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Friday, July 27, 2012

ATOD News REcap for Week Ending July 27

Popular Synthetic Drug Simple to Obtain From China, Experts Say

The popular synthetic drug methylone, a key ingredient in “bath salts,” is simple to order online from China, experts tell The Virginian-Pilot. In one recent case that ended up in federal court, two Virginia men emailed a lab in China, wired several thousand dollars to an English-speaking customer service representative and received 100 pounds of the drug in the mail, according to the newspaper.
“It’s probably easier than buying a case of wine online,” said Richard Yarow, an attorney for a man who pleaded guilty to assisting one of the importers wire money to China. “When you buy wine you at least have to show ID” upon delivery, he added.

Methylone is a white crystalline powder. In addition to being used to make bath salts, it also can be snorted, swallowed or mixed into drinks. The drug costs about $350 per ounce on the street. Importers charge $2,600 to $4,000 per pound. Methylone was legal in most places in the United States until recently, and was sold online and in some gas stations and head shops. Some states began banning synthetic drugs last year, and more have followed suit this year.

Earlier this month, President Obama signed legislation that bans synthetic drugs. The law bans harmful chemicals in synthetic drugs such as those used to make synthetic marijuana and bath salts. Bath salts are marketed under names such as “Ivory Wave,” “Purple Wave,” “Vanilla Sky” or “Bliss.” The drugs mimic the effects of cocaine, LSD, Ecstasy and/or methamphetamine. According to the Drug Enforcement Administration, users have reported impaired perception, reduced motor control, disorientation, extreme paranoia and violent episodes. Bath salts have become increasingly popular among teens and young adults. Packages sent to the United States are subject to inspection, but drug-sniffing dogs usually cannot detect methylone and other synthetic drugs, according to federal agents. A spokesman for U.S. Customs and Border Protection told the newspaper they cannot prevent people from ordering things off the Internet.

Alzheimer’s and Alcohol: The Real Connection

As a doctor who takes care of older adults, I am often asked two types of questions about drinking or alcohol consumption. An 80-year-old male patient, who is “sharp as a bell,” recently told me that for the past many years his singular vice has been having  “a martini with two olives” every night before dinner. He wanted to know if this was medically acceptable, or whether he should quit.

An 84-year-old female patient, who is cognitively intact and a life-time teetotaler, had read that mild-moderate alcohol consumption (1-2 drinks/day) was good for the heart and may even decrease the risk of Alzheimer’s disease. She asks: “Would you recommend that I start having a daily drink?”
Two studies presented at the Alzheimer’s Association International Conference in Vancouver on Wednesday help us to better address these questions. One study followed a group of women 65 or older who started out as non-drinker, mild drinkers, or moderate drinkers (no heavy drinkers, please).  After 20 years, they were evaluated for memory problems and dementia.  The women who went from non-drinking to any level of drinking increased their chances of developing memory or dementia problems by 200 percent.  

Also, the women who were moderate drinkers at the start and stayed that way did not have a lower risk of developing problems than the ones who didn’t drink the whole way through.  So going from teetotaler to any level of drinking was actually harmful.  Being a drinker from the start didn’t necessarily hurt, but it wasn’t protective. A second study looked at binge drinking, or having four or more drinks at one sitting.  Patients were evaluated in 2002 and followed for eight years.  The study found that people who had one binge-drinking episode per month were 62 percent more likely to show memory problems than those who didn’t binge drink.  Those who had two or more binge-drinking episodes were 147 percent more likely to have these problems than the non-bingers.  

So one episode per month was bad, but two episodes was more than two times worse. These studies confirm what we have been recommending for our patients:  If you’re a light or moderate drinker — 1 oz. of alcohol per day if you are a woman, up to 2 oz. for men — you don’t need to change your habits. That martini or glass of wine with dinner is OK.  But if you don’t drink, starting alcohol consumption in your later years isn’t a good idea.  It may increase your risk of mental decline and Alzheimer’s disease. Neither of these studies addressed what to recommend to older patients, relative to alcohol intake, who are already experiencing cognitive decline or have Alzheimer’s. Research has shown that in these individuals, no alcohol intake — or switching to non-alcoholic beers and other beverages — is best, since even small amounts of alcohol can upset their delicate cognitive equilibrium and significantly worsen cognition and even trigger behavioral problems
Dr. George Grossberg is the Samuel A. Fordyce Professor of neurology and psychiatry at the Saint Louis University School of Medicine and past president of the American Association of Geriatric Psychiatry and of the International Psychogeriatric Association (IPA).

Coordinated Strategy Has Impact on High-Risk College Drinking, Study Suggests

A coordinated strategy aimed at high-risk college drinking can be effective, a new study suggests. The strategy addresses alcohol availability, policy enforcement and perceptions about the rate of high-risk drinking among peers, reports. Campuses that implemented the strategy saw a 50 percent decrease in alcohol-related injuries, the researchers report in the journal Alcoholism: Clinical and Experimental Research. The study included five universities in North Carolina, which put together coalitions of campus administrators, faculty and staff, students and community members. Participants on each campus developed a strategic plan for their school. The universities were compared with five similar schools that did not implement an alcohol intervention. “We realized that high-risk drinking is not just a campus problem, and it’s not just a community problem. 

You have to look at the entire ecosystem,” lead researcher Mark Wolfson, Ph.D., of Wake Forest Baptist Medical Center in Winston-Salem said in a news release. Strategies included restricting access to alcohol by underage or intoxicated students, increasing or improving coordination between campus and community police, and establishing consistent disciplinary actions for those who violated policies. Campuses with alcohol-reduction strategies found the percentage of students reporting severe consequences due to their own drinking decreased from 18 percent to 16 percent, while rates were unchanged on campuses without such strategies. 

Those who reported injuring another person while drinking decreased from 4 percent to 2 percent on campuses with alcohol-reduction strategies, compared with a nonsignificant decrease at the other universities. While the results were modest, the researchers said the strategies could help many students. They estimated that on a campus of 11,000 students, these interventions would result in 228 fewer students experiencing at least one severe consequence of drinking over a one-month period, and 107 fewer students would injure others due to alcohol over the course of a year.

One in 10 Employers in U.S. Say They Will Cut Health Coverage

A new study finds about one in 10 U.S. employers say they plan to cut health coverage for workers over the next several years, as the bulk of health care reform regulations are implemented. The results of the study, conducted by the consulting company Deloitte, are less drastic than those of a study conducted last year by the consulting company McKinsey, which found 30 percent of employers would “definitely or probably” stop offering health insurance after 2014. The Wall Street Journal notes the majority of Americans under age 65 who have health insurance receive it through an employer. Currently, most employers who offer health care coverage say they do so because it helps them recruit and keep employees. 

The Deloitte study found about one-third of companies said they might decide to stop offering health coverage under several scenarios: if they find health care reform requires them to provide more generous benefits than they do currently; if a scheduled tax on high-cost plans takes effect; or if they decide the cost of penalties for not offering insurance is less expensive than paying for benefits. Companies with 50 or more employees that do not provide health benefits after 2014 face penalties that start at $2,000 for each worker. The cost for providing health insurance far exceeds that amount for most companies, the article notes. However, companies that provide health insurance get tax breaks, and often can offer lower wages. The survey found fewer than 2 percent of companies with more than 1,000 workers said they would consider dropping coverage, compared with 13 percent of those with 50 to 100 workers.

