Two years ago, as life regained its rhythm and public transit once again filled with people, train and bus operators spotted a troubling trend. Some operators reported instances of people smoking drugs on their vehicles, and worried that the haze it created could linger, potentially affecting workers’ physical and mental health.��

Spurred by operators’ concerns, five transit agencies in Washington and Oregon approached researchers at the 91̽�� with a yes-or-no question: Were transit operators being exposed to drug smoke or residue in their workplace?����

The answer is nuanced. A 91̽��research team conducted a limited-scope, first-of-its-kind assessment and detected fentanyl and methamphetamine on board numerous transit vehicles, both in the air and on surfaces. But nearly all of the positive samples contained small amounts that are unlikely to cause acute medical conditions. And it remains unclear if consistent, long-term exposure — such as that potentially faced by operators working a 40-hour week — poses a risk to worker health.��

“A work environment that includes drug use and drug smoke can make it harder for transit operators to safely and effectively do their jobs, regardless of the level of exposure that operators may face,” said , a 91̽��assistant professor of environmental and occupational health sciences who co-led the assessment. “This research is important, as it draws attention to the stressors and exposures that these essential workers face.” ��

A complete accounting of the project, including research methods and detailed results, is available in the researchers’ The findings from this assessment are not yet submitted for publication. ��

The assessment was limited in scope and narrowly tailored. Researchers collaborated with five transit agencies, which also provided funding: , , and in Snohomish County, and in the Portland metro area.��

Air and surface sampling took place on trains and buses from four agencies and over 28 nights earlier this year. Transit lines and times were selected for sampling based on operator reports of observed drug use, with researchers targeting routes and runs when smoking events were most likely to occur. Both air and surface samples were collected near operators and in other areas of the vehicles where smoke was likely to accumulate.����

The assessment did not explore whether operators had any level of secondhand fentanyl or methamphetamine in their bodies. It also did not attempt to examine all transit routes and times, and researchers said their findings should not be assumed to be typical for all transit vehicles at all times.��

Researchers detected methamphetamine in 98% of surface samples and 100% of air samples, while fentanyl was detected in 46% of surface and 25% of air samples. One air sample exceeded . No similar guidelines exist for airborne methamphetamine.��

No enforceable federal or state regulations exist for either fentanyl or methamphetamine exposures in a workplace.����

The detection of fentanyl or methamphetamine by the lab does not necessarily mean it poses a health risk to operators or the riding public, Baker said.����

No previous studies have demonstrated acute medical conditions resulting from passive exposure to fentanyl or methamphetamine at the levels seen in this study, such as from touching contaminated surfaces or inhaling secondhand smoke. But further consideration should be given to daily secondhand exposure experienced by operators and its potential for long-term health effects, which have yet to be established by evidence-based research.����

“Operators are different from the riding public, because operators are exposed for a much longer time period,” said , a research industrial hygienist in the 91̽��Department of Environmental & Occupational Health Sciences and co-leader of this assessment. “The potential long-term health effects associated with daily exposure have not been adequately researched, so until these relationships are established, we’re suggesting protective measures that transit agencies could implement to keep operators safe.” ��

Those mitigation measures include enhanced cleaning of surfaces, upgraded ventilation and filtration where possible, and operator training. Training topics could include how operators should respond to smoking on board, real and perceived risks of secondhand drug exposure and how and when to use naloxone (Narcan) in overdose emergencies.����

Researchers also emphasized the need to consider operators’ mental health, especially for those in recovery or who may have experienced trauma related to drug use. ��

“Even at a level that is considered ‘safe,’ it can still be stressful to see drug use in your workplace,” Baker said. “Taking steps to protect operators will benefit their physical and mental well-being at work.”��

, a clinical assistant professor of environmental and occupational health sciences, also co-authored the final report. This assessment was funded through a contract with Sound Transit. King County Metro, Community Transit, Everett Transit, and TriMet, in addition to Sound Transit, contributed funding.��

For more information or to contact the researchers, email Alden Woods at acwoods@uw.edu.��

It’s the first time the mindfulness approach has been studied in a large randomized trial as an adjunct treatment. The training helps people better understand the physical and emotional signals in their body and how they can respond to these to help them better regulate and engage in self-care.

