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Friday, June 29, 2012

ATOD news recap week ending June 29

Is the field's historical record fading away?

Asking “How is it that an academic field can come so far and then erase itself?”, a dwindling group of substance abuse research librarians is seeking to call the addiction field into action before their organizations tumble into extinction.

 A strongly worded editorial published online June 12 in the journal Addiction makes a compelling case for addiction field libraries’ role in furthering knowledge among treatment professionals and researchers, but the editorial’s appearance also comes with some disappointing irony. Since the first drafting of the article text more than four years ago, more libraries have shut operations as the article underwent revisions and its authors experienced other delays.
“Every three or four months, another librarian leaves our organization because another library closes,” says Andrea Mitchell, executive director of Substance Abuse Librarians and Information Specialists (SALIS), an organization with a current membership that is down about 60 from a level of 143 just a decade ago.
While addiction professionals can be fiercely attached to the historical context of their profession, it remains difficult to rally the field around the health of research libraries and databases at a time when many individuals assume that any document they need can be accessed for free somewhere online. Not so, say members of SALIS (, who represent libraries housed at institutions such as research centers, government agencies and alcohol industry operations.
SALIS members do have some well-known allies in their effort, such as William White, the nation’s most prominent chronicler of the field’s history. White, senior research consultant with Chestnut Health Systems, sent a comment to Addiction Professional in regard to SALIS’s effort; it read in part:
“The worst of our professional history will repeat itself if the lessons of our history are lost. The best of our clinical practice will erode if we lose the repositories of scientific and experiential knowledge upon which they are based. We risk becoming a profession unguided by memory, knowledge and wisdom.”
Federal moves
Mitchell says pivotal developments occurred in 2003 and 2006 when the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), respectively, discontinued their science library collection operations. At the time of NIAAA’s move, officials there suggested that maintaining the library generally represented an unnecessary cost because of the existence of online databases.
But as Mitchell and her co-authors pointed out in the Addiction article, NIAAA’s former ETOH database (ETOH is the chemical name for alcohol) indexed 55 addiction-specific journals, which they said is significantly more than what can be found on PubMed.
Along with the moves by the national research institutes, the Substance Abuse and Mental Health Services Administration (SAMHSA) in recent years closed its prevention library and cut funding for Regional Alcohol and Drug Awareness Resource centers that disseminated alcohol and other drug agency publications.
The editorial states, “More than 25 libraries or databases have closed in the past decade. Not only have we lost the information base, but the expertise of the librarians.”
This advocacy effort on the part of SALIS even was delayed in itself because of the struggles of some of the libraries. Mitchell herself was laid off from her job in 2008 shortly after commencing work on the journal editorial.
Move to digitize
SALIS’s present effort is focused on stepping up the pace of digitization of print material in the addiction field. “We did a survey in 2009 and found that only a few libraries were digitizing—fewer than five people had digitized more than 500 items,” Mitchell says.
SALIS is now working with the nonprofit digital library Internet Archive in an attempt to digitize 500 books in the field. It is seeking librarians who are interested in getting 10 books per library digitized at no charge, says Mitchell.
But she still believes government agencies ultimately need to play a key role in preserving the alcohol and drug field’s historical context. “We have to have government giving some money,” she says.
What would be the result of a field bereft of library resources? “How do you measure the effect on a scholar going out looking for stuff?” Mitchell asks.
Already she sees an information gap emerging. “It is even difficult trying to find NIAAA memoranda,” she says, adding, “There’s not a lot of ‘new’ happening in alcohol right now.”
A news release issued by SALIS in conjunction with the editorial’s publication states, “If action is not taken, important documents could be lost forever, especially the grey literature, i.e. unpublished reports and working papers, government documents, and programmatic materials, which tend to disappear when libraries are closed.”

SBIRT will be part of collaborative care initiative
An intervention to curb risky substance use will be a service option under an innovative federally funded initiative to implement a collaborative care model for patients who have clinical depression along with diabetes and/or heart disease.
The federal Centers for Medicare and Medicaid Services (CMS) is awarding nearly $18 million to a host of organizations led by the Institute for Clinical Systems Improvement (ICSI), a quality improvement organization sponsored by nonprofit health plans in Minnesota and Wisconsin. Several other healthcare institutions outside of those states will be participating in this project as well.
While all participating sites will support development of a common model and training program to manage depression plus diabetes and/or cardiovascular disease collaboratively, many of the sites also will incorporate the Screening, Brief Intervention and Referral to Treatment (SBIRT) model to address potentially harmful substance use in this patient population.
According to a statement from ICSI, focusing on the substance use issue is of particular concern in Minnesota, which it says ranks sixth in the nation in the prevalence of binge drinking.
“We will spread an innovative model that provides better health, better care and lower costs—truly a Triple Aim Bulls-eye,” said Sanne Magnan, MD, PhD, president and CEO of ICSI.
Components of the care management model under this initiative include use of a computerized registry to monitor patient progress; use of a care manager to provide the individual patient with education and illness self-management support; and relapse and exacerbation prevention.

Rate of Bipolar Symptoms Among Teens Approaches That of Adults

The rate of bipolar symptoms among U.S. teens is nearly as high as the rate found among adults, according to NIMH-funded research published online ahead of print on May 7, 2012, in the Archives of General Psychiatry.

Nationally representative data indicate that about 3.9 percent of adults meet criteria for bipolar disorder in their lifetime, and 2.6 percent meet criteria in a given year.1 However, limited data exist on the rates of bipolar disorder among adolescents, despite strong evidence indicating that bipolar disorder tends to emerge in adolescence or early adulthood.

Kathleen Merikangas, Ph.D., of NIMH, and colleagues analyzed data from the NIMH-funded National Comorbidity Survey-Adolescent Supplement (NCS-A), a nationally representative, face-to-face survey of more than 10,000 teens ages 13 to 18. Using criteria established by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV), the researchers assessed teens for the hallmark symptoms of bipolar disorder—mania and depression. They also examined the rates of teens who showed evidence of mania alone.

