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Monday, March 25, 2013

ATOD and Advocacy Update - Week-Ending March 22, 2013



Alcohoot is the first Israeli company to compete for "coolest" start-up in magazine's annual contest.
One of the companies in Inc. magazine’s annual contest ranking “America’s Coolest Start-up” is not like the others: It’s Israeli. Alcohoot, a start-up that aims to prevent drunk driving by selling law enforcement- grade alcohol Breathalyzers that attach to smartphones, is the brainchild of 24-year-old Jonathan Ofir, a Los Angeles native studying business at the IDC, and his Israel born friend Ben Biron, 23, studying at Wingate University in North Carolina. Rest of the story is here.

Passover without wine? For Jewish addicts, sober seders are a life-saver

It's rare that an Orthodox rabbi chooses to omit an important Jewish ritual in his holiday celebrations. But in the spring of 2000, Rabbi Yosef Lipsker cleared his living room of furniture, set up three large dining tables and invited dozens of people to a special seder that included all the standard Passover observances - except for one. “When it comes to seders, everybody thinks of the four cups of wine drunk during the service,” said Lipsker, a consultant at the Caron Treatment Center for Substance Abuse and Chemical Addiction in Reading, Pa. “But we said, 'Listen, we're going to have you at the seder, but you're going to have four cups of grape juice instead.'” Continue reading here.

Bill Would Require Tamper-Resistant Formulas for Certain Drugs

A new bill introduced Friday in the U.S. House of Representatives would require new drugs, and certain generic drugs, to have tamper-resistant formulas, ABC News reports. The proposed legislation is designed to reduce prescription drug abuse. The Stop the Tamper of Prescription Pills Act (STOPP) would require the Food and Drug Administration (FDA) to only approve drugs if they have a tamper-resistant formula. Drugs in pill form could not be easily crushed and snorted, and could not be melted into an injectable form. The measure would also require generic brands already on the market to be tamper-resistant, if their brand-name equivalents had a tamper-resistant formulation. It would not apply to drugs prescribed for chronic pain or end-of-life treatments. The FDA would be permitted to exempt drugs considered critical to national health, or in cases where a drug does not have a tamper-resistant alternative.
Bill co-sponsor Bill Keating of Massachusetts introduced the STOPP Act last summer, but it stayed in committee. Measures that would require generic drugs to have tamper-resistant formulas have been opposed by some generic drug manufacturers, who have argued it would lead to higher drug costs. Representative Hal Rogers of Kentucky, another sponsor of the bill, noted in a press release, “When OxyContin was first approved by the FDA over a decade ago, it seemed at first glance that its extended-release technology was a godsend for patients suffering from chronic pain. What no one could foresee was that when you crush these pills, they actually create pain in the form of addiction, abuse and senseless, tragic overdose deaths. Now we’ve got some promising technology to deter abuse, as well as the benefit of hindsight. This time around, we can see the train coming from a mile away – and we need to step out in front of it to stop another tidal wave of addiction.”

Critics of Mental Health Disorder Manual Say Mental Illness Being Overdiagnosed

Critics of the soon-to-be-released updated manual used to identify mental illness, say it will expand the list of what constitutes mental illness and will lead to a needless increase in diagnoses, according to CNN. A growing number of psychiatrists, psychologists and clinical social workers say depression and other normal responses to life events are too often labeled as mental illness, increasing the use of potentially dangerous medication, the article notes. In late May, the American Psychiatric Association will publish the updated version of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-5. A group called the International DSM-5 Response Committee plans to launch a campaign designed to block the publication’s release.
Dr. Allen Frances, who led the task force that produced the DSM-IV in 2000, and is now spearheading efforts against the DSM-5, said the new version would incorrectly label one in four people who have chronic pain and irritable bowel syndrome as instead having the DSM-5s newly created “somatic symptom disorder.” This is diagnosed when a person has spent at least six months thinking of and being anxious about their medical illness. Detractors of the manual say some of its recommendations lack scientifically conclusive field testing. They note the manual does not consider the prior effectiveness or ineffectiveness of anti-psychotic medications when considering a patient’s current diagnosis. They also criticize the manual’s combining people with a spectrum of depressions into one group. The DSM-5 will combine problem drinking and alcoholism into a single condition known as “alcohol use disorder.” A recent study suggests these changes may not improve the diagnosis of alcoholism.