Study links alcohol/energy drink mixes with casual, risky sex

(Medical Xpress) -- A new study from the University at Buffalo's Research Institute on Addictions (RIA) has found a link between the consumption of caffeinated energy drinks mixed with alcohol and casual -- often risky -- sex among college-age adults.
According to the study's findings, college students who consumed alcohol mixed with energy drinks (AmEDs) were more likely to report having a casual partner and/or being intoxicated during their most recent sexual encounter. The results seem to indicate that AmEDs may play a role in the "hook-up culture" that exists on many college campuses, says study author Kathleen E. Miller, senior research scientist at UB's RIA. The problem is that casual or intoxicated sex can increase the risk of unwanted outcomes, like unintended pregnancies, sexually transmitted diseases, sexual assault and depression, says Miller. And previous research has linked energy drink consumption with other dangerous behaviors: drunken driving, binge drinking and fighting, for example. "Mixing energy drinks with alcohol can lead to unintentional overdrinking, because the caffeine makes it harder to assess your own level of intoxication," says Miller.
"AmEDs have stronger priming effects than alcohol alone," she adds. "In other words, they increase the craving for another drink, so that you end up drinking more overall."
The good news: Miller's study found that consumption of AmEDs was not a significant predictor of unprotected sex. Drinkers were no less likely than nondrinkers to have used a condom during their most recent sexual encounter.

Regardless of their AmED use, participants in the study were more likely to use a condom during sex with a casual partner than during sex with a steady partner, consistent with previous research. A steady or committed partner is a less risky prospect than a casual partner whose sexual history is unknown, Miller notes, so using a condom may not feel as necessary. To be published in the print edition of Journal of Caffeine Research and available online to subscribers of the journal, the study is part of a larger three-year research project by Miller, funded by the National Institute on Drug Abuse (NIDA).
The research included 648 participants (47.5 percent female) enrolled in introductory-level courses at a large public university. They ranged in age from 18 to 40 but mostly clustered at the lower end of the age spectrum. More than 60 percent were younger than 21.

According to the study's findings, nearly one in three sexually active students (29.3 percent) reported using AmEDs during the month prior to the survey. At their most recent sexual encounter, 45.1 percent of the participants reported having a casual partner, 24.8 percent reported being intoxicated and 43.6 percent reported that they did not use a condom.

According to Miller, drinking Red Bull/vodkas or Jagerbombs doesn't necessarily lead people to get drunk and become intimate with strangers, but it does increase the odds of doing so. But she points out that these drinks are becoming increasingly popular with college-age adults and should be considered a possible risk factor for potentially health-compromising sexual behaviors. The findings may provide a basis for educational campaigns or consumer safety legislation, such as warning labels that advise against mixing energy drinks with alcohol, Miller says.

More information: A copy of the study is available here:… UB-Study.pdf

When campuses and their surrounding communities can join forces to stop alcohol abuse

Not only is alcohol use pervasive among U.S. college students, who typically drink more than their same-aged, non-college peers, but college students also seem to lag behind their peers in 'maturing out' of harmful drinking patterns. There has been little examination of interventions that link community-level and campus-level environments. A unique study that assessed this two-pronged approach to reducing high-risk drinking in and around college campuses has found that it is highly effective in decreasing severe and interpersonal consequences of drinking.
Results will be published in the October 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Alcohol use by U.S. college students is a major public health problem," said Mark Wolfson, a professor with the Wake Forest Baptist Medical Center as well as lead author for the study. "Most college students drink, whether of legal age or not, and many drink at levels that reflect heightened risk. We also know that college students typically drink more than their same-aged peers, and that these elevated levels of high-risk drinking translate into negative health and social consequences, both for the student him or herself, as well as others in terms of unintentional injury deaths as well as blackouts, being the victim of a sexual assault, engaging in unprotected sex, and driving under the influence of alcohol."

Wolfson said it is important to note that colleges typically do not exist in isolation from the surrounding community, and that students very likely live, shop, drink, etc., in the area immediately surrounding the campus. Thus, a community-level intervention, he said, just makes sense. "One example of this would be for college officials to partner with community residents and city leaders and change enforcement practices and policies related to loud and unruly student parties, which can pose significant risks for the partygoers as well as those living in residential areas containing rented houses and apartments adjacent to campus," said Wolfson. "Our study is unique in that it included a focus on colleges and the surrounding community, it used a community organizing approach, it involved implementation of environmental strategies, and that in taking this approach, we were able to demonstrate an impact."
"There have been a number of community-reach initiatives in the past, but very few have addressed the college population," added Ralph Hingson, director of the Division of Epidemiology and Prevention Research at NIAAA. "It is important to protect all students on and off campuses, as college life should be a safe environment for all students."

Wolfson and his colleagues assigned 10 universities in North Carolina to either an Invention or Comparison condition. Those universities designated as an Intervention school were assigned a campus/community organizer, who formed a campus/community coalition that developed and implemented a three-year strategic plan designed to reduce high-risk drinking and alcohol-related consequence among college students. Numerous outcome measures were garnered from a web-based survey of students at each university. "We found that a community organizing approach to planning and implementing environmental strategies on the college campus and in the surrounding community can reduce rates of negative consequences that stem from high risk drinking by college students," said Wolfson. "More specifically, this approach was associated with significant decreases in severe consequences due to the students' own drinking and alcohol-related injuries caused to others."
"It is a key finding that this this approach can reduce alcohol-related harms," said Hingson. "This is a pivotal study because it shows a reduction in alcohol-related harms that some college students can cause other college students, including reductions in physical harms caused by other drinking students. If we can chip away at this, it is a major accomplishment."

"Another important contribution is to the field of alcohol research," said Wolfson. "We have identified the usefulness of measuring the 'dose' of the intervention, at the site level, which is important and something of a methodological innovation, I think." The next step, added Wolfson, is an "implementation manual" he and his colleagues are developing for college officials to use if they want to try implementing the intervention approach used in the study on their own campus.

Provided by National Institute on Alcohol Abuse and Alcoholism

Low Income Means More Medications
Forbes, David Maris, Contributor

According to our national survey released today:
  • 34% of American adults take at least one prescription drug
  • 11.5% of American adults take three or more prescription drugs.
  • 6.5% of American adults take 4 or more prescription drugs.
  • Those at the lowest income level are more likely (two to three times more likely) to be at the highest levels of prescription drug use.
The Lower Income Levels Dominate High Prescription Use Category
Respondents at the lowest income levels indicated that they are much more likely to be taking high levels of prescription drugs (4 or more).
  • In our survey, 10.5% of those earning $0 – $24,999 said they were taking 4 or more prescription drugs.   This compares to zero/no respondents in the highest upper income group ($100,000 – $149,000 income category) indicating they were taking 4 or more prescription drugs Lower Income, and only 3 – 5% those in the $50,000 – $100,000 ranges.
In other words, the lower income respondents are much more likely to be taking four or more prescription drugs than the middle- and upper-income respondents.

However, how does this differ from those taking 1, 2 or 3 drugs?  
When we look at those taking one, two, or three prescription drugs – we don’t see a similar trend of the poor being bigger users of drugs than the higher income levels. Among the many possible explanations, perhaps lower income respondents wait a long time to get medical care and when the patient eventually seeks care, he or she is in worse shape, requiring greater drug intervention.  While we know lack of access to care leads to poorer care and more drastic measures needed when care is eventually used, I am not sure that is what we are really seeing in the data (mostly because there is no linear relationship of income and prescription use for the smaller number of prescriptions).

The second possibility is that what we are seeing is the byproduct of poorly coordinated Federal care  - a system that allows and in face encourages poor patients to be on as many drugs as possible to ensure repeat visits for doctors.  Interestingly, the middle income respondents showed a fairly even use, while the higher income dominated the 1- 2- and 3- medications categories. My own research to better understand Federal healthcare brought me to Appalachia where the combination of low income and aged population make Federal healthcare programs (Medicare and Medicaid) prevalent.

The problems of drug abuse and polypharmacy in Appalachia are staggering.  I visited with one elderly woman who looked older than her years, her legs swollen with edema making walking nearly impossible.  I noticed her shoes did not fit on her feet.  When I asked how many drugs she was currently taking she held up a freezer bag full of medicines.  She told me she takes more than a dozen medications.  I explored it further – she indicated that she was on an antidepressant prescribed by her doctor because he indicated “many people get depressed after surgery” so he prescribed an antidepressant ahead of her knee surgery.  Yes, she was given an antidepressant not to treat, but to prevent, depression – and she was still on it more than a year later.