“We could teach this intervention successfully in eight weeks to a very distressed population, and participants not only really learned these skills, they maintained increases in body awareness and regulation over the yearlong study period,” said , a research associate professor in the and lead author of the study. ��“The majority of participants also reported consistent use of MABT skills, on a weekly basis, over the duration of the study.”

And likely due to using the skills learned in the intervention, the women showed less relapse to drug and alcohol use compared to those who didn’t receive the intervention, Price said. The findings were in March in the journal Drug and Alcohol Dependence.

The training included one-on-one coaching in an outpatient setting, in addition to the substance use disorder treatment the women were already receiving. The intervention is called Mindful Awareness in Body-oriented Therapy (MABT) and combines manual, mindfulness and psycho-educational approaches to teach interoceptive awareness and related self-care skills. Interoceptive awareness is the ability to access and process sensory information from the body.

Researchers studied 187 women at three Seattle-area locations. The cohort, all women in treatment for substance use disorder (SUD), was split into three relatively equal groups. Every group continued with their regular SUD treatment. One group received SUD treatment only, another group was taught the mindfulness technique in addition to treatment, and the third group received a women’s education curriculum in addition to treatment in order to test whether the additional time and attention explained any positive study outcomes.

Women were tested at the beginning, and at three, six and 12 months on a number of factors including substance use, distress craving, emotion regulation (self-report and psychophysiology), mindfulness skills and interoceptive awareness. There were lasting improvements in these areas for those who received the MABT intervention, but not for the other two study groups.

“Those who received MABT relapsed less,” Price said. “By learning to attend to their bodies, they learned important skills for better self-care.”

Co-authors include Elaine Adams Thompson and Kenneth Pike of the UW, and Sheila Crowell of the University of Utah. The study was supported by the National Institute on Drug Abuse and the National Institutes of Health.

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For more information, contact Price at 206-685-4739 or cynthiap@uw.edu.

Grant number: R01 DA033324

The will be published in the July 2014 issue of Addictive Behaviors, but is already online.

Synthetic marijuana, sometimes called “Spice,” is made with shredded plant material coated with chemicals that are designed to mimic THC, the psychoactive compound found naturally in marijuana. The U.S. Drug Enforcement Administration has listed several of synthetic marijuana’s main compounds as Schedule 1 substances, making them illegal. But producers of the drug keep synthesizing new compounds to try to get around those bans.

“Because the formulation is constantly changing, one batch could be innocuous while the next batch affects you totally differently and you land in the hospital with seizures,” said , project director for the 91̽��study and a research coordinator in social work. “So the health effects are very unpredictable.”

Those health effects have not been widely studied yet, but emergency rooms have reported seizures, nausea, vomiting, and cardiovascular and respiratory problems. Psychological effects of using synthetic marijuana can include anxiety, confusion, agitation, irritability, depression and memory issues.

The U.S. military has banned synthetic marijuana in all branches of the service.

Participants in the 91̽��study came from the Department of Defense-funded , a telephone-based intervention trial for Army personnel with untreated substance use issues who are ambivalent about making changes or engaging in treatment. All participants were stationed at Joint Base Lewis-McChord in Washington state at some point during the 2011-2014 recruitment period.

Nearly one-third said they had used illicit substances within the previous 90 days; 38 percent of those used synthetic marijuana, twice as many as had used regular marijuana.

Study participants told researchers they believed that use of synthetic marijuana was significantly higher in the military than in the civilian population. It was the only substance that soldiers believed they used more than civilians, which supports the idea that synthetic marijuana is particularly attractive to military personnel, the researchers said.

“What we think other people do tends to be important in prevention efforts and intervention efforts,” said , lead author of the study and a 91̽��research associate professor of social work. “If soldiers think it’s common for military personnel to use Spice, then they might think it’s OK to use it.”

Walker said soldiers tend to avoid treatment for substance abuse issues because seeking treatment automatically goes on their record.

“Who would sign up for that in the civilian population if your boss and your coworkers will immediately know?” Walker said.

The Warrior Check-Up is not considered treatment, and participation is strictly confidential.

Users of synthetic marijuana were younger and less educated than those who were dependent only on alcohol. They were more likely to be single and earned less money than those who were dependent on other drugs or alcohol. But there were no differences in ethnicity, race, deployment history or religion. Researchers also found that synthetic marijuana users were two-and-a-half times more likely to develop drug dependence than those who used other drugs (but not alcohol).