Middle School Dating Linked to Increased Substance Use in New Study

Middle school students who date report using twice as much alcohol, tobacco and marijuana, compared with their classmates without romantic relationships, a new study finds. Students who date in middle school also have significantly worse study skills, and are four times more likely to drop out of school, compared with their single classmates, Science Daily reports. Researchers at the University of Georgia studied 624 students over seven years, starting when they were in sixth grade. Each year, the students completed a survey that asked about dating, substance use and other behaviors. The study looked at the students’ high school dropout rates, and annual teacher-rated study skills. Study author Pamela Orpinas noted in a news release that the study suggests “dating should not be considered a rite of passage in middle school.” The researchers reported their findings in the Journal of Research on Adolescence.

Spring Break's Biggest Danger? Binge Drinking

It's an annual rite of spring. Millions of teens and college-age kids migrate to beaches all over the world for spring break, posting videos on YouTube that show wild parties fueled by booze, bikinis and sex. During spring break, teens are drawn to crowds and succumb to peer pressure. Things can get downright deadly. Just last week, police said, a 20-year-old college student from Michigan died in an alcohol-related incident while on spring break in Panama City, Fla. Rest of the story is here.

Anesthesia Abuse Increases Among Health Care Professionals, Study Suggests

Abuse of the anesthesia drug propofol is on the rise among health care professionals who have easy access to it, a new study suggests. The study found the number of health care professionals treated for abuse of the drug has increased steadily, the Star Tribune reports. Most of these professionals began using propofol to get to sleep, and quickly became addicted. Propofol is used for surgery and other procedures. It takes effect quickly, and has a fast recovery time, with fewer side effects than other anesthetics, the article notes. The researchers state in a news release, “Propofol addiction is a virulent and debilitating form of substance dependence” with a “rapid downhill course.” They studied data from an addiction center specializing in substance abuse among health care professionals, and found 22 patients treated for propofol abuse between 1990 and 2010. They included doctors, nurses and a dentist. Most of the doctors and all of the nurses were anesthesia providers. Most of them had depression, in addition to a history of childhood sexual or physical abuse. A higher than expected number of patients had family members with schizophrenia. Most of the patients began addiction treatment within a few months after starting to use the drug; five sought treatment after just one propofol binge. About half of patients started treatment after a dramatic event, such as a motor vehicle accident. Some patients received facial injuries after passing out from propofol. The study will appear in the April issue of the Journal of Addiction Medicine.

New 3-ounce alcohol drink sparks concerns

A company hoping to sell 3-ounce vials of high-alcohol malt beverages in flavors like Screw Driver and Apple Pie is asking the state Alcoholic Beverage Control Commission to approve its packaging.  Staff members with the ABC Commission rejected Stout Brewing's packaging for its Stout 21 malt beverage product last month.  Read the rest here.

Report Finds Child Poisoning Often Results From Pills Found in Purses and on Floor

A new report finds small children who end up in the emergency room after being accidentally poisoned from medication are more likely to find the pills in a mother’s purse or the floor than the family medicine cabinet. Children also find pills in other easy-to-reach spots such as sofa cushions and countertops, USA Today reports. The report was released by the nonprofit group Safe Kids Worldwide. Most accidental medication poisonings in children result from ingestion of medication belonging to a child’s mother or grandparents, according to the report. The group evaluated 2,315 emergency department records for children up to age 4. In 2011, approximately 67,000 young children ended up in the emergency room after being accidentally exposed to medication. Accidental poisonings in young children rose 30 percent in a decade, they found. Of the records that stated the source of the medication, 27 percent were on the floor or had been otherwise misplaced, while 20 percent came from a purse, bag or wallet. An additional 20 percent were left on counters, tables, nightstands or dressers, 15 percent were found in a pill box or bag of pills, 6 percent were found in a drawer or cabinet, and 12 percent came from other places. In 86 percent of cases, the medications belonged to adults. Mothers accounted for 31 percent, while grandparents accounted for 38 percent. “You have some grandparents who have their whole pharmacy on the kitchen counter or the bathroom counter, and it is there for the taking,” Salvador Baeza, a pharmacist who directs the West Texas Regional Poison Center in El Paso, told the newspaper. Safe Kids advises parents and other caregivers to store medications out of sight and out of reach. SafeKids CEO Kate Carr recommends that parents ask grandparents and other relatives to secure medications when their children are visiting. “That can be an awkward conversation,” Carr said. “But you can just say that ‘I have a very curious child who is just at that age where they get into everything.’”