I do not know exactly how and why this occurred, and it is possible this one instance, it was appropriate for her situation, although I highly doubt it based on her responses to my questions.  I do believe that part of this is due to uncoordinated care and poor incentives.  Doctors get paid to see Medicare and Medicaid patients, and the more regular follow-up appointments, the better it is for them.  True, many doctors are increasingly starting to not see Medicare patients – trying to weed out a lower profit patient population.  However some of those who do sometimes try to make up for the low payments with volume.  Her case, like so many others, points to the problem of polypharmacy – or people on multiple drugs.
Adverse drug reactions among multiple drugs and even Over-the-Counter (OTC) drugs are a serious problem.  It has been estimated that perhaps approximately 16% of hospital admissions were related to adverse reactions to medicines and approximately 100,000 deaths occur yearly due to adverse drug reactions – making it the 4th leading cause of death and ahead of pulmonary disease, diabetes, AIDS and automobile deaths, according to Polypharmacy

I came away from this trip concerned that the aging of the babyboomers and the implementation of government healthcare for a broader group will make the problems of overspending and uncoordinated care – including deaths related to drug interactions - worse, not better. Those that fear that government sponsored healthcare will lead to fewer prescription drugs are simply wrong. It will lead to the opposite – an explosion of people seeking drug treatments and already squeezed doctors to feel even greater pressure. This conclusion seems to be supported by the data from our survey, although it is admittingly not conclusive.

My takeaway’s:
  • Federal healthcare will initially lead to a large increase in Federal spending on drugs.
  • Adverse events, including deaths, from polypharmacy is a serious problem already and will get worse as babyboomers age and government healthcare programs expand.
  • It appears the poor are much more likely to be on a high level of prescription drugs – more should be done to understand why this is.
This article is available online at:

Cognitive changes may be only sign of fetal alcohol exposure
Distinct facial features not seen in many cases, NIH study finds
Most children exposed to high levels of alcohol in the womb do not develop the distinct facial features seen in fetal alcohol syndrome, but instead show signs of abnormal intellectual or behavioral development, according to a study by researchers at the National Institutes of Health and researchers in Chile. These abnormalities of the nervous system involved language delays, hyperactivity, attention deficits or intellectual delays. The researchers used the term s functional neurologic impairment to describe these abnormalities. The study authors documented an abnormality in one of these areas in about 44 percent of children whose mothers drank four or more drinks per day during pregnancy. In contrast, abnormal facial features were present in about 17 percent of alcohol exposed children.

Fetal alcohol syndrome refers to a pattern of birth defects found in children of mothers who consumed alcohol during pregnancy. These involve a characteristic pattern of facial abnormalities, growth retardation, and brain damage. Neurological and physical differences seen in children exposed to alcohol prenatally — but who do not have the full pattern of birth defects seen in fetal alcohol syndrome — are classified as fetal alcohol spectrum disorders.

“Our concern is that in the absence of the distinctive facial features, health care providers evaluating children with any of these functional neurological impairments might miss their history of fetal alcohol exposure,” said Devon Kuehn, M.D., of the Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute involved in the study. “As a result, children might not be referred for appropriate treatment and services.”

The Centers for Disease Control and Prevention provides information on the treatments for FASD.
Dr. Kuehn conducted the study with NICHD colleagues Tonia C. Carter, Ph.D., Mary R. Conley and Jim Mills, M.D, as well as researchers at the National Heart, Lung and Blood Institute, the National Capital Consortium, in Bethesda, Md., and the University of Chile in Santiago.  Their findings appear online in Alcoholism: Clinical and Experimental Research.

The research was conducted as part of a long-term study of heavy drinking in pregnancy known as the NICHD-University of Chile Alcohol in Pregnancy Study. To conduct the study, the researchers asked over 9000 women at a community health clinic in Santiago, Chile about their alcohol use during pregnancy. They found 101 pregnant women, who had four or more drinks per day during their pregnancies and matched them with 101 women having similar characteristics but who consumed no alcohol when they were pregnant. After these women gave birth, the researchers evaluated the infants’ health and conducted regular assessments of their physical, intellectual and emotional development through age 8. The researchers documented differences in the rate of children affected in the following areas:

Alcohol exposed
Abnormal facial features
17 percent
1 percent
Delayed growth
27 percent
13 percent
Cognitive delays (including intellectual)
35 percent
6 percent
Language delays
42 percent
24 percent
27 percent
2 percent
Some of the women with heavy drinking habits also engaged in binge drinking (5 or more drinks at a time). Even though these women already had high levels of alcohol consumption, the researchers found that this habit increased the likelihood of poor outcomes for their children.

Meet The Drug Dealer Who Helps Addicts Quit
A prescription drug called Suboxone helps wean people off of heroin and pain pills, but addicts have a hard time getting prescriptions. So they're turning to the black market. Unlike pain pills and heroin, Suboxone (generic name: buprenorphine) is very hard to overdose on. Addicts can take it to avoid withdrawal symptoms and manage their cravings for these drugs. "People who are treated with Suboxone are able to go back to school, they're able to go back to work, they're able to start paying taxes and taking care of their children," says Dr. Miriam Komaromy, who directs a state-funded addiction treatment hospital in New Mexico. "It's making them able to return to being a functioning member of society." New Mexico has the highest fatal drug overdose rate the US. For years, it's battled against one of the worst heroin epidemics in the country. And while heroin use has pretty much held steady, a recent report from the New Mexico Department of Health shows the sales of opioid pain relievers that are popular recreational drugs increased by 131% between 2001 and 2010.
Click here to read the rest of the story.

More Colleges Adopt Smoking Bans

A growing number of U.S. colleges are adopting smoking bans. The Christian Science Monitor reports that many schools have adopted total bans, both indoors and out. On Monday, the Ohio Board of Regents recommended a total ban on tobacco products at the state’s public colleges. In June, the University of Maryland announced all 12 of its institutions will become smoke free by July 2013. At schools in the City University of New York system, the use and advertising of tobacco will not be allowed beginning in September. The American Nonsmokers’ Rights Foundation reports that as of July 1, 2012, there are at least 774 campuses that are 100 percent smoke free. According to the National Center for Tobacco Policy, between one-third and one-half of colleges in the United States have likely implemented a smoke-free policy, or are considering one. The American College Health Association conducted a survey in the spring of 2011 that found 85 percent of college students described themselves as non-smokers, and 96 percent said they never used smokeless tobacco. On most college campuses with smoking bans, the consequences for smoking are often nonexistent or minimal, the article notes. Sometimes repeat offenders will face university disciplinary measures, which vary from school to school. The policies generally are enforced by other students, who do not want to be around cigarette smoke.

Physicians Ask FDA to Revise Prescription Label for Opioids

A group of doctors and public health experts has asked the Food and Drug Administration (FDA) to change prescription guidelines for opioids, to prevent prescription drug abuse, according to Reuters. In a petition to the FDA, 37 doctors, public health officials and researchers asked the agency to prohibit use of opioids for moderate pain. They also called on the FDA to add a maximum daily dose, and only permit patients to take opioids for up to 90 days, unless they are being treated for cancer-related pain. While a change in the label would not limit how doctors prescribe opioids, it would prevent drug companies from promoting the drugs for non-approved uses, the article notes. Some of the petitioners said the government needs to do more to address drug companies’ marketing that encourages physicians to prescribe opioids for chronic pain. Dr. Andrew Kolodny, Chair of the Psychiatry Department at Maimonides Medical Center in New York, told the newspaper many of his patients start taking opioids for valid medical reasons, but become addicted when they take them for too long. “We don’t think drug companies should be allowed to advertise these drugs as safe and effective for long-term pain, if we know very well that they’re not,” said Kolodny, who is also President of Physicians for Responsible Opioid Prescribing. Purdue Pharma, maker of OxyContin, said in a statement, “The FDA, its advisory committees, and numerous medical experts maintain that the current indications for long-acting opioids are appropriate. We agree with the FDA that prescribing information for any medication should be subject to ongoing review and modification to the extent that compelling medical evidence emerges.”