The researchers found that 2.5 percent of youth met criteria for bipolar disorder in their lifetime, and 2.2 percent met criteria within a given year. About 1.7 percent reported having mania alone within their lifetime, and 1.3 percent reporting having mania alone within a given year. Rates increased with age—about 2 percent of younger teens reported bipolar disorder symptoms, whereas 3.1 percent of older teens did.

Source: U.S. Department of Health and Human Services, National Institutes of Health

Teens Who Listen to High-Volume Music at Greater Risk of Substance Abuse

Teens and young adults who listen to high-volume digital music with ear buds, or who visit music venues such as clubs or concerts, are at greater risk of substance abuse than their peers who don’t engage in so-called risky music-listening behaviors, according to a new study.

Young people who listen to loud music with ear buds are almost twice as likely to smoke marijuana as those who do not listen to music on MP3 players, the Los Angeles Times reports. Teens and young adults who attend loud concerts and dance clubs are almost six times as likely as those who don’t frequent these venues to have had five or more alcoholic drinks in a row at some point in the previous month, the study found. They are also twice as likely to have sex without using a condom every time.

Researchers in the Netherlands surveyed 944 low-income students at two vocational schools, who ranged in age from 15 to 25. “This study highlights the need to regard high-volume music listening as a risk factor for risk-taking behavior,” they wrote in the journal Pediatrics. They suggested the findings could lead to practical interventions, such as handing out condoms and earplugs at concerts, or printing messages about alcohol abuse on concert ticket stubs.

Many Drivers Convicted of DUI Have Lifelong Struggle With Heavy Drinking
Almost half of adults with a drunk driving conviction said they had been struggling with heavy drinking for a long time, or had resumed heavy drinking after trying to quit or reduce their alcohol use, a new study finds. The study of 696 adults with a drunk driving conviction found 19 percent reported a lifetime of heavy drinking, while 25 percent had resumed heavy drinking again after at least one period of abstinence or moderate drinking, Reuters reports. The researchers write in the journal Addiction that there could be long-lasting benefits from using heavy drinkers’ convictions to get them into treatment.

The researchers found 13 percent had varying drinking patterns throughout their lives, while 14 percent had successfully cut down from heavy drinking to more moderate drinking. In addition, 21 percent had stopped drinking after some period of heavy drinking. Between one-fifth and one-third of chronically heavy drinkers met the definition for alcohol or drug dependence, or for mental health disorders such as depression.

Women were considered heavy or “risky” drinkers if they regularly had more than seven drinks a week, or four or more drinks a day. Men were considered risky drinkers if they had more than 14 drinks a week, or five or more drinks a day. Those who began risky drinking at age 15 or later quit at double the rate of those who began before age 15. While women’s and men’s drinking patterns were similar, women tended to begin risky drinking at a later age, and more often were able to quit.

One-Third of U.S. Treatment Applicants Report Buprenorphine/Naloxone Sold on Street;  One-Fifth Report the Drug Is Used to Get High
“Diversion and abuse of buprenorphine/naloxone have steadily increased since 2005 through 2009,” according to data from a national post-marketing surveillance program* funded by the manufacturer. One of the indicators of diversion and abuse utilized by the surveillance program is a survey of nearly 19,000 applicants to 86 substance abuse treatment programs in 30 states. Both the percentage of applicants who reported knowing that buprenorphine/naloxone, which has been approved for opioid therapy since 2002, was sold on the street and those that reported knowing that the drug was used to get high increased from 2005 to 2009, reaching 33% and 21%, respectively.

In comparison, the percentage who reported that methadone, which has been used since the 1950s for opioid therapy, was sold on the street or used to get high has remained relatively stable over the past three years. The authors note that “the increases in diversion and abuse measures indicate the need to take active attempts to curb diversion and abuse as well as continuous monitoring and surveillance of all buprenorphine products”.

*Conducted for Reckitt Benckiser Pharmaceuticals by an independent contractor, the Surveillance of Diversion and Abuse of Therapeutic Agents (SODATA) utilizes several national indicators of diversion and abuse combined with a survey of applicants to substance abuse treatment programs and a survey of CSAT-certified physicians.
**Surveys were conducted at 86 treatment programs (both providing and not providing pharmacotherapy) from 30 states providing a total of 18,956 completed surveys from 2005 to 2009. While the treatment applicant survey was not a probability sample, the demographic characteristics of the applicant sample were similar to that of the national census of publicly-funded treatment admissions. The applicant survey does not estimate either the incidence or the prevalence of diversion/abuse, but it is an indication of changes in perception of diversion/abuse among a population likely to be knowledgeable about illegal markets through their own experiences, that of others, and direct observations.

Addiction Medicine: Closing the Gap between Science and Practice
CASA Columbia’s new five year national study reveals that addiction treatment is largely disconnected from mainstream medical practice.  While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed.  The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services, including pharmaceutical and psychosocial therapies and other medical care. This landmark report examines the science of addiction--a complex disease that involves changes in the structure and function of the brain--and the profound gap between what we know about the disease and how to prevent and treat it versus current health and medical practice. The read more and download associated files, please click here

Commentary: Taking a Closer Look at College Marijuana Use
Parents, college students, college officials and other policy makers: take heed. Recent findings from the College Life Study (CLS) may be the first to indicate that students who smoke marijuana during college may be risking their longer-term health, particularly if they increase their marijuana use during the college years or continue a heavy use pattern.

Amelia Arria, PhD, Principal Investigator of the CLS and co-author of the study, stressed the importance of finding out more. “These findings need to be examined in other college (and non-college) samples of young people,” she said. “Rather than assuming that marijuana use during college is simply a ‘rite of passage,’ we need to consider possible impacts on long-term physical and mental health and on health care utilization,” she explained.

