Category: Systematic review

Systematic reviews are the cream of the research crop. Those who understand their value thrive at an opportunity to learn more about them.

Off the record: addictions in medical schools

If it’s not recorded, it didn’t happen.
An old saying
We wanted to find out how much teaching on addiction get on medical students. In 2011, our colleagues Sarah O’Brien and Professor Cullen searched PubMed (online database of medical papers) for published literature on training of undergraduate medical students in addiction
There is currently no documentation of drug addiction teaching sessions in Irish medical schools.
We looked at other medical databases and we also searched websites of all 6 medical schools in Ireland.  We have searched the literature published after October 2009.
We found nothing in the medical databases. Schools’ homepages did not mention addiction either.
A telephone survey may provide a more accurate representation of how addiction medicine education is incorporated into the medical school curricula.
Substance use disorders are a worldwide problem, and have become a major health concern in Ireland particularly.
In their new position paper on addiction, the Irish Medical Organisation recognized the lacking education and called for “appropriate training of all physicians in treatment of addiction” (Irish Medical Organisation, 2015). Although the science behind addiction treatment has discovered new treatments for addiction, the medical doctors don’t know about them, mainly because they get no training on addiction. As a result, they feel unprepared to treat people with addiction who receive inadequate care.

To cite this article: Mitch Wilson, Walter Cullen, Christine Goodair & Jan Klimas (2016): Off the record: Substance-related disorders in the undergraduate medical curricula in IrelandJournal of Substance Use, DOI: 10.3109/14659891.2015.1112853

How can we do better job in studying Topiramate?

Topiramate prevents seizures in people with epilepsy. Previously, we looked at all studies to see whether Topiramate can help treat cocaine addiction, reduce cocaine use and prolong treatment retention.
No current evidence supported the clinical use of Topiramate for the treatment of cocaine dependence.
Some of these studies were not blinded. This means that the participants knew whether they got the actual Topiramate or a flat placebo. Too many people dropped out of these studies. They did not measure things in the same way. For instance, not a single study measured craving in the same way. If things from several studies aren’t measured in the same way, we cannot put them together to answer the question whether Topiramate works. Finally, the studies excluded people who also had other drug use disorders. Most people have multiple disorders.
One study was different than all others. It was Dutch. Not only did the participants use less cocaine but they also received less Topiramate and their dose was set over a shorter time than in the American studies.
All of these cues make Topiramate very interesting to study even more, especially if it’s paired with a structured support, such as contingency management. Contingency management helps people curb cocaine addiction by rewarding healthy habits.
There is no drug for cocaine use disorder.  In the past, researchers have studied whether drugs for depression, epilepsy or seizures could treat cocaine addiction.
Until we do better job as researchers, we won’t know whether Topiramate works for cocaine use disorder.
Reference: Klimas, J., Wood, E., Werb, D. How Can We Investigate the Role of Topiramate in the Treatment of Cocaine Use Disorder More Thoroughly? Addiction, 2016, In Press: 

New review out now: Epilepsy drug fails crack addiction

This review asked whether a drug for epilepsy seizures – Topiramate – can help treat cocaine addiction, reduce cocaine use and prolong treatment retention.
No current evidence supports the clinical use of Topiramate for the treatment of cocaine dependence.

·      We looked at all scientific literature up until December 2014.
·      We also wanted to see how whether people quit treatment prematurely and whether they had any side effects. We included people of any gender, age or ethnicity.


       We found 5 studies with 518 patients; all were done in USA
       Topiramate did not help people stay in treatment longer
·      The mean duration of the trials was 13 weeks (range eight to 24 weeks).
·      The side effects were the same for Topiramate and placebo.
Topiramate could possibly help people stay cocaine-free without having more side effects than placebo.

       There is no drug for cocaine dependence.
       In the past, researchers have studied whether drugs for depression, epilepsy or seizures could treat cocaine addiction.
       There is a need to understand how to treat cocaine addiction. 
Reference: Singh, M., Keer, D., Klimas, J., Wood, E., Werb, D. Topiramate for Cocaine Dependence: A Systematic Review and Meta-Analysis of Randomized Control Trials. Addiction, 2016, In Press:
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Reducing drinking in illicit drug users: an impact story @COMETinitiative

Research impact is often hard to prove. It takes years before our findings change the world and the change is often small.  This new abstract published in the Trials journal summarizes a poster presentation from the conference of the Core Outcome Measures in Trials (COMET) Initiative.  This year the conference was in Calgary, Canada, on May 20-21.


One out of three people who receive methadone in primary care drink in excess of the recommended limits. This poses significant risk to their health, especially to their liver; it complicates their care and increases risk of relapse.  
We wanted to inform addiction treatment in primary care with respect to psychosocial interventions to reduce drinking in concurrent problem alcohol and illicit drug users, by: exploring the experience of (and evidence for) psychosocial interventions, developing and evaluating a complex intervention to improve implementation. Evaluation of the intervention tested core feasibility and acceptability outcomes for patients and providers.  
Our Cochrane review found only four studies. Having inconclusive evidence, we interviewed 28 patients, 38 physicians and nurses. Patient interviews informed development of a national clinical practice guideline, as well as design and outcomes of the evaluation project. Feasibility outcome measures included recruitment, retention, completion and follow-up rates, as well as satisfaction with the intervention. Secondary outcome was proportion of patients with problem alcohol use at the follow up, as measured by Alcohol Use Disorders Identification Test.  
Information from the Cochrane review and the qualitative interviews informed an expert panel consultation which developed clinical guidelines for primary care.  The guideline became part of a complex intervention to support the uptake of psychosocial interventions by family physicians; the intervention is currently evaluated in a pilot controlled trial. Two new alcohol education programmes were created as a response of the community to the problem and a lack of specialist support services for patients with dual dependencies. Both Coolmine Therapeutic Community and the Community Response Agency run a 10-week group that specifically seeks to include people with dual dependencies, from methadone programmes. 

Cite this article as: Klimas et al.: Reducing drinking in concurrent
problem alcohol and illicit drug users: an impact story. Trials 2015
16(Suppl 3):P11. doi:10.1186/1745-6215-16-S3-P11

Alcohol and Methadone Don’t Mix! What’s New in Addiction Medicine? lecture series

Please join us on Tuesday, October 27 for this month’s edition of the “What’s New in Addiction Medicine?” lecture series.

This (free) event features a presentation by Dr. Jan Klimas and will be held between 12-1pm.  The talk is entitled “Methadone and Alcohol Don’t Mix” and will be hosted at St. Paul’s Hospital in the Hurlburt Auditorium (2nd floor).  A light lunch will be provided.
We strongly encourage guests to RSVP as soon as possible to ensure sufficient food and space.  (Please note that you will not need to bring your registration ticket(s) to the event.)
To RSVP, please click here.  (If you are experiencing any difficulty accessing the link, please type into your browser or email Cameron Collins at the address listed below.)
Please don’t hesitate to forward this email on to anyone who you think may be interested in this lecture or the series more broadly.  A calendar of upcoming presentations is available here.
If you have any questions about event logistics, please DO NOT respond to this email.  Instead, contact Cameron Collins ([email protected]).