Objective-To assess the use of opioids by primary care physicians for the treatment of chronic pain.Methods-A written survey was completed by 248 primary care physicians. Outcomes of interest included type of opioids prescribed, common pain diagnoses treated, opioid prescribing concerns, treatment of patients with a history of substance use disorders and clinic-based protocols for pain management.Results-The mean age of the physicians who completed the questionnaire was 41 years. The majority were between the ages of 30 and 49 years (68%) with an equal number of men and women. Seventy percent were family physicians, 28.7% internists and less than 2% were community physicians and geriatricians. Physician concerns regarding opioid therapy included prescription drug abuse (84.2%), addiction (74.9%), adverse effects (68%), tolerance (60.7%), and medication interaction (32%). The survey found that the majority of the physicians were comfortable in prescribing narcotics to patients with terminal cancer. However, they were less comfortable prescribing narcotics to patients with low back pain and persons with a current or past history of drug or alcohol abuse. Physician management practices suggested that urine toxicology tests were underutilized with only 6.9% reporting obtaining this test before prescribing opioids and only 15.0% performing urine toxicology tests on patients already prescribed opioids. Logistic regression analysis revealed that whether or not physicians routinely conducted urine toxicology screens was significantly (p = 0.015) predicted by whether they had a system to track patients on opioids when prescribing narcotics. The primary limitation of the study is the reliance on physician self-report rather than objective measures of physician behavior. Conclusions-The survey suggests physicians are concerned about drug abuse, addiction, adverse effects, tolerance, and medication interaction. Their comfort level in prescribing opioids varies with the patient characteristics. Urine toxicology testing is underutilized in the primary care setting.

Protein kinase C D (PKCD), a Ca 2+ -independent, phospholipiddependent serine/threonine kinase, is among the novel PKCs (D, E, and H) expressed in mouse epidermis. We reported that FVB/N transgenic mice that overexpress (f8-fold) PKCD protein in basal epidermal cells and cells of the hair follicle are resistant to the development of both skin papillomas and squamous cell carcinoma (SCC) elicited by 7,12-

Background: To assess the value of blood alcohol levels (BAL) and carbohydrate deficient transferrin (CDT) in trauma patients. Methods: A prospective study was conducted among 213 patients admitted to a university hospital after trauma. Outcomes of interest include the development of alcohol withdrawal, infections, respiratory problems, cardiac events, thromboembolism and length of stay. Results: The majority (78%) of the trauma patients in the study were males over the age of 18. 75% reported drinking an alcohol containing beverage in the previous 30 days, 34% had ≥ 5 heavy drinking days, and 18.7% met current DSM-IV criteria for alcohol abuse and 13.1% current criteria for dependence. Twenty-two percent (n=48) had a positive blood alcohol level (BAL) and 14% (n=30) a CDT level >2.5%. Twelve percent (n=27) of the sample developed alcohol withdrawal and 55% (n=113) had one or more adverse health events during their hospitalization. The development of alcohol withdrawal was associated with an admission CDT >2.5% (chi-square 4.77, p<.029) and/or a positive BAL (chi-square 54.01, p<.001). The alcohol biomarkers identified 13 male and 3 female high-risk patients (7.4% of the total sample), who denied excessive alcohol use, who would have missed if these markers were not used. A composite morbidity trauma score composed of 25 adverse health events was associated with a positive BAL (p<0.022). Conclusion: The study provides additional empirical evidence that supports the use of BAL in all patients admitted for trauma. The usefulness of CDT in trauma patients remains unclear and will require larger samples in more critically ill patients.

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