First-Ever Safe Drug Disposal Ordinance Adopted in Northern California
The Alameda County (Calif.) Board of Supervisors this week adopted an ordinance that requires the pharmaceutical industry to pay for a safe medication disposal program for county residents. The Safe Drug Disposal Ordinance is the first of its kind in the nation.  Advocates for the disposal programs such as CADCA coalition member CommPre, a program of Horizon Services, Inc., in Hayward, said the law will save lives by preventing accidental drug overdose and keeping flushed pills from contaminating water.  The ordinance is based on a Canadian “producer responsibility” model and does the following:
·         The ordinance requires pharmaceutical companies that sell drugs under brand and generic names in Alameda County to establish a producer-financed and managed take-back program, as is done in other countries including Canada, Australia, and France;
·         Producers cannot charge visible fees, forcing internalization of costs, to implement the stewardship program so take-back is just a cost of doing business;
·          The program must have an outreach and promotion campaign including prominently displayed signage; • Producers must pay an oversight fee to the county
·         Controlled substances are excluded from the ordinance for now, awaiting Drug Enforcement Administration findings on the issue;
·         Failure to comply allows a maximum penalty of up to $1,000 per day fine

The county operates drop-off boxes in several cities, even operating a “mobile med disposal” system for transportation-challenged seniors, Pratt said, but the ordinance will help pharmaceutical companies to take responsibility for the entire “life span” of their products. Making drug disposal easier will encourage senior citizens to get rid of expired medications and unneeded drugs, helping to eliminate medication mix-ups, and it will help reduce youth access to prescription drugs and over-the-counter medications. Alameda County saw the rate of hospitalizations from unintentional poisonings among adults 60 and older jump by 43 percent between 1998 and 2006. Nationally, prescriptions for controlled substances increased by 154 percent between 1993 and 2003. Municipal wastewater treatment plants can't keep up. They were designed to treat biological agents in drinking water, not antibiotics, steroids, anti-depressants and pain medications that people throw away or flush. A 2008 Associated Press investigation found pharmaceuticals in the drinking water supplies of at least 41 million Americans in 24 major metropolitan areas. With persistence from the coalition, including County Supervisor and coalition member, Nate Miley, Pratt said the coalition’s prevention plan included the “three Ps: partnering, promotion, and policy” about two years ago.  The coalition has been partnering with the local waste and water agencies, and had some success focusing on the dangers to the environment, but then utilized the other environmental angle when their county council amended the ordinance to include health and safety findings.

Estimated Number of Emergency Department Visits for  Misuse or Abuse of Pharmaceuticals More Than Doubles from 2004 to 2010
The estimated number of drug-related emergency department (ED) visits involving the misuse or abuse of pharmaceuticals increased significantly from 2004 to 2010, according to data from the Drug Abuse Warning Network (DAWN). More than 626,000 ED visits in 2004 were related to the misuse or abuse of pharmaceuticals, compared to more than 1.3 million in 2010. In 2010, approximately one-half (49%) of these pharmaceutical misuse or abuse visits involved pain relievers (both opioid and non-opioid) and more than one-third (35%) involved drugs to treat insomnia and anxiety. In contrast, the number of ED visits involving illicit drug use was relatively stable from 2004 to 2009, and then increased by 20% from 2009 to 2010 (see figure below). There were more than 1.1 million ED visits related to the misuse or abuse or illicit drugs in 2010, primarily for cocaine (42%) and marijuana (39%). The authors suggest that educational efforts “emphasize the difference between appropriate therapeutic use and drug misuse or abuse” and that “raising awareness among first responders, such as emergency medical technicians and emergency department staff, about the possible effects of pharmaceuticals and appropriate treatments can also help reduce the negative effects of these drugs on patients’ health and well-being”

Some Doctors Say Change in Opioid Prescribing Rules Could Hinder Pain Treatment

Some doctors are concerned that making it more difficult to prescribe opioids could hinder treatment of patients in pain, ABC News reports. Earlier this week, 37 health care workers signed and submitted a petition to the Food and Drug Administration (FDA), urging officials to change labels on prescription opioids, in an effort to curb prescription drug abuse.

“I believe this is not an appropriate way to address the disease of addiction,” said Pam Kedziera, Clinical Director of Fox Chase Cancer Center’s pain program. “Pain is a significant problem in the United States, and those who suffer deserve treatment.”

The petition asks the FDA to prohibit use of opioids for moderate pain. It also calls on the agency to add a maximum daily dose, and only permit patients to take opioids for up to 90 days, unless they are being treated for cancer-related pain. While a change in the label would not limit how doctors prescribe opioids, it would prevent drug companies from promoting the drugs for non-approved uses.

“We’ve seen the pendulum go from it being extremely difficult for physicians to prescribe opioids to patients who didn’t have cancer… to where it was clearly being overprescribed,” Dr. Joshua Prager, Director of the Center for Rehabilitation of Pain Syndromes at the University of California at Los Angeles, told ABC News. “What I would argue for is that there really has to be balance that doesn’t have the pendulum swing back too fast and too far beyond what is reasonable.”

Both Kedziera and Prager object to a 90-day limit on opioids. Kedziera says she is concerned about taking chronic pain patients off medication just so that they will not exceed the limit.
Dr. Gregory Collins, who heads the Cleveland Clinic’s Alcohol and Drug Recovery Center, said he believes the measures outlined in the petition “unduly restricts doctors’ access to opiate medication in the treatment of numerous noncancer but painful conditions.”

