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Monday, March 25, 2013

ATOD and Advocacy Update - Week-Ending March 15, 2013

Attorneys General: Abuse-Resistant Generic Prescription Painkillers Needed

The group representing the nation’s attorneys general is calling on the Food and Drug Administration (FDA) to require manufacturers and marketers of generic prescription pain drugs to develop versions of their products that are resistant to tampering and abuse. In the letter, the National Association of Attorneys General (NAAG) told the FDA, “In our states, nonmedical users are shifting away from the new tamper-resistant formulations to non-tamper-resistant formulations of other opioids as well as to illegal drugs. There is great concern in our law enforcement community that many non-tamper-resistant products are available for abuse when only a few products have been formulated with tamper-resistant features.” The letter is signed by 48 state and territorial attorneys general, the Boston Herald reports. The attorneys general said they are concerned that generic versions of extended-release opioid prescription drugs and other non-tamper-resistant products may reach the market. “The letter applauds the FDA for developing guidelines that will assist with the formulations of opioid drugs with abuse-deterrent properties, but encourages the agency to ensure generic versions of such products are designed with similar features,” according to NAAG news release.

Combination of Mental Illness and Substance Use Disorder Raises Risk of Being Murdered

A new study finds people with mental illness who also have a substance use disorder are nine times more likely than the general population to be murdered. Overall, people with mental illness were almost five times as likely to be a murder victim, compared with those with no psychiatric diagnosis. The researchers studied Swedish government data covering psychiatric diagnoses and causes of death among the nation’s 7.2 million adults, from 2001 to 2008. During that time there were 615 murders; 141 of the victims had a mental disorder, The New York Times reports. People with personality disorders were three times more likely to be murdered compared with the general population. People with depression were 2.6 times more likely to be murdered, while having an anxiety disorders increased the risk 2.2 times, and schizophrenia, 1.8 times. The Stanford University researchers noted that while the issue of homicide by people with mental disorders has received much attention, their risk of being a victim of homicide has rarely been examined. The study appears in the British Medical Journal.

Stress & Addiction: Research Identifies How Stress Triggers Drug Relapse
Recent research from Brown University could pave the way for new methods of treatment for those recovering from addiction. Researchers identified an exact brain region in rats where the neural steps leading to drug relapse take place, allowing them to block a crucial step in the process that leads to stress-induced relapse.  Prior research has established that acute stress can lead to drug abuse in vulnerable individuals and increase the risk of relapse in recovering addicts. But the exact way that stress triggers the neural processes leading to relapse is still not clearly understood. The Brown study provides new insights on how stress triggers drug abuse, and could lead to more effective treatments for addiction. Rest of this story is here.

Prescription Painkiller Abuse Takes Hold in Western States

Prescription painkiller abuse, which has centered on Eastern and Southern states, is now taking hold in Western states, The Wall Street Journal reports. Law enforcement and public health authorities in these states have been caught unprepared, the article notes. They are evaluating the problem, and starting to develop policies to counter it. They have long battled methamphetamine abuse in their states. Oregon, Colorado, Washington and Idaho have the country’s highest prescription drug abuse rates, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). In a survey, SAMHSA found 6.5 percent of Oregon residents ages 12 and older abuse opioid painkillers, compared with 4.5 percent in Kentucky. In 2007, Southern and Appalachian states topped SAMHSA’s list for prescription painkiller abuse. In those states, public education campaigns on the safe disposal of the drugs have reduced the number of pills stolen from medicine cabinets. State laws have helped decrease the supply of pills on the black market. In West Virginia, officials organized more than 100 community forums about painkiller abuse, and helped develop local solutions. The prescription opioid abuse rate is now 4.8 percent, compared with 5.9 percent two years ago. After Florida took steps to reduce prescription drug abuse, the state reported last fall the number of prescription drug-related deaths decreased in 2011. Deaths related to oxycodone decreased more than 17 percent. mThe growth of prescription drug abuse in Western states has been fueled by drug-trafficking rings. People addicted to the drugs, and drug dealers, obtain large amounts of oxycodone or hydrocodone from physicians in Southern California or Nevada, which have “pill mills.” They then transport the pills to nearby states. Arizona, which ranked sixth in the SAMHSA survey, does not have a unified plan to tackle prescription drug abuse, according to the newspaper. Colorado’s state drug task force is still focused on methamphetamine, although hospital admissions due to opioids increased to 7 percent of all visits last year.

