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Friday, November 22, 2013

ATOD & Advocacy Update - Week Ending November 22, 2013



Zohydro to be Manufactured by Same Company That Makes Addiction Medicine
The newly approved pure hydrocodone product, Zohydro ER (extended release), will be made by the same company that manufactures Vivitrol, a drug used to treat patients addicted to opioids or alcohol, The New York Times reports. The Food and Drug Administration (FDA) approved Zohydro ER last month for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Drugs such as Vicodin contain a combination of hydrocodone and other painkillers such as acetaminophen. Zohydro is expected to reach the market in early 2014. In December 2012, a panel of experts assembled by the FDA voted against recommending approval of Zohydro ER. The panel cited concerns over the potential for addiction. In the 11-2 vote against approval, the panel said that while the drug’s maker, Zogenix, had met narrow targets for safety and efficacy, the painkiller could be used by people addicted to other opioids, including oxycodone. In 2010, Zogenix bought the right to market Zohydro in the United States from another company, Elan, the article notes. The following year, a company named Alkermes, which makes Vivitrol, bought a unit of Elan that included Zohydro. The deal included the existing agreement with Zogenix. Some law enforcement agencies and addiction experts have voiced concern that approval of a pure hydrocodone drug will lead to an increase in overdoses.

PCP-Related Visits to the Emergency Room Jumped 400% Between 2005 and 2011
PCP-related emergency room visits jumped 400 percent between 2005 and 2011, according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA). PCP (phencyclidine), also known as “angel dust,” can cause hallucinations when taken at high doses. The number of PCP-related visits to hospital emergency rooms jumped from 14,825 in 2005, to 75,538 in 2011, Medical News Today reports. The largest increase was seen among patients ages 25 to 34. In 2011, about two-thirds of PCP-related visits were made by males, and almost half were made by people ages 25 to 34. Other illegal drugs, including marijuana, cocaine and heroin, were involved in about half of PCP-related emergency room visits in 2011. PCP can be snorted, smoked, injected, or swallowed and is most commonly sold as a powder or liquid and applied to a leafy material such as mint, parsley, oregano, tobacco, or marijuana. Many people who use PCP may do it unknowingly because it is often used as an additive and can be found in marijuana, LSD, or methamphetamine. In a hospital or detention setting, a person on PCP may become violent or suicidal, and can become very dangerous to themselves and to others. “This report is a wake-up call that this dangerous drug may be making a comeback in communities throughout the nation,” Dr. Peter Delany, Director of SAMHSA’s Center for Behavioral Health Statistics and Quality, said in a news release. “PCP is a potentially deadly drug and can have devastating consequences not only for individuals, but also for families, friends and communities. We must take steps at every level to combat the spread of this public health threat.”

Addiction Treatment with a Dark Side
In Demand in Clinics and on the Street, ‘Bupe’ Can Be a Savior or a Menace.
For Shawn Schneider, a carpenter and rock musician, the descent into addiction began one Wisconsin winter with a fall from a rooftop construction site onto the frozen ground below. As the potent pain pills prescribed for his injuries became his obsessive focus, he lost everything: his band, his job, his wife, his will to live. Mr. Schneider was staying in his parents’ basement when he washed down 40 sleeping pills with NyQuil and beer. His father heard him gasping and intervened, a reprieve that led Mr. Schneider into rehab, not his first program, but the one where he discovered buprenorphine, a substitute opioid used to treat opioid addiction. In the two years since, by taking his “bupe” twice daily and meeting periodically with the prescribing psychiatrist, Mr. Schneider, 38, has rebounded. He is sober, remarried, employed building houses, half of a new acoustic duo and one of the many addicts who credit buprenorphine, sold mostly in a compound called Suboxone, with saving their lives. Continue reading here.