The majority of participants believed their use of synthetic marijuana resulted in failing to meet obligations, such as being late for work, doing their job poorly, or not handling home and child care responsibilities well.

One hazard of using synthetic marijuana was needing more and more to get the same effect, a hallmark of drug dependence. More than three-quarters of users reported using it for much longer than intended (i.e., planning to take just a few puffs after work, but then smoking it for hours).

Walker said there are many reasons why someone would become dependent on alcohol or drugs, but soldiers face added stressors.

“They live very stressful lives. Most of them are young, and they may be going to war or coming back from war,” she said. “Being in the Army is very demanding.”

The military recently announced that it has developed a urinalysis that can detect synthetic marijuana, but Walton said that test doesn’t necessarily have a very high success rate.

“Those drug tests aren’t identifying all the users out there,” he said. “And, unfortunately, because of the consequences of self-reporting to substance use treatment, positive drug tests are the primary reason soldiers enter treatment. The Warrior Check-Up hopes to change that by helping military personnel change their substance use before it negatively impacts their lives and careers.”

Co-authors are Adam Pierce, , and of the UW; and of the University of Houston. The study was funded by the Department of Defense.

# # #

For more information, contact Walker at ddwalker@uw.edu or 206-543-7511, or Walton at towalton@uw.edu or 206-543-7511.

Department of Defense grant: W81XWH-09-2-0135.

Faculty members from the 91̽��School of Pharmacy and the 91̽��School of Medicine have secured a $4.7 million National Institutes of Health grant to study drug disposition during pregnancy. Disposition refers to how the drugs are absorbed, distributed, metabolized, and excreted.

The principal investigator on this multi-part, five-year grant from the NIH National Institute on Drug Abuse is Jashvant Unadkat, professor of pharmaceutics.

Unadkat’s grant includes researchers from the 91̽��Departments of Pharmaceutics, Pharmacy, and Obstetrics and Gynecology. It will involve three subprojects, each examining different drug types and their disposition in pregnant women and their fetuses: the drug abuse treatment methadone, amphetamines and other illicit drugs, and the antidepressant bupropion.

Researchers will work with the British company Simcyp to synthesize the data from all three projects. Simcyp uses a population-based simulator to conduct physiological pharmacokinetic modeling — a mathematical modeling technique for predicting the disposition of synthetic or natural chemical substances in virtual human populations. The analysis may help predict how pregnant women and their fetuses handle illicit drugs, medications for drug abuse, and antidepressants.

Longterm, researchers would like to improve treatment of pregnant women who need to take medications. They hope to guide prescribers on how to adjust dosages. The researchers also want to provide new tools to predict fetal exposure to drugs during pregnancy and to evaluate risks to the baby.

The Unadkat lab has been studying drug disposition during pregnancy for more than 25 years.��Earlier, Unadkat’s goals were to develop therapeutic strategies to prevent transmission of HIV from mother to child before birth. One of his key findings was that HIV drug disposition can be substantially altered in pregnant women, so much so that the usual doses administered to men and non-pregnant women do not have the same therapeutic effect in pregnant women.

“These research findings led us to ask a broader question about how to adjust dosing regimens of drugs taken during pregnancy to maintain efficacy and reduce toxicity,” said Unadkat.��“It’s inevitable that pregnant women need to take medicinal drugs, because many women have clinical conditions that need to be treated.��Not attending to conditions like hypertension or HIV infection could be harmful for the mother and her fetus.”

Unadkat later broadened his research to study illicit as well as licit drugs. His group recognized that the use of illicit drugs in pregnancy is an important social issue. Research on the effects of these drugs during pregnancy could help in assessing risk to the fetus.

Faculty members throughout the 91̽��School of Pharmacy study the safe and effective use of medications taken during pregnancy. For this new NIH grant, Unadkat will collaborate with several such colleagues. Project leaders from the 91̽��School of Pharmacy are Nina Isoherranen, Qingcheng Mao, Jashvant Unadkat and Joanne Wang; and co-investigators are Gail Anderson, Rodney Ho and Ed Kelly. Co-investigators from the School of Medicine are Justine Chang, Michael Grayett and Alyssa Stephenson-Famy.

“I’m delighted to have the opportunity to collaborate with such a wide range of scientists on this NIH grant,” said Unadkat. “It is my hope that the research we are conducting could one day improve the health and well-being of pregnant women and their babies.”