Mild Traumatic Brain Injury Linked to Increased Risk for Addiction: Study

Mild traumatic brain injury (TBI) may be linked to an increased risk of addiction, a study of military personnel suggests. Researchers found mild TBI was linked with an increased risk for alcohol dependence, up to 180 days after the injury occurred. They also found an increased risk for nondependent abuse of drugs or alcohol and nicotine dependence in the month after the airmen sustained the injury, reports. The study included 5,065 active-duty airmen who suffered a mild TBI that resulted in temporary confusion or disorientation, memory loss, and/or a brief loss of consciousness. They were compared with a group of 44,733 airmen who suffered other types of injuries. The study found the risk of alcohol dependence was significantly raised in airmen with a mild TBI, compared with those in the comparison group. The risk was greatest soon after the injury occurred, and decreased over time. The study appears in the American Journal of Psychiatry. The researchers wrote, “Screening for addiction-related disorders should be considered as part of routine care for mild TBI and might best capture the first 30 days post-mild TBI, with repeat alcohol screening thereafter for at least 6 months following the injury.”

An Ugly Truth in the War on Drugs

This week, representatives from many nations will gather at the annual meeting of the United Nations Commission on Narcotic Drugs in Vienna to determine the appropriate course of the international response to illicit drugs. Delegates will debate multiple resolutions while ignoring a truth that goes to the core of current drug policy: human rights abuses in the war on drugs are widespread and systematic. Read the Rest of this NY Times Op-Ed here.

Enrolling in College Does Not Lead to Later Substance Abuse Problems, Study Suggests

Enrolling in college does not lead to substance abuse problems later in life, despite high levels of binge drinking on campuses, a new study suggests. College enrollment may prevent adult substance abuse in students who would not be expected to attend college because of low household income or their mother’s low level of education, reports. Researchers at Penn State University studied data from 1,092 high school seniors who participated in a national survey in 1979. The survey included information on whether the students enrolled in college a year later. The participants were contacted when they were 33 years old, and asked about their alcohol, tobacco and drug use. They found adults were more than six times as likely to engage in problem drinking at age 33 if they did not attend college. “Hypothetically, if we could send everyone in the United States to college, that would be protective overall and would significantly reduce problematic substance use in adulthood,” lead researcher Stephanie Lanza said in a news release. “But because it’s not the reality that everyone in the United States goes to college, we had to apply our statistical techniques to balance the data. After doing that, we found that college enrollment does not protect against problem drinking, nor does it place individuals at risk for future problem drinking.” The results will be published in the journal Structural Equation Modeling.

U.S. Military Studying Ways to Reduce Substance Abuse Among Service Members

Military researchers are studying ways to reduce substance abuse among service members, their families and veterans, a Defense Department official said this week. “We’re doing a great job with those physical wounds,” said Dr. Michael E. Kilpatrick, Deputy Director for Force Health Protection and Readiness Programs. The military now wants to focus on the invisible wounds of war, he added. Every service member undergoes a health assessment after deployment to detect mental health and substance abuse problems, followed by annual assessments, Dr. Kilpatrick said. The Army conducts health assessments in the combat theater each year, the Air Force News Service reports. All of these assessments include questions about alcohol and tobacco use. “We find a very high rate of people who respond that they think they’re having trouble with alcohol,” Dr. Kilpatrick noted.  A report issued by the Institute of Medicine last fall concluded substance abuse among members of the U.S. military and their families has become a public health crisis. The Defense Department’s approaches to preventing and treating substance abuse are outdated, the report stated. The Defense Department requested the report, which found about 20 percent of active duty service members say they engaged in heavy drinking in 2008, the latest year for which data was available. Binge drinking increased from 35 percent in 1998, to 47 percent a decade later. The report also found the rate of prescription drug abuse is on the rise. In 2002, an estimated 2 percent of active-duty personnel said they misused prescription drugs, compared with 11 percent in 2008. The Institute of Medicine recommended integrating prevention and treatment efforts more into primary health care, to reduce the stigma associated with seeking help for substance abuse. The military also should do more to preserve the confidentiality of those seeking assistance, the report noted.

