8.5% (high dose). Mean urinary terminal elimination half-lives across doses were 23.6 +/- 6.6 hours for methamphetamine and 20.7 +/- 7.3 hours for amphetamine. Methamphetamine renal clearance across doses was 175 +/- 102 mL/min. The mean amphetamine/methamphetamine percentage ratio based on the area under the urinary excretion-time curve increased over time from 13.4 +/- 6.5% to 35.7 +/- 26.6%. Slow urinary excretion results in drug accumulation and increases in detection time windows. Our findings also support the presence of an active renal excretion mechanism for methamphetamine.

Administration, Oral↗

PubMed2004

Heart rate and blood pressure responses to tobacco smoking among African-American adolescents.

Ethnic differences in both physiological response to and health consequences of tobacco smoking-some of which have been attributed to ethnic preferences for menthol cigarettes-have been described in the literature. We compared acute physiological responses to smoking in African-American and European-American adolescent menthol cigarette smokers seeking smoking cessation treatment. One-hundred- twenty-eight adolescents (32% African-American, 71% female; mean age 15.16 +/- 1.32 years, mean Fagerström Test of Nicotine Dependence (FTND) score 6.73 +/- 1.53, cigarettes per day (CPD) 16.9 +/- 2.64) participated in an experimental session during which they smoked one menthol cigarette of their usual brand. Blood pressure, heart rate, and exhaled carbon monoxide (CO) concentrations were measured before and after smoking; mean puff volume (mL), puff duration (sec) and maximal puff velocity (mL/sec) during smoking were also determined. Two sample t-tests were performed to assess ethnic differences in smoking topography; analysis of covariance was used to determine whether heart rate and blood pressure after smoking one menthol cigarette varied by ethnicity, after controlling for baseline physiological measures. No significant ethnic differences were observed in either smoking topography or acute cardiovascular response to smoking. These preliminary findings warrant extension to a broader group of nontreatment-seeking adolescent smokers of both ethnicities.

Adolescent↗

PubMed2003

Validated method for the simultaneous determination of Delta 9-tetrahydrocannabinol (THC), 11-hydroxy-THC and 11-nor-9-carboxy-THC in human plasma using solid phase extraction and gas chromatography-mass spectrometry with positive chemical ionization.

A fully validated, highly sensitive and specific method for the extraction and quantification of Delta(9)-tetrahydrocannabinol (THC), 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in plasma is presented. This method incorporates Escherichia coli beta-glucuronidase hydrolysis to cleave glucuronic acid moieties to capture total analyte concentrations, and simultaneous solid phase extraction (SPE) of the three analytes in a single eluant with separation and quantification on a bench-top positive chemical ionization (PCI) gas chromatography-mass spectrometry (GC-MS) in the selected ion monitoring (SIM) mode. Quantitation was achieved by the addition of deuterated analogues for each analyte as internal standards (IS). Limits of quantitation (LOQ) were 0.5, 0.5 and 1.0 for THC, 11-OH-THC and THCCOOH, respectively, with linearity ranging up to 50 ng/ml for THC and 11-OH-THC, and 100 ng/ml for THCCOOH. Absolute recoveries ranged from 67.3 to 83.5% for all three analytes. Intra-assay accuracy and precision ranged from 1.2 to 12.2 and 1.4 to 4.7%, respectively. Inter-assay accuracy and precision ranged from 1.4 to 12.2 and 3.1 to 7.3%, respectively. This method was used to analyze plasma samples collected from individuals participating in a controlled oral THC administration study. Statistically significant (P< or =0.05) increases of 40% for 11-OH-THC and 42% for THCCOOH concentrations were found between hydrolyzed and non-hydrolyzed results. This method will be utilized in ongoing controlled cannabinoid administration studies and may be a useful analytical procedure for the fields of forensic toxicology and cannabinoid pharmacology.

Dronabinol↗

PubMed2003

Quantitative determination of the enantiomers of methadone and its metabolite (EDDP) in human saliva by enantioselective liquid chromatography with mass spectrometric detection.