Based on how often they used marijuana over six years, the researchers first divided the college students in this sample into two categories: users and non- or rarely-using students. Most (71.5%) did not use marijuana (or used only rarely). The 29.5% who did use were then sub-divided into five groups based on the onset, frequency, and progression of their marijuana use.
Analysis indicated that all marijuana using students—except those who rarely used—were at risk for several adverse health outcomes, including injury, illness,and emotional problems bad enough to interfere with day-to-day tasks; poorer overall health (self-reported); more symptoms of psychiatric problems; lower quality of life (health-related); and, three years after college, increased service use for physical and mental health problems. Non-users fared significantly better than most of the using groups. Students who were chronic users or whose use increased beginning in year three of college had the worst health outcomes.

A major strength of the study is that it takes into account health at baseline and a number of other variables including alcohol and tobacco use over time. No data were available to quantify the costs of these problems, but the findings should be of interest to policymakers and others who are concerned about the rising costs of health care services.

Stressing again that the possible link between marijuana use and adverse health outcomes needs more study, Arria went on to say that even modest differences in health outcomes should be a wake-up call for the students themselves as well as their parents. “For this (growing) subset of college-bound adolescents who use marijuana, college may be an opportune time and place to intervene before problems escalate,” she said. “Colleges should consider using assessment tools to spot trouble and do something about it—through college health centers and academic assistance programs,” she added.

The writer is Principal Investigator of the College Life Study and Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, Department of Family Science. She is also Scientific Director of the Parents Translational Research Center at the Treatment Research Institute.

Prescription Painkiller Abuse Jumped 75 Percent From 2002 to 2010, Study Finds
A new study finds prescription painkiller abuse jumped 75 percent between 2002 and 2010. Men and adults ages 26 to 49 were most likely to abuse prescription painkillers.

Bloomberg News reports the study is the first to examine who is likely to abuse prescription painkillers, and how often it occurs. The study found more than 15,000 people overdosed on painkillers and died in 2009—more than double the number in 2002.
“Chronic nonmedical use is increasing and these drugs have very dangerous risks,” study author Christopher Jones of the Centers for Disease Control and Prevention’s Injury Center told Bloomberg News. “As sales of these drugs have gone up so has the unintended adverse events.” These events include overdoses, deaths, emergency room visits and addiction, he said.

The study, published in the Archives of Internal Medicine, is based on data from the National Survey on Drug Use and Health, which provides national estimates on substance abuse. The researchers found 3.8 per 1,000 people said they used prescription painkillers for nonmedical purposes for 200 days or more in 2009-2010, compared with 2.2 per 1,000 in 2002-2003. That represents a 75 percent increase. The study took population growth into account, the authors noted.

Men who used prescription painkillers for nonmedical purposes for 200 or more days annually rose 105 percent from 2002 to 2010. Among adults ages 26 to 34, the rate jumped 81 percent, the article notes. Among teens 12 to 17, nonmedical use of painkillers dropped 26 percent during those years. Overall, almost one million people reported using pain relievers nonmedically for 200 days or more in 2009-2010, while 4.6 million people used them for 30 days or more. The researchers conclude that “these findings underscore the need for concerted public health and public safety action to prevent nonmedical use of these drugs.”

Addiction epidemic: Americans’ problems with pain meds go back a century
More than 100 years ago, Dr. John Witherspoon, who became president of the American Medical Association, urged the medical community to avoid widespread narcotics use.
It “stalks abroad throughout the civilized world,” he wrote in a 1900 issue of the Medical Association journal. “(It is) wrecking lives and happy homes, filling our jails and lunatic asylums.” Now, 112 years later, prescription pills have become a staple of modern medical treatment, promising pain relief to millions of patients, but as rates of prescription drug abuse and pills-related deaths spike, patients, doctors and families are left to consider Witherspoon’s warning.
“For most physicians, it’s always been about the patients,” Dr. Lynn Webster, president-elect of the American Association of Pain Medicine, said.

“Our belief was if you were using it for the right purpose, it would help deal with pain and most people would not be harmed,” Webster said. “But, frankly, I don’t believe we appreciated … how harmful (the pills) could be to so many people.”

Around the turn of the 20th century, when Witherspoon was writing, doctors were dealing with another potential threat in the medical community.

Researchers had recently released a synthetic form of heroin known as diacetylmorphine to help address pain and cure morphine addiction. Within several years, pharmaceutical companies had released several versions and forms of the drug, including tablets, lozenges and liquids. But after several years, doctors found the drug, marketed as “Heroine,” to be just as addictive and damaging as morphine itself.

For this reason, doctors and medical professionals shied away over the following decades from opiate-based pain killers.  Doctors, who feared the drugs’ addictive qualities, largely refused to prescribe the pills for pain treatment. And patients, who feared both the effects and the stigma of addiction, didn’t ask.

“People felt guilty if they used opioids for pain,” said Dr. Seddon Savage, director of the Center on Addiction, Recovery & Education at Dartmouth College. “People felt they were addicts if they had to use.”

Toward the beginning of the 1960s, however, that attitude began to change.  Around that time, pain management began to emerge as an area of medical practice, and doctors and medical providers started to focus on hospice and palliative care for cancer patients and those in severe and chronic pain. “That was really when it started,” Savage said.

Managing pain
Over the decades to follow, medical research focused much more on pain treatment. Several national organizations formed, pushing pain treatment strategies, and doctors and hospitals started to prescribe opiate-based medications to treat acute and chronic pain.
“Until then, people feared the indignity of dying of addiction would be worse than having their pain controlled,” said Webster, of the pain medicine association.  “That obviously evolved,” he said. “We began to believe that people who suffer from a great deal of pain, should not, and we came up with options to treat them.”

Doctors and medical professionals initially welcomed the drugs, applauding them for increasing access to effective pain treatment for patients. And rates of prescription drug use increased slightly over that time.  By the early 1970s, national surveys reported 300,000 new users of pain killers, and by 1986, that number reached 500,000, according to a survey by the national Substance abuse and Mental Health Services Administration. “Those numbers stayed pretty stable over time,” said Dr. Ruben Baler, a health scientist with the National Institute on Drug Abuse.