Friday, July 20, 2012

ATOD News Recap for Week Ending July 20

NJ Governor Signs Measure Requiring Treatment for Low-Level Drug Offenders
New Jersey Governor Chris Christie on Thursday signed a measure that requires treatment for low-level drug offenders who otherwise would go to prison, according to The Star-Ledger. The law establishes a $2.5 million pilot program that will expand drug courts in three New Jersey counties. It also expands the types of crimes that make inmates eligible for drug court, which will now be mandatory for those inmates. The article notes drug court programs require inmates to undergo intensive outpatient or inpatient treatment. In order to qualify, inmates must have a drug addiction, be receptive to treatment and be deemed able to be helped by treatment. The inmates appear regularly before judges, who determine whether they are meeting the terms of the five-year program. New Jersey spends $42,000 to house an inmate for one year, compared with $11,300 for drug courts, according to the newspaper. Governor Christie wanted inmates in every county to qualify for mandatory drug treatment, but Democratic legislators objected to the cost. The governor agreed to their suggestion of a five-year period to phase in the program to all counties, to allow the state time to fully fund the program, while giving private treatment facilities time to expand.
Advocates Call for State Laws to Encourage People to Seek Help for Overdose Victims
Advocates around the nation are pushing for state laws that give people limited immunity on drug possession charges if they seek medical help for someone suffering from an overdose, the San Francisco Chronicle reports. Eight states have passed such “Good Samaritan” laws during the past five years, the article notes. A similar measure is under consideration in the District of Columbia, but faces opposition from prosecutors and police. Critics of the laws say they are equivalent to get-out-of-jail-free cards. The measures condone drug use, and could prevent police from investigating drug dealing, or juvenile drug use, they argue.
A study conducted by researchers at the University of Washington found 88 percent of opiate users surveyed in the state, which passed a “Good Samaritan” law in 2010, said they would now be more likely to call 911 during an overdose. The study found 62 percent of police surveyed said they would not make an arrest for possession anyway, so their behavior would not be changed by the law. Most of the state laws protect people from prosecution if they have small quantities of drugs and seek medical aid after an overdose. The laws are designed to limit immunity to drug possession, so that large supplies of narcotics would remain illegal.
Adults Over 50 Often Ignore Prescription Drug Warning Labels
Adults over age 50 often ignore prescription drug labels that highlight key safety information, a new study suggests. The researchers say the labels should be redesigned and placed in a more prominent place to prevent dangerous medication errors. The warning labels include instructions such as, “Do not drive while taking this medication,” or “Avoid smoking while taking this drug,” the Los Angeles Times reports.
The study, published in the journal PLoS One, found participants over age 50 were much less likely to pay attention to the warning labels than those ages 20 to 29. The researchers tracked participants’ eye movements while they looked at prescription vials with warning labels affixed to them, and later tested what they remembered about the labels. They discovered younger participants scanned the labels more actively, while older ones looked at the labels with a more fixed gaze. The article notes that the findings are particularly significant because older adults often take more medications than younger ones, which puts them at greater risk of making drug errors. Older participants were less likely to recall the warning labels, usually because they had not noticed them in the first place, the article notes. When they noticed the labels, they were as likely as younger participants to recall them. There are no federal standards that regulate prescription warning labels. The researchers recommend that since all study participants looked at the large white pharmacy labels, warnings could be more effective if they were featured prominently in the white space, instead of a separate location on the label.
Drug-Related ER Visits - Emergency room trips all too common with drug abuse and overdose
Emergency Rooms (ER) report all drug-related information to a special government public health watchdog. Drug overdoses and adverse reactions are through the roof, compared to a few years ago. The 2010 U.S. drug-related emergency room report was just released. Nearly half of all drug-related ER visits are related to abuse or overdose, while the other half are from bad side-affects to drugs. The Substance Abuse and Mental Health Administration (SAMHSA) is a public health agency within the U.S. Department of Health and Human Services. SAMHSA’s main objective is to “[R]educe the impact of substance abuse and mental illness on America’s communities.” The Drug Abuse Warning Network (DAWN) is a public health surveillance system under the jurisdiction of SAMHSA. DAWN monitors drug-related emergency room visits and drug-related deaths investigated by medical examiners. The goal of DAWN is to provide SAMHSA with accurate, current and detailed information concerning illicit drugs, pharmaceuticals and alcohol. This information compiled by DAWN is intended to better inform public health agencies to shape policy for the, “prevention, intervention and treatment of substance abuse.”
  • The 2010 report evaluated 4.9 million drug-related ER visits in the U.S.Drug abuse or misuse caused 47 percent of the ER visits. Bad reactions to a drug accounted for another 47 percent of ER visits.
  • ER visits related to the abuse or misuse of pharmaceuticals was more common than those for illicit drugs, 435 vs. 378 per 100,000.
  • Between 2004 and 2010, the abuse or misuse of pharmaceuticals went from 626,472 to 1,345,645, an increase of 115 percent in just six years.
  • Isolating ER visits due to bad reactions to pharmaceuticals, taken as prescribed, by a medical professional increased by 86 percent between 2005 and 2010.
  • ER visits due to misuse or abuse of illicit drugs showed cocaine as the most common drug at 210 per 100,000 visits. Marijuana was the runner up at 151 visits per 100,000. Third in line was heroin, at 93 per 100,000 and fourth was amphetamines or methamphetamines at 55 per 100,000.
As Prescription Drug Abuse Rises, U.S. Re-Examines Drug Policy
The increase in prescription drug abuse in the United States is forcing the government to re-examine its emphasis on trying to stop shipments of illegal drugs into the country, The New York Times reports. A shift in the nation’s drug policy would have an effect in Mexico and Central America, the article notes. Some experts say money currently spent on fighting illegal drug shipments could be instead used to bolster courts and prosecutors’ offices, which could lead to long-term stability in those countries. “The policies the United States has had for the last 41 years have become irrelevant,” Morris Panner, a former counternarcotics prosecutor in New York and at the American Embassy in Colombia, who is currently an adviser at Harvard’s Kennedy School of Government, told the newspaper. “The United States was worried about shipments of cocaine and heroin for years, but whether those policies worked or not doesn’t matter because they are now worried about Americans using prescription drugs.” Mexico and Central American countries including El Salvador, Honduras and Guatemala, are facing growing violence caused by drug traffickers. The traditional American response has been to add law enforcement and military equipment and personnel, to help these governments fight drug trafficking. The U.S. State Department has recently added a focus on programs to support stronger communities and legal institutions. The programs are training Mexican prison guards, judges and prosecutors, and supporting local programs designed to prevent at-risk youth from joining gangs. U.S. government officials acknowledge that arresting drug traffickers and seizing large drug shipments has not made Mexico more stable. However, law enforcement, with a focus on cocaine interdiction, continues to be a major strategy in the U.S. government’s fight against illegal drugs, the newspaper states.
Increase in Cigarette Prices Leads to Rise in Binge Drinking Among Young Adults
Increases in cigarette prices lead to significant increases in binge drinking in young adults, a new study suggests. The study found increased cigarette prices due to taxes did not decrease smoking rates in people under 30, The Atlantic reports. The researchers based their findings on data from the 2001-2006 Behavioral Risk Factor Surveillance System surveys, which included 1.3 million people. They found increases in state cigarette prices were associated with increases in current drinking among people ages 65 and older, and binge and heavy drinking among those ages 21 to 29. They found reductions in smoking among adults ages 30 to 64, drinking among those ages 18 to 20, and binge drinking among those 65 and older. “Researchers, practitioners, advocates, and policymakers should work together to understand and prepare for these unintended consequences of tobacco taxation policy,” the researchers wrote in the journal Substance Abuse Treatment, Prevention, and Policy.

Expert Panel Warns About Dangers of Legalizing Marijuana
An expert panel warned Tuesday that legalizing marijuana in just one state could drive down prices and encourage more people to use the drug, according to the Los Angeles Times. The panel was sponsored by the American Enterprise Institute. Voters in Oregon, Colorado and Washington will consider ballot measures in November that could legalize marijuana, the article notes. “Legalization is unprecedented—not even the Netherlands has done it—it is entirely possible it will happen this year,” said Jonathan Caulkins, co-author of “Marijuana Legalization: What Everyone Needs to Know,” and a professor at Carnegie Mellon. He said the effects would be “enormous.” If marijuana is legalized in one or more states, the price collapse in those states could make it more difficult to enforce marijuana laws nationally, the experts said. Caulkins added that under Colorado’s measure, it would be fairly easy for residents to obtain a grower’s license. “They would be able to provide marijuana to New York state markets at one quarter of the current price,” he said, and added that similar price declines would be seen in other states. Mark Kleiman, a professor of public policy at UCLA, said if any of the measures pass, federal officials should “sit down with the governor of the state and say, ‘Look, we can make your life completely miserable—and we will—unless you figure out a way to avoid the exports.” The states could impose strict limits on how much marijuana retailers could sell to each customer, he added. The Washington state measure would create a strong system of regulations that would be designed to prop up prices. Caulkins observed that if the federal government struck down the regulations, the result could be a free-for-all. “The federal government will face some really difficult choices where actions are like double-edged swords,” he said.