A sensitive enantioselective liquid chromatographic assay with mass spectrometric detection (LC-MS) has been developed and validated for the simultaneous determination of saliva concentrations of (R)- and (S)-methadone (Met) and (R)- and (S)-2-ethylidene-1,5-dimethyl-3,3-diphenyl-pyrrolidine (EDDP, a primary metabolite of Met). Saliva specimens were collected using Salivette devices (Sarsedt), and centrifuged; collected saliva was then spiked with deuterated internal standards, D3-Met and D3-EDDP, and directly injected into the LC-MS. Enantioselective separations were achieved on a liquid chromatographic chiral stationary phase (CSP) based upon immobilized alpha(1)-acid glycoprotein (AGP) using a mobile phase composed of acetonitrile: ammonium acetate buffer (10mM, pH 7.0) in a ratio of 18:82 (v/v), a flow rate of 0.9 ml/min and a temperature of 25 degrees C. Under these conditions, enantioselective separations were observed for methadone (alpha=1.30) and EDDP (alpha=1.17) within 15 min. Met, EDDP, D3-Met and D3-EDDP were detected using selected ion monitoring at m/z 310.20, 278.20, 313.20 and 281.20, respectively. Linear relationships between peak height ratio and drug-enantiomer concentrations were obtained for methadone in the range of 5.0-600.0 ng/ml, and for EDDP from 0.5 to 15.0 ng/ml per enantiomer with correlation coefficients better than 0.9994, where lower limit of quantification (LLOQ) for Met was 5 ng/ml and for EDDP 0.5 ng/ml. Acceptable intra- and inter-day precision of the method (CVs<4.0%) and accuracy (CVs<4.0%) were obtained. These findings demonstrate the accuracy and precision of the method used to successfully analyze saliva obtained from patients enrolled in a methadone-maintenance program.

Chromatography, Liquid↗

PubMed2003

Treatment of adolescent tobacco smokers: issues and opportunities for exposure reduction approaches.

The cycle of tobacco dependence typically begins with the initiation of tobacco use during adolescence. Many teenagers try to quit smoking, fail and subsequently desire treatment for their tobacco dependence. Adolescents do not currently benefit from the same level of societal support for quit attempts as adults, and they may be less motivated for total cessation despite the short and long-term health consequences of smoking. Overall, the combination of low participation, high attrition and low complete cessation rates for adolescent smokers in treatment prompts the consideration of alternative treatment endpoints. It is likely that interactions among the processes of child and adolescent development, smoke exposure and trajectory influence patterns of tobacco use and treatment for tobacco dependence in adolescents. A rational framework is needed to integrate the study of these dynamic interactions to address tobacco dependence among youth from an exposure reduction, in addition to a cessation, perspective. This paper considers the issues and potential implications of tobacco exposure reduction therapy as an intermediate treatment goal for adolescent smokers who are dependent or dependence-prone, but for whom initial treatment interventions do not yield complete tobacco cessation.

Adolescent↗

PubMed2003

Characteristics of African American teenage smokers who request cessation treatment: implications for addressing health disparities.

BACKGROUND: Ethnoracial disparities in both tobacco-related mortality and treatment outcome for smoking cessation have been reported among adults, but there is a dearth of information on ethnoracial differences among adolescent smokers. OBJECTIVE: To compare smoking-related characteristics in African American and non-African American teenaged applicants for a smoking cessation trial. PARTICIPANTS, DESIGN, AND SETTING: Four hundred thirty-two teenaged smokers (mean [SD] age, 15.6 [1.5] years; 61.8%, female; 31.9%, African American) responded via telephone to various media advertisements. Self-reported sociodemographic, smoking-related, and clinical data were obtained to determine preeligibility for trial participation. MAIN OUTCOME MEASURES: The number of cigarettes smoked per day, Fagerström Test for Nicotine Dependence (FTND) score, motivation to quit, self-reported health problems, and medication use. RESULTS: Compared with non-African Americans, African Americans had lower FTND scores (mean [SD] score, 5.31 [2.24] vs 6.18 [2.18]; P<.01), and smoked fewer cigarettes per day (mean [SD] number of cigarettes, 12.6 [8.3] vs 15.4 [7.5] cigarettes/d; P<.04). The FTND scores were similar in both groups when adjusted for the number of cigarettes smoked per day. African American and non-African American teenagers reported similar motivation to quit (mean [SD] score, 8.64 [1.68] vs 8.53 [1.59], respectively). No difference was found in frequency of physical health problems (eg, asthma), diagnosed psychiatric conditions, or prescribed psychiatric medication although fewer African American teenaged smokers took medication for physical problems (21.2% vs 36.7%). CONCLUSIONS: Cessation treatment interventions designed for African American youths should include lower FTND-defined levels, or the use of other instruments that do not focus on the number of cigarettes smoked per day. Our findings also highlight the importance of ethnocultural issues in treatment research that aims to address health disparities.

Adolescent↗