The benefits and health risks of beer and wine
More than a few baby boomers imbibed too much during their misspent youth, leaving them with a lifelong apprehension of what can come from drinking alcohol. But a raft of medical studies over the past generation shows that alcohol has proven health benefits, provided you drink in moderation — one or two drinks a day, three or four days a week. Many doctors say the findings are no longer in doubt, even if some boomers with long memories continue to be skeptical. “There’s no question that people who drink moderately have lower rates of heart attacks, lower rates of diabetes, and live longer,” said Dr. Eric Rimm, associate professor in the departments of epidemiology and nutrition at the Harvard School of Public Health in Boston. “If you ask most cardiologists, they would say drinking in moderation is beneficial.” Even more interesting: People who only drink occasionally, or on weekends, aren’t likely to enjoy the same health benefits as those who drink every other day, Rimm suggested. Alcohol reduces the risk of blood clotting in the 24 hours after drinking, for example, but not in the days after. Other benefits, such as a rise in good cholesterol, making it easier to process glucose, are more likely to extend throughout the week. Please click here to continue reading.

Alcohol Has Bigger Effect on People in Middle Age Due to Physical, Lifestyle Changes
Alcohol affects people more in middle age due to physical and lifestyle changes, according to The Wall Street Journal. As people start to take more medication in their 40s and 50s, the risk of alcohol and drug interactions also increases. As people reach middle age, they experience changes in body composition, brain sensitivity and liver functioning, the article notes. “All of the effects of alcohol are sort of amplified with age,” David W. Oslin, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania, told the newspaper. “Withdrawal is a little bit more complicated. Hangovers are a little bit more complicated.” Changes in body composition during middle age result in more alcohol circulating in the bloodstream. In addition, the liver, which metabolizes alcohol, gets less efficient as people age. The level of certain enzymes that break down alcohol decreases. Hormonal changes that women experience during menopause can increase their sensitivity to alcohol. In middle age, people tend to drink less than they did when they were younger, notes Robert Pandina, director of the Center of Alcohol Studies at Rutgers University. So when you do drink “you might have a more sensitive response to alcohol because you’ve lowered your exposure to alcohol over all,” he said. Drugs that can interact with alcohol include heartburn drugs such as Zantac, acetaminophen, and blood thinners like Coumadin. Mixing blood thinners with alcohol can cause bleeding. “People on Coumadin shouldn’t really drink at all,” Dr. Oslin noted. Combining alcohol with some pain medications and benzodiazepines can make a person “more prone to sedation, more prone to cardiovascular risk and more prone to overdose,” he added. According to the Centers for Diseases Control and Prevention, about 52 percent of people ages 45 to 64 had at least 12 drinks in the previous year.

Senate Passes Measure Establishing System to Track Prescription Drugs
The U.S. Senate this week passed a measure that will establish a system to track prescription drugs from the time they are manufactured until they are sold at a drugstore, The News & Observer reports. The bill awaits President Obama’s signature. Over the next seven years, The Drug Quality and Security Act calls for drug manufacturers, repackagers, wholesale distributors and dispensers to pass and hold onto key information about each drug’s distribution history. The goal is to allow unit-level product tracing within 10 years. Four years after the law is enacted, manufacturers will serialize drugs in a consistent way across the industry, to allow for efficient tracing to respond to recalls and notices of theft and counterfeiting. “This legislation will improve the safety of compounded drugs as well as establish an unprecedented tracing system that will, for the first time ever, track prescription drugs from manufacturing to distribution, thereby thwarting drug counterfeiters,” Senate Health, Education, Labor, and Pensions Committee Chairman Tom Harkin of Iowa said in a news release. “Americans must have the confidence that their drugs—whether obtained at a hospital, at a doctor’s office, or at the pharmacy counter—are safe, and that is exactly what this bill does.” John Castellani, President and CEO of the Pharmaceutical Research and Manufacturers of America, said in a statement, “The counterfeiting of prescription drugs is on the rise within the United States but oftentimes goes unnoticed or unreported, leaving many Americans unaware of this problem. In fact, some experts have cited the counterfeiting of these medicines as even more lucrative than the trafficking of illegal drugs like heroin and cocaine. This act will improve the security of the finished drug supply chain and reduce the impact of the patchwork of state laws related to the pedigree requirements for drug distribution.”