Bill Would Require Most Painkillers to Have Safeguards to Prevent Abuse
A bill to be introduced Thursday in the U.S. House would require most painkillers to have safeguards to prevent abuse, The Wall Street Journal reports. Under the provisions of the bill, most prescription painkillers would have some form of abuse deterrence, such as being more difficult to crush or inject. The exact details of how drug manufacturers could meet the new standards are vague, the article notes. The bill does not set time lines for compliance. If pain medications did not adopt the safety features outlined in the bill, they would be removed from the Food and Drug Administration’s (FDA) approved list of generic drugs. While several brand-name painkillers, such as OxyContin and Opana, have tamper-resistant formulations, most generic painkillers do not. Patents for OxyContin and Opana are set to expire in 2013. The FDA has not yet ruled whether abuse-deterrent features will be required on the generic versions of those drugs.
“This bill should help protect first-time users and younger people who gain access through relatives or their own family’s medicine cabinets,” the measure’s lead sponsor, Rep. Bill Keating of Massachusetts, told the newspaper. Congress is “understanding the scope of this and looking at it as a major public health epidemic,” he added. He said there is broad bipartisan support in the House for the measure. The bill’s cosponsors are Republicans Mary Bono Mack of California and Hal Rogers of Kentucky, and Democrat Stephen Lynch of Massachusetts. The Generic Pharmaceutical Association opposes the bill. “The proposed legislation would be detrimental to patients and could potentially remove FDA-approved safe and effective generic medicines from those who rely on them,” said the group’s president, Ralph G. Neas. “Addressing prescription-drug abuse is of utmost importance to the generic pharmaceutical industry. Policy makers should let the medical evidence guide actions in addressing this critical issue.”
Almost One-Fourth of College Women Try Hookah Smoking During Freshman Year
Almost one-quarter of college women try hookah smoking during their freshman year, a new study finds. The researchers found the more alcohol the women drank, the more likely they were to try hookah smoking. Those who used marijuana engaged in hookah smoking more often than those who didn’t, according to Science Daily. The study included 483 first-year female college students, who completed an initial survey about their precollege hookah use, followed by 12 monthly online surveys about their experience with hookah smoking. The researchers note hookah smoking has increased dramatically among young adults over the past 20 years. Many college students mistakenly believe hookah smoking is safer than smoking cigarettes. Hookah smoking has been linked to many of the same diseases caused by smoking cigarettes, including lung cancer, respiratory illness and periodontal disease, the researchers from The Miriam Hospital Center note in a news release. “The popularity and social nature of hookah smoking, combined with the fact that college freshmen are more likely to experiment with risky behavior, could set the stage for a potential public health issue, given what we know about the health risks of hookah smoking,” said lead author Robyn L. Fielder. The findings are published in the journal Psychology of Addictive Behaviors.
Hookah bars feature water pipes that are used to smoke a blend of tobacco, molasses and fruit called shisha. The World Health Organization (WHO) noted in a report that the smoke inhaled in a typical one-hour hookah session can equal 100 cigarettes or more. The WHO report also stated that even after it has been passed through water, the tobacco smoke in a hookah pipe contains high levels of cancer-causing chemicals.
CDC Report: 1 in 13 Pregnant Women Drink
A new government study has revealed that almost eight percent of women who are pregnant report alcohol use, leaving the topic about drinking among pregnant women in the United States an important public health issue. Researchers from the U.S. Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities studied data from 2006 to 2010 on almost 14,000 pregnant women and more than 330,000 non-pregnant women, aged 18 to 44. The study will be published in the July 20 issue of the CDC's journal Morbidity and Mortality Weekly Report. The results showed that about 7.6 percent of pregnant women - one-in-13 - said they drank alcohol within the past month. The rate of drinking among non-pregnant women was 51.5 percent. Middle-aged women reported the highest use of alcohol - about 14 percent. College graduates and employed women drink about 10 percent of the time while white women reported about eight percent. Researchers also found that about one percent of pregnant women were binge drinkers. The average frequency and intensity of binge drinking was similar among pregnant and non-pregnant women who were binge drinkers - about three times per month and six drinks on each occasion. The reports said that on average, women with a high school education or less reported binge drinking about three times a month and having about six drinks per occasion, compared with about three times per month and about 5 drinks per occasion for college graduates. The researchers noted that women who binge drink before pregnancy are more likely than non-binge drinkers to continue drinking during pregnancy. Binge drinking is defined as having five or more drinks on at least one occasion in the past 30 days. According to the CDC, Alcohol use during pregnancy can cause birth defects and developmental disabilities. Women who are pregnant or might get pregnant should abstain from using alcohol. Alcohol consumption during pregnancy is a risk factor for poor birth outcomes including fetal alcohol syndrome, birth defects, and low birth weight. Any alcohol use is defined as having at least one drink of any alcoholic beverage in the past 30 days.
House Bill Targets Health Economics, Evidence-Based Medicine
 A flat budget for the National Institutes of Health (NIH) isn't the only unpleasant surprise for research advocates in a House of Representatives spending bill released yesterday. The draft bill, which reflects Republicans' desire to undo the 2010 health care law and trim the Department of Health and Human Services, would wipe out HHS's Agency for Healthcare Research and Quality (AHRQ), the main supporter of evidence-based medicine. The bill also bars NIH from funding economics studies.  Approved by the House Appropriations subcommittee on labor, HHS, and education, the bill holds NIH's budget at $30.6 billion. None of NIH's funding can be spent on "any economic research," the bill states. Howard Silver, executive director of the Consortium of Social Science Associations in Washington, D.C., says the provision appears to apply to long-running surveys on aging and retirement as well as research on health disparities and the costs of illness. "Any research where socio-economic status, wealth, or income are variables could be banned," he says. According to these NIH slides, NIH funded a total of $194 million in economics research in 2009. "To outright ban certain research makes no sense," says Jennifer Zeitzer, director of legislative relations for the Federation of American Societies for Experimental Biology.  Another directive would require NIH to certify to the HHS secretary that every grant it funds is "of scientific value" and will impact public health. That seems unneeded, Zeitzer says—it's what NIH's peer review process is for.  The bill would also abolish the $405 million AHRQ, which funds studies of the value of medical treatments. The AHRQ-supported Preventive Services Task Force, an independent advisory group that evaluates screening tests and other methods of identifying people with disease risks, would be transferred to another HHS office.  The bill also targets all HHS discretionary funding for patient outcomes research. As a result, the new Patient-Centered Outcomes Research Institute (PCORI) created by the health care bill would apparently lose $150 million of its projected $320 million 2013 budget, says David Moore of the Association of American Medical Colleges in Washington, D.C.  In addition, because the bill zeroes out the HHS Prevention and Public Health Fund, which was part of the health care bill, it would trim $787 million from the budget of the Centers for Disease Control and Prevention, according to the Trust for America's Health . The administration had proposed drawing on this fund for $80 million in Alzheimer's research at NIH as well. If the bill passed, that research might have to be cancelled or funded by cuts elsewhere.

Although lawmakers may introduce amendments to save threatened programs before the full committee meets to vote on the bill, the fate of the targeted items may not be decided until the House and Senate agree on a compromise bill later this year, Silver says.

