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The proportion of cancer cases diagnosed through a cirrhosis follow-up program was lower in the nonabstinent group than in the abstinent group (11.9% vs 28.4%; P < .0001). Median overall survival was similar, however: 5.8 months for the abstinent group vs 5.0 months for the nonabstinent group (P = .09). The French team also evaluated the importance of participation in a cirrhosis follow-up program before cancer diagnosis. Patients who were diagnosed during a cirrhosis follow-up program (n = 190) were more likely to receive intent-to-cure treatments (15.4% vs 37.6%; P < .0001) than those who were not in such a program. For the entire cohort, the lead time-adjusted median survival was 11.7 months among patients enrolled in a cirrhosis follow-up program vs 5.4 months for those diagnosed incidentally (P < .0001). Survival was shorter for patients with alcohol-related HCC than for those with non-alcohol-related disease (9.7 months vs 15.0 months; P = .042). Costentin explained that despite guidelines recommending biannual screening, fewer than 30% of the patients in this study were involved in a cirrhosis follow-up program. The same figures have been reported in the United States. "Patients with liver cancer diagnosed during a surveillance program had prolonged survival compared to patients diagnosed incidentally, and nonabstinent patients were less likely to be included in a surveillance program," she said. "Survival times in abstinent patients were comparable to nonalcohol patients medicaid and longer than in nonabstinent patients. "Therefore, in order to improve the prognosis of HCC in the alcoholic population, efforts should be made to improve screening for cirrhosis, a goal that can be reach by increasing awareness among primary care practitioners towards the alcohol issue," Costentin continued. Screening for liver cancer also needs improvement. datos In addition, physicians need to become more aware of the positive impact of liver cancer screening, as do patients with liver disease, she explained. Access to alcoholism treatment may also need to be facilitated.
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However, past year marijuana use has dropped in the last five years among eighth and 10th graders. Marijuana-Daily use: Daily rates among 10th and 12th graders remained relatively stable at 2.5 percent and 6 percent for the past few years. Marijuana Edibles: Teens who live in states where medical marijuana is legal report a higher use of marijuana edibles. For example, among 12th graders reporting marijuana use in the past year, 40.2 percent consumed marijuana in food in states with medical marijuana laws compared to 28.1 percent in states without such laws. Synthetic Cannabinoids: Past year “synthetic marijuana” (K2/Spice) use among 10th and 12th graders dropped significantly from last year. For example, the rate for seniors fell to 3.5 percent compared to 5.2 percent in 2015, with a dramatic drop from its peak of 11.4 percent the first year it was measured in 2011. Cocaine: Past year cocaine use was down among 10th graders to 1.3 percent from 1.8 percent last year. Cocaine use hit its peak in this measure at 4.9 percent in 1999. Inhalants: Inhalant use, usually the only category of drugs used more by younger teens than their older counterparts, was down significantly among eighth graders compared to last year, with past year use at 3.8 percent, compared to 4.6 percent in 2015. Past year inhalant use peaked among eighth graders in 1995 at 12.8 percent. MDMA (Ecstasy or "Molly"): Past year use is down among eighth graders to 1 percent, from last year’s 1.4 percent. MDMA use is at its lowest point for all three grades in the history of the MTF survey. Heroin: Heroin rates remain low with teens still in school. High school seniors report past year use of heroin (with a needle) at 0.3 percent, which remains unchanged from last year. In the history of the survey, heroin (with a needle) rates have never been higher than 0.7 percent among 12th graders, as seen in 2010. Cold and Cough Medicine: Eighth graders alone reported an increase in misuse of over-the-counter cough medicine at 2.6 percent, up from 1.6 percent in 2015, but still lower than the peak of 4.2 percent when first measured in 2006. Attitudes and Availability: Attitudes towards marijuana use have softened, but perception of harm is not necessarily linked to rates of use. For example, 44 percent of 10th graders perceive regular marijuana smoking as harmful ("great risk"), but only 2.5 percent of them used marijuana daily in 2016. This compares to a decade ago (2006) when 64.9 percent of 10th graders perceived marijuana as harmful and 2.8 percent of them used it daily. The number of eighth graders who say marijuana is easy to get is at its lowest in the history of the survey, at 34.6 percent.https://www.drugabuse.gov/news-events/news-releases/2016/12/teen-substance-use-shows-promising-decline
The only other service provided was emergency counseling, and three interim participants requested and received emergency counseling during the 4 months of treatment. Patients who failed to show up for three consecutive doses were discharged from the interm methadone—program-wide rule that did not change for study participants. The clinic staff did not contact individuals who missed doses. Dr. Thomas Hilton of NIDA's Division of Epidemiology, Services and Prevention Research says, "Dr. Schwartz and his team have demonstrated that interim medication is a significant recruitment tool. This might even be an appropriate way to start treatment for everyone needing methadone maintenance. It exposes patients to some degree of structure, helps them ease into a more intensive, full-service program and accommodate their lifestyle to the structure required in the full service program." Interim methadone also may be an important tool for retention, says Dr. Hilton, because patients may be ready for the medication before they're ready for counseling. After a few months on methadone alone, patients may be better able to engage with a counselor, making the relationship more productive. Six methadone programs in the Baltimore area have taken their cue from the study's findings and now offer interim maintenance. "What the interim treatment approach does is add patients to existing programs," Dr. Schwartz explains. "It is not hard for the staff to do, it's less expensive, and it's effective. We hope it becomes more widespread." Schwartz, R.P., et al. A randomized controlled trial of interim methadone maintenance. Archives of General Psychiatry 63(1):102-109, 2006.https://www.drugabuse.gov/news-events/nida-notes/2007/04/interim-methadone-raises-odds-enrolling-in-comprehensive-treatment