Poison Control Experts Warn of Danger From Detergent Capsules That Look Like Candy
Poison control experts are warning parents about single-dose detergent capsules that look like candy. These products were involved in about 10,000 cases of exposure involving young children, The Wall Street Journal reports. “Some children who have gotten the product in their mouths have had excessive vomiting, wheezing and gasping,” the American Association of Poison Control Centers notes on its website. “Some get very sleepy. Some have had breathing problems serious enough to need a ventilator to help them breathe. There have also been reports of corneal abrasions (scratches to the eyes) when the detergent gets into a child’s eyes.” Last year, single-dose detergent pods became popular, the article notes. Thousands of children who ate or otherwise came into contact with laundry pods received medical attention. Some had breathing problems that required days of hospitalization. A 7-month-old boy in Florida died in August after eating a laundry detergent capsule. Proctor & Gamble, which makes Tide Pods, was warned about possible problems three years ago by officials at an Italian poison control center. They contacted the company to report children were biting into small packets of the company’s concentrated liquid detergent called Dash Ecodosi. The poison control officials recommended making the capsules’ packaging opaque, and more difficult to open. After the company made the changes, reported poison cases fell by 60 percent over six months, according to the newspaper. While Proctor & Gamble studied the problem in Italy, it launched Tide Pods in the United States and Canada in clear containers. The company said it wanted to see whether making the packages opaque worked before trying them in North America. It changed the packaging in the United States and Canada this past spring. Clear packages are now largely phased out.

Office of the National Coordinator to help fight Rx drug abuse
Developing standards to bring prescription info from state databases into EHRs and HIEs
In an effort to combat the prescription drug abuse epidemic, the Office of the National Coordinator (ONC) has launched a new interoperability initiative to better link drug monitoring programs with health IT systems. In a blog post, Jennifer Frazier, ONC's behavioral health subject matter expert, says the new Standards & Interoperability Framework Initiative seeks to solve problems related to the lack of common technical standards and vocabularies that could help prescription drug monitoring programs "share computable information" with health IT systems. The PDMP & Health IT Integration framework "will bring together the PDMP and heath IT communities to establish a standardized approach to retrieve data stored in the PDMPs and deliver it to EHRs and HIEs," Frazier writes. Finding a better way to give care providers easy access to PDMP data "can't happen quickly enough, as clinicians across the country struggle to fight a growing national public health crisis," she adds. "Opioid painkillers, such as hydrocodone and oxycodone, are typically the most abused drugs. Patients are prescribed these drugs to help manage pain from injury or surgery. When taken as prescribed, these medications are generally safe; but when misused or abused, they can be highly addictive – even deadly." Please click here to continue.

New study identifies spiritual change among adolescents in treatment
A research team hopes that its latest study of factors that influence good outcomes in adolescents with substance use problems will lead more clinicians and programs to take a second look at spiritually based treatment approaches for youths. The study, which will be published next spring in Alcoholism Treatment Quarterly, found that daily spiritual experiences (encompassing more than formal religious practices alone) served as a strong predictor of sobriety in a youth population with complex problems. Strikingly, while one-third of study participants had self-identified as agnostic or atheist at the start of the study, two-thirds of those individuals would claim some spiritual identity two months later, after receiving substance use treatment. Continue here.

The bottom of the bottle: Alcoholism still tough to treat in an era of craft liquor
Evanston’s first craft brewery, Temperance Beer Company, started churning out batches of booze earlier this year; its first craft whiskey distillery, FEW Spirits, just won a $250,000 loan from the town for an expansion project. With 409 craft breweries opening in the U.S. in 2012 alone and five times as many U.S. micro-distilleries in 2012 as in 2005, it’s clear that the small-batch liquor industry is booming. For some people, however, one sip of alcohol is a sip too many. Read on here.