Freshman brains change with images of alcohol
Connections among brain regions involved in emotion processing and cognitive control may change with increased exposure to alcohol and alcohol-related cues during the first year of college. Read the rest here.

Legislators Introduce Bill to Strengthen Restrictions on Hydrocodone

A bipartisan group of legislators introduced a bill that would tighten restrictions on hydrocodone, the Los Angeles Times reports. The Safe Prescribing Act of 2013 follows recommendations made in January by a Food and Drug Administration (FDA) advisory panel. The panel voted to strengthen restrictions on hydrocodone combination drugs, such as Vicodin. The group recommended that the FDA make the drugs more difficult to prescribe. The FDA proposal forbids refills without a new prescription, as well as faxed prescriptions and those called in by phone. Distributors of the drugs would have to store the drugs in special vaults. Nurse practitioners and physician assistants would be banned from prescribing the drugs. Forty-one members of Congress from both parties signed onto the proposed legislation as co-sponsors, the article notes. “Prescription drug abuse threatens families in Massachusetts and across the country with no regard for income, education, or political party. Congress needs to step up and take action to help fight the epidemic of prescription drug abuse sweeping the country,” bill co-sponsor Representative Ed Markey of Massachusetts said in a news release. He introduced the bill Wednesday, along with Representative Vern Buchanan of Florida, Senator Joe Manchin of West Virginia and Senator Mark Kirk of Illinois. “Too many of our loved ones are dying every day from prescription drug overdoses and are abusing hydrocodone painkillers for non-medical purposes,” Representative Buchanan said. “This epidemic has reached such violent proportions that drug deaths now outnumber traffic fatalities in this country.”

Does Relapse Mean Failure?
We all evolve and learn in the process of parenting an addict. When I first entered this world, my way of thinking was cut and dried. You either recovered or you didn’t. If you didn’t, you failed. Well, learning is hard, especially if you happen to be an adult.  And when learning involves first unlearning what you believe to be true, it is particularly difficult. Rest of the story is here.

More awareness of children’s mental health needed, say experts
Children’s mental health and how it affects families, community and business was discussed Thursday morning at the annual “Is It Good for the Children” seminar sponsored by the Rock Hill Commission on Children and Youth. More than 50 community leaders gathered at the Cotton Factory to learn more about the issue and hopefully spark more community conversation on mental illnesses. Click here to read the rest of the story.

How big is the school counselor shortage? Big

A recent survey taken in California showed that a majority of voters there believe that the best approach to preventing violence in schools is through improving mental health services and emergency response training for school staff. But in the midst of a national debate about how to keeps kids in school safe, one thing we aren’t hearing much about is the serious shortage of school counselors. Rest of the story is here.

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, News-Medical.net 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, HealthCanal.com 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.”

Friday, March 8, 2013

ATOD and Advocacy Update - Week-Ending March 8, 2013



Percentage of College Freshmen Drinking Beer in the Past Year Continues to Decline

The percentage of U.S. college freshmen reporting that they drank beer occasionally or frequently in the past year has declined significantly since the early 1980s, according to data from the Cooperative Institutional Research Program’s annual college freshman survey. In 1982, 73.7% of college freshmen reported drinking beer in the year before entering college. Since then this rate has declined nearly every year, reaching a record low of 33.4% in 2012. While the decline in beer consumption over the past three decades is encouraging, one-third of college freshmen still report drinking beer in the year before entering college. Research has shown that early alcohol use—particularly before the age of 18—is associated with a higher risk of alcohol abuse or dependence as an adult. NOTES: The 2012 results are based on the responses of 192,912 first-time, full-time, freshmen at 283 U.S. baccalaureate colleges and universities. The survey is typically administered during the freshmen orientation process. The data have been statistically adjusted to reflect the responses of the approximately 1.5 million first-time, full-time students entering 1,613 four-year college and universities as first-year students in 2012.