But, in the mid-1990s, the usage rates began to rise dramatically.  Starting around 1992, the number of new users spiked from about 500,000 to 2.5 million in 1998, according to the national survey. Several factors likely contributed to the stark increase in usage rates, and it’s hard to pinpoint a single cause, Baler said, “You can’t draw a conclusion there was any single cause and effect,” he said.

But this timeline coincided with the introduction of several new prescription drugs to the market, other doctors noted. In the early 1990s, pharmaceutical companies released several time-released morphine pills, and in 1996, Purdue Pharma released OxyContin, the market version of oxycodone, another prescription strength pain killer.

Over the next eight years, the pharmaceutical industry exploded. Oxycodone sales jumped six-fold between 1997-2005, according to media reports, and, by 2008, the United States accounted for nearly half of the world’s pharmaceutical market, with $289 billion in annual sales, according to New York University’s Stern School of Business. The prescription pills allowed patients to take just one or two doses a day to relieve their pain, as opposed to prior treatments which were required more frequently, according to Savage, of the Dartmouth addiction center. But with qualities similar to heroin, cocaine or other recreational drugs, the pills also allowed non-medical users an easy high without dealing on the streets.

By contrast, these pills were now available in home medicine cabinets.
“It’s completely different,” said Dr. James Martin, medical director of St. Joseph Hospital’s emergency and EMS departments in Nashua. “People are able to treat their pain at home now, and that means the pills are available at home,” he said. “There are all kinds of challenges that come from that.”

Dangerous prescriptions
The challenges have only grown over recent years. According to a 2012 study by Quest Diagnostics, prescription drug abuse causes more than 20,000 deaths each year, including 14,800 from opiate-related medications. In addition, hospitals reported more than 475,000 pill-related emergency room visits in 2009, more than twice the number reported five years earlier, according to the study. Such incidents include both patients and non-medical users alike, analysts said. Like users looking to get high, patients often can often become addicted and overdose on the pills, seeking to dull their pain, Webster said.

“The disease of addiction is about 50 percent due to our genetic makeup,” he said. “Because you have pain doesn’t protect you from that. … There’s always going to be a subset of the pain population who’s at risk for harm.” To battle this epidemic, health professionals, public safety officers and lawmakers across the country are looking to limit access to pills.
Police departments are holding drug take-back days, in which they collect extra pills from the public before they reach the streets. And, at the state level, lawmakers are implementing prescription monitoring programs, in which they monitor distribution of pills between clinics. Looking forward, medical researchers are working toward non-addictive medications that could replace opioids.

But, in the short term, the answer requires a greater focus on public awareness, medical analysts said. Doctors, public safety officers, teachers and other members of the public need to work more to educate the public about the potential risks and consequences of prescription drug abuse. “We need a lot more education about pain, we need a lot more education about opioids and we need a lot more education about disease of addictions,” Webster said. “There’s a perception out there that because these are prescription, they’re less dangerous. That’s not the case. We’re seeing that every day.”

Drug Abuse Kills 200,000 People Each Year: UN Report
Drug abuse kills about 200,000 people worldwide each year, according to a new United Nations (UN) report. Global treatment for drug abuse would cost $250 billion per year if everyone who needed help received proper care, according to the UN. Fewer than one in five people who need treatment actually receive it, according to the Associated Press. Crimes committed by people who need money to finance their drug habit, as well as loss of productivity, add tremendous costs for many countries, the report notes.

The UN estimates that about 230 million people, or 5 percent of the world’s population, used illegal drugs at least once in 2010. In the United States, female drug use was two-thirds the male rate, while in India and Indonesia, females constituted only one-tenth of those using illegal drugs.
The 2012 World Drug Report cited an increase in synthetic drug production worldwide, “including significant increases in the production and consumptions of psychoactive substances that are not under international control.” Overall, use of illegal drugs remained stable during the past five years, at between 3.4 and 6.6 percent of the world’s adult population. Marijuana was the most widely used drug.

Coca bush cultivation has decreased 33 percent over the past 12 years. Seizures of methamphetamine more than doubled in 2010 compared with 2008. In Europe, seizures of Ecstasy pills more than doubled.

“Heroin, cocaine and other drugs continue to kill around 200,000 people a year, shattering families and bringing misery to thousands of other people, insecurity and the spread of HIV,” the Executive Director of the UN Office on Drugs and Crime, Yury Fedotov,  said in a news release. He added that as developing countries emulate industrialized nations’ lifestyles, it is likely that drug consumption will increase.

Congress agrees to add synthetic drugs to Controlled Substances Act
“K2” and “Spice” would permanently appear on Schedule I

The Drug Enforcement Administration (DEA) commended House and Senate negotiators for agreeing on legislation to control 26 synthetic drugs under the Controlled Substances Act. These drugs include those commonly found in products marketed as "K2" and "Spice." The addition of these chemicals to Schedule I of the Controlled Substances Act will be included as part of S. 3187, the Food and Drug Administration Safety and Innovation Act. Schedule I substances are those with a high potential for abuse; have no medical use in treatment in the United States; and lack an accepted safety for use of the drug.

In addition to scheduling the 26 drugs, the new law would double the length of time a substance may be temporarily placed in Schedule I (from 18 to 36 months). In addition to explicitly naming 26 substances, the legislation creates a new definition for "cannabamimetic agents," creating criteria by which similar chemical compounds are controlled.

In recent years, a growing number of dangerous products have been introduced into the U.S. marketplace. Products labeled as "herbal incense" have become especially popular, especially among teens and young adults. These products consist of plant material laced with synthetic cannabinoids which, when smoked, mimic the delirious effects of THC, the psychoactive ingredient of marijuana. According to the United Nations Office on Drugs and Crime, more than 100 such substances have been synthesized and identified to date. DEA has used its emergency scheduling authority to place in Schedule I several of these harmful chemicals.
Newly developed drugs, particularly from the "2C family" (dimethoxyphenethylamines), are generally referred to as synthetic psychedelic/hallucinogens. 2C-E caused the recent death of a 19 year-old in Minnesota.