Researchers identify a group of 39 genes linked with alcoholism
There is good evidence from studies of families and twins that genetics plays an important role in the development of alcoholism. However, hundreds of genes likely are involved in this complex disorder, with each variant contributing only a very small effect. Thus, identifying individual risk genes is difficult. Using a new approach that combines genome-wide association studies (GWAS) with information about which human proteins interact with one another, researchers from the University of Iowa and Yale University Medical School have identified a group of 39 genes that together are strongly associated with alcoholism. "The discovery of these genes may open a new window into the biological mechanisms underlying this alcoholism disorder," says Shizhong Han, PhD, UI assistant professor of psychiatry and corresponding author of the study, which was published Nov. 21 in the American Journal of Human Genetics. "Eventually, it's our hope that the findings might help to develop drugs to treat or prevent this disorder." Han and his colleagues based their approach for identifying risk genes on the idea that genes may be "guilty by association" of contributing to the disease -- that although many different genes contribute to alcoholism, these genes, or more precisely, their protein products, are not independent of each other. "The proteins made by these genes could be neighbors, or they could be part of the same functional biological pathway," Han explains. "We took advantage of their biological relatedness to identify a network of genes that interact and together contribute to the susceptibility to alcoholism." The team conducted the study by using two large data sets collected for the genetic study of addiction -- the Collaborative Study on the Genetics of Alcoholism (COGA) and the Study of Addiction: Genetics and Environment (SAGE). These data sets document genome-wide common variants information from several thousand people linked to information about these individuals' alcohol dependence or other types of addiction\. The research team analyzed the merged SAGE and COGA datasets for genetic variants associated with alcoholism. No single variant was strongly associated with the condition, but when the researchers integrated information about protein-protein interactions from the Human Protein Interaction Network, they identified a network of 39 genes that was not only enriched for alcoholism-associated genes, but also was collectively strongly associated with alcoholism. This strong association held for both European Americans and African Americans. Furthermore, the team was able to replicate the finding in three additional genetic datasets, two of individuals of European ancestry and one of individuals of African ancestry, suggesting that the findings are robust. To minimize the possibility of the result being a false positive, the researchers also analyzed the gene network for associations with other complex human diseases - bipolar disorder, depressions and diabetes. The gene network was not associated with any of these conditions. In addition to finding the highly statistically significant association between the gene network and alcoholism, many of the genes identified also appear to be biologically relevant to brain processes likely to be affected in alcoholism. For example, the network contains genes for ion channel proteins that appear to be involved in tolerance toward some of the physiological effects of alcohol. Other genes code for proteins involved in general brain processes, including synaptic transmission, ion transport, and transmission of nerve impulses.

Drug testing is a great idea. Thanks, Rep. Radel.
Rep. Trey Radel voted in favor of drug-testing the folks who get food stamps. In that case, why don’t we drug-test all people who get federal money? Let’s start with members of Congress! Radel, the Florida Republican whose campaign was heavy on balancing the budget, would be the first to save the government some money on that plan. The 37-year-old congressman who describes himself on Twitter as a “Hip Hop Conservative” — whatever that is — lasted just 10 months in the nation’s capital before his Nose Snow Rewards Card balance tripped the radar of law enforcement. He was busted last month after buying $250 worth of cocaine from a federal agent. And it apparently wasn’t his first time on this particular sleigh ride. Continue reading here.

What’s So Bad About Casual Drug Use?
Most people who try cocaine don't go on to become addicts
So Representative Trey Radel, the Republican from Florida, a self-styled “conservative voice” in Congress, has pleaded guilty to a misdemeanor charge of cocaine possession. And Toronto’s city council has stripped Mayor Rob Ford of much of his power after it came out that he had smoked crack (never mind that Ford’s well-known drunken antics were not cause for such censure). Rather than arguing whether such figures are hypocrites (Radel voted in favor of mandatory drug testing for food-stamp beneficiaries) or debating how they should attempt damage control (he’s also pledged to enter a substance-abuse program after paying a fine and receiving a year’s probation), let’s ask a more basic question: What’s so scandalous about casual drug use?  Continue reading here.

More Than Half of Teens With Mental Health Disorders Do Not Receive Treatment: Study
More than half of teens in the United States who have mental health disorders do not receive treatment, according to a new study. The findings come from an analysis of more than 10,000 teens. Of those teens who do receive help, most are not treated by a mental health professional, HealthDay reports. They are treated by pediatricians, school counselors or probation officers. “It’s still the case in this country that people don’t take psychiatric conditions as seriously as they should,” lead researcher E. Jane Costello of Duke University said in a news release. “This, despite the fact that these conditions are linked to a whole host of other problems.” Overall, in the past year, 45 percent of teens with psychiatric disorders received some form of service. The most likely to receive help were those with attention deficit hyperactivity disorder (74 percent), conduct disorder (73 percent) or oppositional defiant disorder (71 percent). Those least likely to receive services were those with phobias (41 percent) and any anxiety disorder (41 percent). Black teens were much less likely than white teens to receive mental health treatment. There are not enough qualified pediatric mental health professionals in the United States, Costello said. “We need to train more child psychiatrists in this country,” she noted. “And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion’s share of the work.” The findings appear in the journal Psychiatric Services.


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