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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.

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