The substances added to Schedule I of the Controlled Substances Act also include 9 different 2C chemicals, and 15 different synthetic cannabanoids.

The American Association of Poison Control Centers reported that they received 6,959 calls related to synthetic marijuana in 2011, up from 2,906 in 2010.

Illegal Drug Use Around the World — 5 Things You Need to Know

Global illegal drug use is expected to rise by 25% over the next few decades as rapid urbanization, industrialization, and population growth in developing countries fuel the demand for illegal substances, the UN’s anti-drug agency said in its new annual report this week. The report by the UN Office on Drugs and Crime (UNDOC), which underlines the fight against drug abuse with data on the consumption and production of illegal substances, also projects that developing countries will shoulder the burden of the global drug problem in the coming decades. Here are the highlights of the UN findings:

1. Roughly 230 million people have used an illegal drug at least once in 2010.
In 2010, 5% of the world adult population aged 15-64 used illegal drugs at least once. Problem drug users, who mainly depend on cocaine and heroin, make up an estimated 0.6% of the world adult population, amounting to roughly 27 million. Every year, approximately 200,000 people worldwide die from drug abuse.
2. The global number of illegal drug users will go up by 25% by 2050.
If the annual prevalence of illegal drug use stays stable at 5% of the adult population over the next few decades, demographic trends indicate that the total number of illicit drug users will increase by a quarter by 2050, which is in proportion to world population growth. Although the current rate of 5% might appear like a small proportion of the world’s adult population, if this rate continues, there may be some extra 65 million illegal drug users by 2050 compared to 2009-2010.
3. The increase in illicit drug use will be most pronounced in developing countries.
Drug use is linked to urbanization. With the urban population of developing countries expected to double between 2011 and 2050, they will see a marked increase in the demand for drugs. In other words, the burden of the global drug problem will shift to countries that are relatively ill-equipped to deal with it, explains Yury Fedotov, the UN anti-drugs chief. In addition, developing countries’ higher projected population growth and younger populations, the main consumers of drugs, will raise the demand for illicit drugs in those nations.
4. Two of the world’s most popular illegal drugs are cannabis (marijuana) and amphetamine-type stimulants (ATS).
There are an estimated 119-224 million marijuana users globally, making it the most popular illegal substance in the world. Amphetamine-type stimulants, such as methamphetamine (but excluding ecstasy), come in second with around 14-52.5 million users worldwide. As of now there are no signs that marijuana will lose its status as the illegal drug of choice, says the report.
5. More women will use illicit drugs.
While men who take illegal drugs still greatly outnumber women, the gender gap, especially in developing countries, will narrow as conservative, sociocultural barriers break down and as gender equality improves.

Friday, June 15, 2012

ATOD News Recap Week Ending June 15, 2012

More High School Students Using ADHD Drugs to Get Better Grades

A growing number of high school students are using attention deficit hyperactivity disorder (ADHD) drugs, such as Adderall and Ritalin, to help them get better grades, The New York Times reports. Teens get them from friends, buy them from student dealers, or pretend to have ADHD in order to get prescriptions.
Gary Boggs, a special agent for the Drug Enforcement Administration (DEA), told the newspaper it is a nationwide problem.

Prescription stimulant drugs being abused by teens also include Vyvanse and Focalin. The DEA considers these drugs Class II controlled substances, along with cocaine and morphine, because of their high potential for addiction. Many teenagers do not understand that giving a friend a prescription stimulant pill is legally considered the same as selling it, and can result in a felony prosecution, the article notes.
These medications can calm people with ADHD, but they can provide energy and focus for people without the disorder. Abusing these drugs can lead to mood swings and depression, heart irregularities and extreme exhaustion or even psychosis during withdrawal, according to medical experts. There is little evidence about the long-term effects of young people abusing these stimulants.

According to drug counselors, some teenagers move from abusing stimulants to painkillers and sleeping pills.
Paul L. Hokemeyer, a family therapist at Caron Treatment Centers in Manhattan, told the newspaper, “Children have prefrontal cortexes that are not fully developed, and we’re changing the chemistry of the brain. That’s what these drugs do. It’s one thing if you have a real deficiency — the medicine is really important to those people — but not if your deficiency is not getting into Brown.”

Kerlikowske: Addiction is a Disease, Not a Moral Failure

Addiction is a disease, not a moral failure, according to Gil Kerlikowske, Director of the White House Office of National Drug Control Policy. He is scheduled to speak about addiction and drug control policy Monday at the Betty Ford Center in California. He will call for more alternatives to current drug policy, including early intervention through health care, better access to treatment, more support during recovery, and effective public education, The Desert Sun reports. “Recovery is this long-term, lifelong process, with its own set of challenges and its own needs — and yet we fail to highlight that process,” he told the newspaper in an interview.
In 2010, 23 million people aged 12 or older needed treatment for an illicit drug or alcohol use problem, according to the Substance Abuse and Mental Health Services Administration. Of these, 2.6 million received treatment at a specialty facility. Kerlikowske also will call for a review of laws that can add to the challenges of recovery, such as barriers that prevent many minor drug offenders from obtaining housing and federal student aid. His goal is to curb the growing number of prison inmates, many of whom are coping with drug abuse, while reducing the $50 billion cost of incarcerating them. Kerlikowske will be joined by U.S. House Representative Mary Bono Mack of Palm Springs, who has been raising awareness about prescription drug abuse. Bono Mack, who co-chairs the  Congressional Caucus on Prescription Drug Abuse, has introduced legislation that would revise  Food and Drug Administration drug classifications to ensure that drugs containing controlled-release oxycodone hydrochloride would be prescribed only for severe pain.

Teens With Mental Health Disorders More Likely to Become Long-Term Opioid Users

A new study concludes teenagers and young adults with mental health disorders are more likely to be prescribed opioids for chronic pain, and more likely to become long-term opioid users, compared with their peers who don’t have a mental health disorder. Teens and young adults with mental health disorders are 2.4 times more likely to become long-term users of opioids, HealthDay reports. The researchers defined long-term use as using the drugs for more than 90 days within a six-month period, with no gap in usage of more than 30 days.