Addressing global scourge of illicit drugs

Discussions about illicit drugs can often hinge on misunderstandings about terms. This confusion is glaring when words such as “decriminalization,” where drug possession is no longer criminalized, and “legalization,” legalizing the sale of drugs like heroin or cocaine, are used interchangeably. There is also confusion about the effectiveness of the 1961, 1971 and 1988 international drug conventions, which regulate our global approach to drug control. Those who label the conventions as ineffective now talk about liberalizing drug laws and amending the regulations. But the system is working — especially when it comes to health. Read the rest of this story here.

Medical Group Warns Against Giving Attention Drugs to Healthy Teens
Healthy children and teenagers should not be given drugs designed to treat attention deficit hyperactivity disorder, the American Academy of Neurology said this week. While young people with the disorder benefit from the treatment, the group noted, a growing number of healthy young people are taking these medications in an effort to increase concentration and school performance. “Doctors caring for children and teens have a professional obligation to always protect the best interests of the child, to protect vulnerable populations, and prevent the misuse of medication,” said position statement author William Graf, M.D. of Yale University, in a news release. “The practice of prescribing these drugs, called neuroenhancements, for healthy students is not justifiable.” The statement concludes there are both legal and developmental reasons these medications should not be prescribed to healthy children and teens, Reuters reports. The long-term effects of these drugs have not been studied in children, the group notes. Children and teens may not have sufficient decision-making abilities while their cognitive skills and emotional abilities are still developing. In addition, children and teens face the risks of being over-medicated and dependent on the drugs, according to the statement. “The physician should talk to the child about the request, as it may reflect other medical, social or psychological motivations such as anxiety, depression or insomnia. There are alternatives to neuroenhancements available, including maintaining good sleep, nutrition, study habits and exercise regimens,” Dr. Graf said.

·         Army Report Recommends Changes to Address Mental Health Care Deficiencies
A study of the Army’s mental health care system identifies a number of gaps, and provides recommendations, including increasing the number of behavioral health specialists, the Los Angeles Times reports. The review found 4 percent of soldiers returning home from combat have behavioral health problems. When they seek help, they must choose from a confusing assortment of programs, and face gaps in mental health records due to uncoordinated record-keeping systems, and inconsistent training for mental health workers. Lt. Gen. Howard B. Bromberg, Deputy Army Chief of Staff, said behavioral health specialists are being moved into combat zones, so soldiers can receive immediate help. The Army is also working to reduce processing delays for soldiers seeking help. Currently, many must wait for more than a year before their cases are finalized, the article notes. U.S. Senator Patty Murray of Washington, former chairwoman of the Senate Veterans Affairs Committee, requested the report after hearing that a screening team of forensic scientists at Madigan Army Medical Center in her state were refusing post-traumatic stress syndrome (PTSD) diagnoses for soldiers who had been identified as having the disorder by their own Army counselors and psychiatrists. Her office found more than 40 percent of PTSD diagnoses for patients under consideration for medical retirement at Madigan were overturned by a psychiatry screening team. An Army review found “no systemic issues of soldiers being disadvantaged in the disability process” regarding the diagnoses of PTSD, according to the Army News Service. Army Surgeon General Lt. Gen. Patricia Horoho noted the Army has doubled the number of behavioral health care providers. The Army plans to continue expanding the number of these workers. “We want to get behavioral health care out of brick and mortar and into the soldier’s lifespace,” she said. “Soldiers are then more likely to seek behavioral health and other wellness care.”