Do 'Study Drugs' Breed a Nation of Winners -- or Cheaters?
America is a nation obsessed with winning. We're so afraid that our kids won't be prepared for jobs when they finish school -- which could ultimately cost us our tenuous competitive edge in the global economy -- that we pile on the homework and make getting into college the focal point of life from middle school on.  Is this obsession with achievement equipping our children for real life? Or are they simply getting the message that it's no longer about how they play the game, but about winning at all costs? Recent trends suggest that kids aren't working harder but "smarter," often with the aid of dangerous prescription drugs.
"Smart Pills" Invade the Classroom Performance-enhancing drugs used to be a "sports" problem. Now they are an issue for anyone who wants to stay competitive in school. Disproportionately, it is the teens earning As and Bs, striving to get into the nation's top universities -- not the stereotypical druggies -- who are finding themselves sidelined by a stint in drug rehab for prescription drug abuse.  Children are learning that success comes not by training, practice and hard work, but by taking shortcuts. We tell young people, "Don't use drugs," but our beliefs and actions encourage them to win at all costs. There's a whole group of scientists who, in a 2008 editorial in Nature, welcomed the use of "cognitive enhancers" to produce a nation of people performing at their best. They have been joined by a contingency of parents who are willing to overlook, or even encourage, their children to boost their academic performance using prescription drugs. Not surprisingly, young people are less likely to view study drugs as cheating than steroid use in sports. More youth are asking, "Why work hard, stay up all night studying and still risk not doing well when you can pop a pill, get good grades, and make teachers, parents and coaches happy?" The question some have asked is, how is using performance-enhancing drugs to improve grades any more fair than using steroids to play better baseball?
To the Head of the Class, But at What Price?
One in 10 teens has used Adderall or Ritalin without a doctor's prescription, reports The Partnership at Studies show 1 in 4 college students have misused ADHD medications. And there's no reason to assume prescription drug abuse ends after college. Researchers have reported that professors, scientists and academics also misuse prescription drugs to improve their professional standing. Students use prescription stimulants to enhance their focus and boost their energy, which reportedly allows them to study faster, remember more and earn the grades expected by the nation's elite universities. The drugs are relatively cheap and easy to get, usually from friends, student dealers or by faking ADHD symptoms to get a prescription. What few teens (and apparently, few adults) realize is that misusing prescription drugs has consequences. Studies show that abusing ADHD drugs can lead to depression, mood swings, exhaustion, heart rate and blood pressure irregularities, and psychosis. In large doses, users may experience convulsions and hallucinations. These risks are particularly worrisome among adolescents and young adults whose brains and bodies are still developing at a rapid rate.  One of the most severe, yet often overlooked, risks is addiction. "Study drugs," which include Adderall, Vyvanse, Ritalin and Focalin, have been classified as Schedule II controlled substances (in the same class as cocaine) by the Drug Enforcement Administration because they have high potential for abuse. Teens who abuse ADHD meds are also more likely to abuse prescription painkillers, sleep aids and illicit drugs like cocaine, meth or heroin.
Cooperation Over Competition
A shift away from performance-enhancing drugs won't happen until we teach our children the value of cooperation over competition. Human beings are not inherently competitive, research suggests, but rather learn to compete as a result of cultural norms and social training. A more natural -- and more productive -- approach requires going against the "scarcity" mindset that says my success requires your failure.  It not only feels better to live, play and work in an environment where no one loses, but it is more likely to breed achievement, research suggests. Studies show that stress, depression and low self-esteem result from competition, whereas cooperation has been linked to emotional maturity and a strong sense of self. When other people are viewed as opponents rather than friends or collaborators, there is a lack of trust that prohibits creative problem-solving and full utilization of every individual's unique talents and skills.  Parents hope that competition will help their kids "toughen up" for the inevitable hardships of life. And while there is some benefit in challenging ourselves to find out what we're capable of, competition often has the opposite effect. The humiliation of losing can leave lasting scars, while the euphoria of victory fades quickly because it is based on a shaky sense of self-worth. Somewhere down the line, every winner will lose. Someone will always be better, smarter, faster.
A New Definition of Success
Competition can produce great accomplishments, but is it teaching our children the kind of lessons that will matter 10 or 20 years down the line? Even for those who go on to receive top honors from the nation's best universities and land prestigious jobs with impressive salaries, have they learned anything about the type of person they want to be? Are they content? We need a new definition of intelligence based not only on academic prowess but also emotional intelligence, life skills and other abilities -- and a new definition of success based on a young person's health and satisfaction rather than the name of the college they'll be attending. Having goals and going after them is admirable, but living someone else's dream is a waste of a child's unique talents. Genuine confidence isn't built on achievement alone but also who each child is as a human being, regardless of how they stack up to anyone else.

David Sack, M.D., is board certified in psychiatry, addiction psychiatry and addiction medicine. He is CEO of Elements Behavioral Health, a network of addiction treatment programs that includes Promises Treatment Centers, The Ranch outside Nashville, The Sexual Recovery Institute, and The Recovery Place.
Commentary: Illegal Online Pharmacies: A Potentially Fatal Threat to Consumers
Over 96% of websites claiming to sell prescription medications are out of compliance with U.S. pharmacy laws and practice standards—a statistic that may come as a surprise to the average American consumer.  While this statistic may seem irrelevant to Americans who have never considered using the Internet to purchase products such as antibiotics or allergy medications, prescription drugs are among the most sought after e-commerce products — the 13th most purchased product online behind categories such as furniture, baby products and household supplies. Getting a prescription filled online is not necessarily bad; it can be convenient and sometimes cheaper. However, there are important factors to consider when purchasing pharmaceuticals over the Internet: (a) the sellers of online medications are atypical; (b) medicine from unsafe sources can be toxic; and (c) the criminal networks behind these websites don’t care about your health – only your money. The newly formed Center for Safe Internet Pharmacies (CSIP) is working hard to address all three factors, and underscoring the importance of knowing who you are buying from. While most consumers think they can spot a “good” versus a “bad” pharmacy website, they are often indistinguishable. Internet-based prescription drug dealers (or “illegitimate online drug sellers”) are very good at mimicking legitimate online pharmacies — even going so far as to display forged, seemingly authentic pharmacy licenses on their websites — which is why intuition alone is not enough. Most importantly, one should know a legitimate online pharmacy will always require a valid prescription. This means a prescription obtained by a practitioner who has examined the patient at some point. Illegitimate online drug sellers may require a prescription, but source the drugs from unverified supply chains, unregulated for safety or authenticity. Alarmingly, some physicians are not trained to make this distinction and unknowingly promote illegitimate online drug sellers to patients. So who buys medication online? Although the “typical” online medication buyer is over the age of 55, there are growing numbers of young adults buying online without a prescription. 1 in 6 American adults, approximately 36 million people, are estimated to have bought medication online without a valid prescription. This can be a deadly or life-altering prospect. Craig Schmidt, a 30-year-old plastics salesman, purchased Xanax (an anxiety drug) and Ultram (a pain drug) from an online pharmacy without ever seeing or speaking to the doctor that prescribed the medications. The Xanax tablets that Schmidt received contained quadruple the active ingredient that a doctor would prescribe. As a result of this overdose, Schmidt nearly died and has been left permanently impaired with widespread brain damage that inhibits him from driving or even walking without stumbling. Unfortunately, stories like Craig Schmidt’s are not as uncommon as one would hope. In 2010, the U.S. market alone accounted for an estimated $75 billion in sales for counterfeit drug makers; a lucrative prospect for criminal networks. There has also been a rising trend of malware appearing on illegal pharmacy sites – designed to steal your information and used for credit card or identity theft. took action on 47,000 illegal pharmaceutical sites last year alone and 27,000 of them contained malware.

How can this problem be fixed? The prevalence of illegal online drug sellers has made it virtually impossible for the law enforcement community to address the problem alone. So, in late 2010, CSIP was created to provide a first-ever private sector solution, and among the first public-private partnerships, formed to protect consumers from rogue Internet pharmacies. The mission of the organization is four fold: to educate consumers about the threat of illegal pharmacies, to work with law enforcement to eliminate the criminal networks, to share information among companies about illegal sites and to aid in building a “white list” of safe sites. Currently, CSIP members include 11 corporations who are part of the Internet ecosystem. These companies will be announcing their partnership with U.S. Government agencies to tackle the problem of illegal online drug sellers at the White House on July 23, 2012. The event will kick off CSIP’s public education campaign, which will include a website with: a URL checker where consumers can confirm the legitimacy of online pharmacy websites, search engine advertising and public service announcement videos.

Friday, July 6, 2012

ATOD news recap for week ending July 6, 2012

Addiction Treatment Falls Woefully Short – Can’t We Do Better?
By David Sack, M.D.

Millions of people know what it’s like to lose everything to addiction. Millions more know what it’s like to live with a parent or family member who abuses drugs or alcohol. What too many don’t know is how to get better. In spite of a large body of research showing that addiction is a chronic disease, only one in 10 addicts receives any form of treatment – often, treatment that falls woefully short of what we know works, according to a five-year study by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.