The study included data from more than 62,000 teens and young adults up to age 24. Long-term use of opioids was more common among males, older youth and those living in poorer communities, with more white residents, the researchers report in the Journal of Adolescent Health. They were treated for back pain, neck pain, headache, and arthritis/joint pain.

“There are a number of reasons adolescents and young adults with mental health issues are more likely to become long-term users of opioids,” study author Dr. Laura Richardson, of the Seattle Children’s Research Institute and the University of Washington, said in a news release. “Depression and anxiety might increase pain symptoms and lead to longer treatment, and physicians may see depressed patients as being more distressed and may be willing to treat pain symptoms over a longer period of time.”

Perils of Early Substance Abuse
Animal study suggests young females’ use of marijuana heightens chances their offspring will abuse drugs

Mothers who use marijuana as teens—long before having children—may put their future children at a higher risk of drug abuse, new research suggests. Researchers in the Neuroscience and Reproductive Biology section at the Cummings School of Veterinary Medicine conducted a study to determine the transgenerational effects of cannabinoid exposure in adolescent female rats. For three days, adolescent rats were administered the cannabinoid receptor agonist WIN-55, 212-2, a drug that has similar effects in the brain as THC, the active ingredient in marijuana. After this brief exposure, they remained untreated until being mated in adulthood.
The male offspring of the female rats were then measured against a control group for a preference between chambers that were paired with either saline or morphine. The rats with mothers who had adolescent exposure to WIN-55,212-2 were significantly more likely to opt for the morphine-paired chamber than those with mothers who abstained. The results suggest that these animals had an increased preference for opiate drugs.
The study was published in the Journal of Psychopharmocology and funded by the National Institutes of Health.

“Our main interest lies in determining whether substances commonly used during adolescence can induce behavioral and neurochemical changes that may then influence the development of future generations,” said Research Assistant Professor John J. Byrnes, the study’s lead author, “We acknowledge that we are using rodent models, which may not fully translate to the human condition. Nevertheless, the results suggest that maternal drug use, even prior to pregnancy, can impact future offspring.” Byrnes added that much research is needed before a definitive connection is made between adolescent drug use and possible effects on future children. The study builds on earlier findings by the Tufts group, most notably a study published last year in Behavioral Brain Research by Assistant Professor Elizabeth Byrnes that morphine use as adolescent rats induces changes similar to those observed in the present study.

Other investigators in the field have previously reported that cannabinoid exposure during pregnancy (in both rats and humans) can affect offspring development, including impairment of cognitive function, and increased risk of depression and anxiety.

Study Links Prescription Drug Abuse and Depression, Suicidal Thoughts in College Students

A new study finds college students who use prescription drugs for non-medical purposes are at increased risk of depression and thoughts of suicide. The researchers analyzed the answers of 26,600 college students who participated in a national research survey by the American College Health Association. They were asked about their non-medical prescription drug use, including painkillers, antidepressants, sedatives and stimulants, as well as their mental health symptoms in the past year.

About 13 percent of students reported non-medical prescription drug use, Science Daily reports. Those who reported feeling sad, hopeless, depressed or considered suicide were significantly more likely to report non-medical use of any prescription drug. The link between these feelings and prescription drug abuse was more pronounced in females, the researchers report in Addictive Behaviors. The researchers conclude that students may be inappropriately self-medicating psychological distress with prescription medications.

“Because prescription drugs are tested by the U.S. Food and Drug Administration and prescribed by a doctor, most people perceive them as ‘safe’ and don’t see the harm in sharing with friends or family if they have a few extra pills left over,” researcher Amanda Divin of Western Illinois University said in a news release. 

“Unfortunately, all drugs potentially have dangerous side effects. As our study demonstrates, use of prescription drugs — particularly painkillers like Vicodin and OxyContin — is related to depressive symptoms and suicidal thoughts and behaviors in college students. This is why use of such drugs need to be monitored by a doctor and why mental health outreach on college campuses is particularly important.”

Psychogenic Drug's Success Prompts Calls for Use as an Antidepressant
In a report recently posted in the Journal of Biological Psychiatry, there appears to be mounting evidence that the dissociative anesthetic ketamine has profound abilities in mitigating the effects of depression, especially in patients who struggle with the debilitating diagnosis of bipolar disorder. For these patients, modern pharmacotherapy has been hit-and-miss in the worldwide effort to simmer the wildly fluctuating symptoms of mania and depression. Effective treatments for bipolar disorder are desperately needed.

Ketamine is a drug that is used in specialized medical and veterinary procedures. In humans, the drug is used in pain management for patients who have developed severe tolerance to opioids. The drug is quite effective in that roll. For pediatric patients, ketamine is used as an analgesic and anesthetic; the drug is quite safe for utilization with children and adolescents. The drug is an n-methyl-D-aspartate (NMDA) antagonist, which means that it exerts its effects by blocking the actions of NMDA. It is becoming abundantly clear in modern research that the NMDA receptor complex is intimately involved in modulating antidepressant and anti-suicidal effects in affected patients. The drug's success in this roll opens an entirely new avenue of study for research scientists. The NMDA receptor system is still an unknown factor in the influencing of mood and mood stability. The research reported here begs for new efforts at nailing down the cause and effects of NMDA activity in depression.

As a recreational drug, ketamine is often abused. In America, it has pockets of devoted fans. The drug is chemically related to the insidious dissociative anesthetic PCP. It is also a chemical relative to the over-the-counter drug dextromethorphan. Each of these drugs exerts unique effects on the central nervous system, effects that include a detachment of peripheral nervous system messages from communication with the brain. The resultant experience is one of sedation and detachment from surroundings. The next effect is one of a user sitting passively, quietly, and uncommunicative with surroundings. Ketamine users call this experience as having descended into the "k-hole."

