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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.

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