The Desperate State of Addiction Treatment
  • Rather than helping, most forms of addiction treatment are hindering recovery and costing the public in the process. The CASA report identified the following specific problem areas:Stigma – One-third of Americans still regard addiction as a moral failing or a lack of willpower rather than a treatable disease. Addiction affects more Americans than other chronic health conditions, yet the disease is shunned by the medical community, CASA reports. Spending to treat addiction ($28 billion to treat 40 million people) falls far behind other conditions, such as diabetes ($44 billion to treat 26 million people), cancer ($87 billion to treat 19 million people) and heart conditions ($107 billion to treat 27 million people).
  • Inadequate Training – Medical professionals are in a unique position to intervene in addiction. More than two-thirds of addicts are in contact with a physician about twice a year, CASA reports. But because most medical professionals have very little training or education in addiction, they are unprepared to provide simple screenings, a diagnosis, treatment or referrals. While doctors routinely screen patients for other chronic health conditions, they just as routinely overlook addiction, even though addiction is at the root of 70 other health problems, 20 percent of deaths in the U.S. and one-third of all hospital inpatient costs, according to CASA. Almost half of Americans say they would reach out to their health care provider for help with addiction, CASA reports, yet less than 6 percent of referrals to treatment come from health professionals. A much larger percentage (44.3 percent) comes from the criminal justice system, which is not surprising given our history of treating addiction as a crime rather than a disease.
  • Lack of Quality Care – Because there are no clear national standards delineating who can provide addiction treatment in the U.S., the people providing care are often addiction counselors who may lack the knowledge and skills to provide evidence-based treatment. In some states, these individuals are not required to be licensed or certified, and may only need a high school diploma or GED to qualify. Addiction counselors are valuable members of the treatment team, but do not always provide sufficient care alone. Because addiction is a medical illness, patients are better served by a multidisciplinary team that also includes physicians, nurses and graduate-level mental health professionals. Instead of being treated as a chronic disease that requires individualized care and ongoing management, addiction is too often treated as an acute condition that can be addressed within a few days. While the most reputable addiction treatment centers are accredited by independent bodies like CARF, many facilities are not reviewed, regulated or held accountable for their treatment practices. Because of these obstacles, patients are often left alone to sort through the vastly different treatment approaches without independent data to help them make informed decisions. Even when high-quality treatment is available, patients may be barred by cost considerations, stringent eligibility criteria, limited insurance benefits and long waiting lists.
  • Insufficient Insurance Coverage – Private insurance has failed to provide adequate benefits for addiction treatment, leaving patients to try to cover their own costs. While private insurance covers 54.4 percent of costs in general health care spending, it covers only 20.8 percent of the costs of addiction treatment, CASA reports.
Room for Improvement: Uniting Science with the Steps

Thanks to scientific research, we know that addiction is a disease that changes the function and structure of the brain. We know the risk factors and have effective ways to screen for the disease and intervene promptly. We have more information about the science of addiction than ever before, yet more people are addicted now than at any time in our history.

Science has shown us how we get addicted, but it hasn’t helped us understand how we get better. Part of the problem, as CASA reports, is that treatment hasn’t kept pace with science. But another part of the problem has been largely ignored, even in the recent CASA report. While treatment needs to catch up to science, I believe science also has some catching up to do. The millions of people suffering with addiction need more than scientific knowledge; they need practical, real world solutions that help them make critical decisions about their health. What is needed is a new blueprint for treatment – one that integrates a science-based model with 12-Step recovery programs. Instead of treating addiction solely as a brain disease (like diabetes and other medical conditions, it is also a complex behavioral disorder) and focusing on pharmacotherapy, we also need to closely examine the movement that has helped millions of addicts sustain a drug-free life: 12-Step recovery. Recovery is more than going to meetings, sharing stories and embracing random recovery principles; it is part of a neurophysiological process that reshapes the brain by remedying the deficits caused by drug and alcohol abuse.

We Can – and Must – Do Better

Addiction is a medical illness that requires medical care. We can, and must, do better in this area. But we would have an even greater impact if we also learned from the success of people in long-term recovery and considered the research supporting the efficacy of the 12-Step model. It is not an either/or proposition, for as any recovering addict knows, we need all the tools we can muster to beat this disease.
David Sack, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO of Elements Behavioral Health, a network of treatment programs that includes Promises, The Recovery Place, The Sexual Recovery Institute, and The Ranch.

Summer Is Peak Time for Teens to Try Drugs, Alcohol: Report
Experts advise parents to be alert, help kids structure their days

More teenagers start drinking and smoking cigarettes and marijuana in June and July than in any other months, U.S. health officials say. During each of those summer days, more than 11,000 teens on average use alcohol for the first time, 5,000 start smoking cigarettes and 4,500 try marijuana, according to the report, which was released Tuesday by the U.S. Substance Abuse and Mental Health Services Administration.
"These months include periods when adolescents are on a break from school and have more idle time; they have fewer structured responsibilities and less adult supervision," said Dr. H. Westley Clark, director of the administration's Center for Substance Abuse Treatment.

The findings are based on data from the administration's annual National Survey on Drug Use and Health for the years 2002 to 2012, which include interviews with more than 230,000 teens.  December is the only other month in which substance-start rates approach June and July levels, according to the report. During the rest of the year, daily first-time alcohol use runs from 5,000 to 8,000 occurrences a day. Approximately 3,000 to 4,000 teens start smoking cigarettes, and about the same number try marijuana, according to the report. More teenagers start using hallucinogens and inhalants in the summer, the researchers found. There was, however, no such increase in those starting to use cocaine or abuse prescription drugs.
Parents need to know that summertime is when their teens are more likely to start smoking, drinking and using drugs, Clark said.

"Even though summer months are about free time, it is also about greater risk," he said. And parents need to talk to their children about these risks.

Among other programs the Substance Abuse and Mental Health Services Administration has a Smart Summer campaign that encourages parents to help prevent children from using these substances by setting boundaries, monitoring activities and being involved in their kids' lives, Clark said.
Bruce Goldman, director of substance abuse services at Zucker Hillside Hospital in Glen Oaks, N.Y., said parents need to work with their kids to plan their time -- to have some structured activity every day. "You should have an open dialogue with your children in terms of what they're doing and about alcohol and drugs," he said. "The longer you can delay adolescents from experimenting with alcohol and drugs, the better their chances of not developing problems later in life," Goldman said. "It's critical that parents be alert."
Source: HealthDay News
Methadone Linked to Three Out of Ten Prescription Painkiller Overdose Deaths

More than 15,500 people die every year of prescription drug overdoses, and nearly one-third of those overdoses involve the drug methadone, according to a Vital Signs report released recently by the Centers for Disease Control and Prevention. Researchers found that methadone accounts for only 2 percent of painkiller prescriptions in the United States, yet it is involved in more than 30 percent of prescription painkiller overdose deaths.  Methadone has been used for decades to treat drug addiction, but in recent years it has been increasingly prescribed to relieve pain. As methadone prescriptions for pain have increased—more than 4 million prescriptions are written for the drug every year—so have methadone-related fatal overdoses. CDC results showed that six times as many people died of methadone overdoses in 2009 as died in 1999.

Learn more about this problem, spread the word to others, and take action: Visit the Vital Signs web page to find the Vital Signs MMWR article, fact sheet, podcast, and feature article.
And just to close out the week properly…..
Say what? Michigan deploys chatty urinal cakes in bars as part of anti-drunken driving effort
Michigan hopes to keep drunks off the road with the help from a special message in men's bathrooms featuring an attention-getting woman's voice.  Talking urinal-deodorizer cakes have been distributed to Michigan Licensed Beverage Association members in Wayne County, including Detroit, state officials announced. A recorded message will play reminding men who step up to the urinals to call a cab or a friend, if needed, to get home safely.

"Not only do we want to turn some heads and get people talking, we hope everyone takes the message to heart," Michael L. Prince, director of the Michigan Office of Highway Safety Planning, said in a statement.

Bay, Ottawa and Delta counties also are getting them. The motion-activated messages are part of a statewide Fourth of July education and enforcement effort. The federally funded drunken driving crackdown runs through Sunday. It also includes stepped up patrols in 26 counties involving a number of agencies.

"At first it may be seen as humorous, but the seriousness of the message will stand out and encourage patrons to find a safe ride home," said Michigan Licensed Beverage Association Executive Director Scott T. Ellis.

Talking urinal cakes have been used in other states for similar efforts.