In the study cited in the Journal of Biological Psychiatry, a project headed by the National Institute of Health treated bipolar, depressed patients with a single dose of ketamine. A control group of depressed patients received placebo. In both groups, the patients were carefully monitored and evaluated. Patients kept notes and scores of their experiences. The results were startling. The ketamine-receiving patients reported near immediate improvement in their depression. The improvement in depression symptoms extended for over three days. In addition, ketamine apparently reduced the number and severity of suicidal thoughts in the patients who received the treatment. This particular effect was most startling. Up to this point, no pharmaceutical product has exhibited combined effects as an anti-depressant and as a means of reducing suicidality. Overall, 79% of the patients treated with ketamine improved. No one reported improvement following ingestion of placebo. These effects are staggering.

Ketamine seems to have potential that extends well beyond the emergency room and operating theater. It may be that ketamine and other NMDA receptor antagonists are the opening act in the development of an entirely new class of drugs designed to alleviate the crushing symptoms of bipolar disorder and severe depression.

Name That Drug: A Heavyweight Drug That Toils in the Shadows

This month's mystery drug is a prescription medication; it is a controlled substance. It is unique to its chemical genre in that it is available as an oral, subcutaneous, intramuscular, rectal, and sublingual medication. Although the drug has a moderate potential as a drug of abuse, it has never caught on with the larger substance-abusing world. However, it has been a drug that healthcare workers have become entangled with. Like many drugs of its ilk, it was first "developed" in Germany in 1908. It was not synthesized. (To regular readers of this column, this is an important clue). In Europe, the drug was instantly popular in the form of an elixir. As an elixir, this month's drug starred as a reliable and long-acting cough suppressant. And as an antitussive, the drug gained the attention of the American pharmaceutical industry. Europe and America were still struggling to control the spread of cough-borne diseases, such as tuberculosis and whooping cough; this month's drug had instantly found its niche. In America, its first utilization was as a cough suppressant. In the modern era, the drug is predominately used as an analgesic, a drug used to treat moderate to moderately severe pain.

This drug is most commonly found in the form of a tablet or capsule. It is ordinarily compounded with adjunct drugs, drugs of lesser potency and little addictive potential. It is manufactured in instant release and time-released formats. The drug is an analgesic. And as an analgesic, it has the potential to create dependency. Considered to be 150% as powerful as codeine, this drug exerts effects for 4-6 hours following ingestion. When utilized for pain management, the drug can be found in some countries as a controlled release drug. In that sense the drug is quite similar to Oxycontin (oxycodone) and Opana (oxymorphone). But unlike those two powerful sustained release drugs, this month's drug has not spawned legions of devoted recreational abusers. In the U.S., this drug is routinely partnered with acetaminophen and aspirin. In other countries it can be found loaded with caffeine, antihistamines, and decongestants. In some places, it can even be found loaded with vitamins. In the U.S., the most commonly encountered commercial product is a drug called Synalgos-DC.

This drug is a chemical descendant from the opium poppy. It bears great structural resemblance to codeine. In fact, one could argue colloquially that this month's drug is a "codeine molecule on steroids." And in that sense, this month's drug will precipitate signs and symptoms that can be said to be classically "narcotic-like." Traditional effects of sedation, muscle relaxation, papillary constriction, and slow and raspy speech will emerge. But of interest to recreational drug users is that this month's drug can cause "ecstasy-like" effects. In fact, many users cite the drug's ability to stimulate feelings of empathy and happiness as being most alluring. Unlike other drugs in its class, this month's drug can provoke mixed feelings of euphoria, relaxation, and stimulation. Some recreational users of the drug have even claimed that the drug has heightened their abilities of interpersonal communication. Recreational users cite improved skills of persuasion and debate. These claims are unusual for drugs of its class.

But for this drug and all others of the class, there are some very insidious side effects. For starters there is constipation. The constipation side effect can be turned to an advantage when applied as a treatment for irritable bowel syndrome. Like Loperamide (Imodium etc.), this month's drug can serve as an effective therapy in treating diarrhea. But unlike Loperamide, the drug will cause central effects that include drowsiness and problems with coordination. People taking this drug will have difficulty in operating machinery and engaging in complex physical tasks. If combined with alcohol, use of this drug will result in significant additive effects that can exacerbate balance and speech. Short-term memory is blunted as well. Tolerance and dependency develop quickly. When that happens, a sudden stoppage in administration will result in rather severe withdrawals.

Because of its euphoria-producing effects, this month drug is believed by some to be a sort of secret. Recreational users of it know that they have a "sleeper." But despite the drug's unique appeal, abuse of it has never risen to a point where public safety authorities have been threatened by it. For those adherents who exclusively abuse this prescription drug, the development of tolerance is a quick and certain. Especially when the drug is ingested in amounts that are much greater than the recommended therapeutic dose. To date, there are no reports of users smoking or snorting this drug. Perhaps the fact that the drug is usually compounded with other non-controlled substances has snuffed out any effort to use the drug in a parenteral form. To snort or inject the drug, a user risks some serious physiological consequences. Especially for those who try to intravenously inject this drug, the result can include life-threatening shock.

This month's drug is obviously an opiate and controlled substance (Schedule II). The intrepid chemist has been known to convert this drug into dihydromorphine. This is a difficult task and one that is not commonly heard of in the recreational drug user world. Additionally, this month's drug was once ventured as a substitute for methadone in cases where opiate substitution therapy was conjured. The arrival of buprenorphine on the scene has put a stop to that idea. The month's drug is a codeine product and in reality can be called a "codeine molecule on steroids."

 Click here for this month's mystery drug.

NJ Parents Finally Understanding Drug Abuse Problem, Survey Finds
A new study finds Jersey parents now see their own home as an access point for both prescription and over-the-counter drugs by children.
Angelo Valenti, the Executive Director of the Partnership for a Drug-Free New Jersey says for many years parents were completely clueless about this, but a just-released survey finds “Four in ten parents have taken inventory of the prescriptions and over the counter medicine within the past 2 months, and about 20 percent are disposing of their unused, unwanted and expired medicine – and these are steps that we’ve been encouraging parents to take over the last several years.”