Addiction Expert: Care Needed in Implementing New Buprenorphine Prescribing Rules

In January, new government regulations took effect that allow greater take-home privileges for buprenorphine patients who are treated in clinic-based Opioid Treatment Programs (OTPs). While this change will allow more patients to have increased flexibility as they progress in their recovery, providers must be careful in deciding who to give the medication to, in order to avoid diversion, says a New York addiction specialist. “Prescribers and the rest of the health care team need to have a dual focus on both doing everything they can to help the patient, and also trying to keep buprenorphine prescribing safe by limiting misuse, abuse and diversion that may come about by their prescribing,” says Dr. Edwin A. Salsitz, MD, Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center. The changes in regulations, made by the Substance Abuse and Mental Health Services Administration (SAMHSA), do not apply to methadone treatment. Previously, patients could not receive a one-week take-home supply of buprenorphine or methadone from an OTP until they were stable in treatment for nine months. Under the new rule, this time requirement for patients receiving buprenorphine products no longer applies. If an OTP physician program physician determines that a patient is suitable, the program can dispense a one-week supply of medication, or longer, to a newly admitted patient. SAMHSA made the changes based on several factors, including differences between methadone and buprenorphine in abuse potential and actual abuse, death rates, and the fact that methadone is subject to tighter federal controls than buprenorphine. “Buprenorphine abuse has been increasing, but SAMHSA believes that the controls and oversight in place in the OTP, as well as enhanced monitoring will mitigate abuse concerns,” the agency stated in a letter to treatment providers. Buprenorphine also can be prescribed by certified physicians in an office-based setting, known as office-based opioid treatment (OBOT). Office-based treatment is a popular choice among patients who wish to avoid daily visits to a treatment clinic, Dr. Salsitz notes. However, he adds, not all patients are initially suitable candidates for office-based treatment. “The main benefit of someone going to an opioid treatment program and being dispensed buprenorphine is the security and structure that OTP provides,” he says. “It is virtually impossible for an OBOT to provide the same oversight, structure and security for both the patient and the medication, as is provided by clinic-based treatment. One possible paradigm is to begin buprenorphine treatment in an OTP if enhanced oversight and structure are needed, and then when the patient has stabilized, the patient can be referred to an office-based treatment program.” Choosing whether a patient addicted to opioids should be treated with buprenorphine or methadone, and whether they should be treated in a clinic or in a physician’s office, are complicated issues, Dr. Salsitz observes. “These issues currently have no clear answers, but they need to be researched and evaluated,” he says. In stressing the need for strict oversight of buprenorphine prescribing, Dr. Salsitz pointed to a recent SAMHSA report that found hospital emergency department visits linked to buprenorphine increased substantially – from 3,161 visits in 2005 to 30,135 visits in 2010, with 52 percent involving non-medical use. He notes, “If a doctor gives a new patient 30 days of buprenorphine without any real followup, some of that medication may end up on the street.”

Binge Drinking Costs Billions in Wisconsin, Study Finds
A new study calculates binge drinking cost Wisconsin $6.8 billion last year. Easy availability of alcohol, combined with low alcohol taxes, has contributed to high rates of alcohol use in the state, NPR reports. One-fourth of adults in Wisconsin are binge drinkers, the highest percentage in the country. Binge drinking is defined as having five or more drinks in a short period for men, and four for women. The study by the University of Wisconsin Population Health Institute calculates binge drinking costs each person in the state about $1,200 in higher taxes, more health care and other costs. Study co-author Penny Black told NPR there were 50,000 hospitalizations in Wisconsin due to binge drinking in 2011. More than 60,000 binge drinkers were arrested in 2010. The large number of college students in the state plays a role, Black observed.”We know that binge drinking is a huge problem in the 18- to 25-year-old population, but in Wisconsin specifically, that behavior continues past college,” she said. “And it’s really kind of a norm. And that’s why we are No. 1 in the nation as far as binge drinking rates.” Overall alcohol use is a problem in the state—the general consumption rate for alcohol is 30 percent higher than the national average. One reason is that alcohol is easy to obtain, she said. “Alcohol is available at every event — church event, school event, sporting event. We have local control here so there is no monitoring of the number of licenses that are allowed for people to sell alcohol.” Low alcohol taxes also contribute to the problem, according to Black. Wisconsin has one of the lowest alcohol taxes in the country.”We know that increased prices are a deterrent for younger drinkers, so it would help on front end in that it would reduce some drinking,” she said. “And then on the other end it would help pay for more of the problems that are caused by excessive alcohol use.”

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