He points out that, “Under 10 percent are locking the medicine cabinets, but I think if we look at that number and we look at what that number would have been 5 or 10 years ago, I think the number would have been close to zero percent…so this is an ongoing process…Something that has really come on to the scene over the last several years, with the knowledge that the medicine cabinet has become a major source for access by young people of prescription medications that they’re abusing…I think that this is a learning process and we are seeing progress every day with this message.”

Valenti adds the Partnership has recently developed the AMCCRX drop app.

“On that app,” he says, “you can find locations where there are permanent collection sites throughout the state where you can dispose of your medicine 365 days of the year…A few years ago these sites were not available, so you can see there are steps being taken, there are partnerships being formed between law enforcement and the prevention community in order to address this epidemic that we are facing.”
He also says the Partnership for a Drug-Free New Jersey has several programs that are available to community groups are free of charge.

New Studies Shed Much-Needed Light on Alcohol-Induced Memory Blackouts

National survey studies suggest that roughly one in four college students who drink will experience a blackout in a given year, making blackouts a surprisingly common outcome of excessive drinking.

Blackouts are periods of amnesia, caused by excessive consumption of alcohol, during which a person actively engages in behaviors but the brain is unable to create memories for what transpires. This leaves holes in a person’s memory that can range from spotty recall for the events of the previous night (known as fragmentary blackouts) to the utter absence of memory for large portions of an evening (known as en bloc blackouts). Blackouts are very different from passing out, when a person falls asleep or is rendered unconscious from drinking too much. During blackouts, people can participate in events ranging from the mundane, like eating food, to the emotionally charged, like fights or intercourse, with little or no recall. According to Dr. Aaron White, Program Director for Underage and College Drinking Prevention Research at the National Institute of Alcohol Abuse and Alcoholism (NIAAA), “It can be quite difficult for an outside observer to tell if someone is in a blackout. The person could seem aware and articulate, but without any memory being recorded.”
Dr. White found in a study he conducted in 2002 that half of the 800 college students surveyed experienced at least one alcohol-induced blackout, 40 percent experienced one in the previous year and nine percent reported a blackout in previous two weeks. In a 2009 study of 4,500 students about to enter their freshman year of college, Dr. White found 12 percent of males and females who drank in the previous two weeks experienced a blackout during that time.

In the first few months of 2012, three new studies were published about blackouts among college students. According to Dr. White, “We know that alcohol is capable of causing episodes of amnesia, but what takes place during those episodes, the consequences that follow and why some people are more susceptible to them than others are still unclear. That is why these recent studies are so important.” Dr. Marlon Mundt and colleagues at the University of Wisconsin School of Medicine and Public Health recently published two papers on blackouts. In the first study, they observed that college students who black out are more likely to experience alcohol-related injuries than those who do not. Those reporting a history of six or more blackouts at the beginning of the study were more than 2.5 times more likely to be injured in an alcohol-related event over the next two years. The second study estimated that emergency department costs due to injuries sustained during blackouts could total $500,000 or more per year on large campuses.

A study by Dr. Reagan Weatherill at the University of California, San Diego, and colleagues from the University of Texas, Austin, provides important insight into why some people are more likely to experience blackouts than others. Compared to subjects without a history of blackouts, those with a history of blackouts exhibited a significant decline in activity in the frontal lobe of the brain, measured using fMRI, during the completion of a memory task while intoxicated. The findings suggest that some people are more likely to experience alcohol-induced blackouts than others due to the way alcohol affects brain activity in areas involved in attention and memory. Dr. White adds that studies of twins have pointed to a genetic vulnerability to blackouts–if one twin tends to black out, so does the other one.

The way college students drink increases the odds of blackouts, says Dr. White. “Alcohol is more likely to cause a blackout when it gets into your body, and therefore your brain, fast. It catches the memory circuits off guard and shuts them down. Doing shots or chugging beer, and doing it on an empty stomach, gets the alcohol into your bloodstream quickly.” He also notes that females are at particular risk for blackouts. They tend to weigh less than males and have less water in their bodies for the alcohol to get diluted into, which leads to higher levels of alcohol in the brain, he explains. They also have less of an enzyme called alcohol dehydrogenase in the gut that breaks down a small percentage of alcohol before it even gets into body. Females also are more likely to skip meals to save calories when they drink, so there is less food in the stomach to help absorb the alcohol. They are also more likely to drink beverages with higher alcohol concentrations, like wine and mixed drinks rather than beer.

In order to avoid blackouts, Dr. White advises drinkers not only to limit the total amount they consume, but to pace themselves, add in non-alcoholic beverages and eat food while they’re drinking. For more about safe drinking limits he refers readers to the NIAAA website, Rethinking Drinking.

Senate Report: Prescription Drug Abuse One of Biggest Drug Policy Threats Facing US

A new Senate report highlights the growing problem of prescription drug abuse, calling into question the conventional wisdom that drug cartels in Latin America should be the major focus of US drug policy, The Christian Science Monitor reports.

According to the report from the Senate Caucus on International Narcotics Control, the Office of National Drug Control Policy views prescription drug abuse as the nation’s fastest growing drug problem. The report states that overdose deaths from prescription painkillers now outnumber deaths involving heroin and cocaine combined, accounting for 20,044 of 36,450 overdose deaths in the US in 2008. The number of people seeking treatment for addiction to legal opiates increased 400 percent between 2004 and 2008. Prescription drug abuse is also leading to increased violent robberies of pharmacies, making it a security issue as well as a health issue. Use of marijuana and cocaine appears stable. The findings in the report indicate that Latin American drug cartels are less important than they once were in fueling drug abuse in the United States, the newspaper notes. They are not major suppliers of prescription drugs; a government survey found 70 percent of people abusing prescription drugs got their pills from a relative or friend.

“The epidemic raises the tricky question of just how many resources the US should continue putting into international drug enforcement in Latin America, when it’s clear that the more pressing challenges facing the country lie within its own borders and its domestic laws regarding pharmaceutical drugs,” the article states.