SOURCE: Adapted by CESAR from data from the Higher Education Research Institute (HERI), Cooperative Institutional Research Program (CIRP), The Freshman Survey. Available online at http://heri.ucla.edu/tfsPublications.php. For additional information, contact the Higher Education Research Institute at heri@ucla.edu.



Federal Judges Work With Prosecutors to Create Drug Courts
Following decades of success for drug courts at the state level, federal judges around the nation are collaborating with prosecutors to create the special treatment programs for defendants who are addicted to drugs, The New York Times reports. These defendants normally would face significant time in prison, the article notes. The judges hope to work around drug laws that are often seen as too harsh and inflexible. The Justice Department is permitting U.S. attorneys to reduce or even dismiss charges in some drug cases. Defendants in drug court must accept responsibility for their crime, and agree to receive drug treatment and other social services. They must attend regular meetings with judges, who monitor their progress. If they successfully participate in the program, they receive a reduced sentence, or even no jail time. Failure to successfully complete the program results in them being sent to prison. Defendants facing more serious charges are not eligible for drug court. Legal experts say drug courts are a less costly and more effective option than prison for many low-level repeat offenders. According to the Office of National Drug Control Policy, every dollar spent on drug courts yields more than two dollars in savings in the criminal justice system alone. Federal judges have instituted drug court programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. So far, about 400 defendants have been involved in federal drug court programs. The United States Sentencing Commission has established guidelines for sentencing since 1984, after studies found federal judges were giving different sentences for similar crimes. Judges feel the guidelines interfere with their judicial independence, according to the article. “When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, told the newspaper. “It feels wrong.”



Doctors Disagree on Best Way to Prevent Prescription Painkiller Abuse
There is disagreement among doctors about the best way to prevent prescription painkiller abuse, sometimes even among physicians in the same hospital, according to The Plain Dealer. The Cleveland Clinic is among the institutions where colleagues disagree on the best approach to the problem. Some doctors want stricter rules for prescribing opioids, arguing this could decrease addiction and drug abuse. Others are concerned tougher rules could penalize patients with long-term pain, particularly if the new rules call for opioid treatment only for those in severe pain, rather than moderate pain. This is a personal and subjective call, they say. One Cleveland Clinic pain management specialist, Dr. Riad Laham, wrote a letter to the Food and Drug Administration (FDA) arguing that such a rule could lead patients to lie about their pain to meet higher thresholds, and could result in more illegal street sales of opioids. Dr. Andrew Kolodny, who heads Physicians for Responsible Opioid Prescribing (PROP), says opioids are overprescribed. “We’re not trying to take these people’s opioids away from them, we’re trying to prevent new starts,” he told the newspaper. Dr. Edward Covington, Director of the Cleveland Clinic’s Neurological Center for Pain, supports a PROP petition to the FDA that states “an increasing body of medical literature suggests that long-term use of opioids may be neither safe nor effective for many patients, especially when prescribed in high doses.” The group wants the FDA to change prescribing rules for opioids, so they are not indicated for moderate pain, to recommend a maximum daily dose, and to limit patients’ continuous use to a maximum of 90 days, the article notes. The FDA, in a letter dated January 22, told PROP that it “has been unable to reach a decision on your petition because it raises significant issues requiring extensive review and analysis by agency officials.” The FDA did not say when it expects to make a decision.




The Painful Truth About Prescriptions
Has American medicine gotten too good at treating pain? The profession once took pain to be a positive sign of healing. As recently as 50 years ago, even patients recovering from surgery went without medicine to relieve the ache and discomfort. Today, when patients complain of pain, doctors listen and respond, and in many ways that’s a good thing. Read the rest of the story here.




The Last All-Nighter
The first time I took Adderall I didn’t think twice. It was 2007. I was in my last year at UCLA, where I had come down with a bad case of senioritis, and found myself cramming for finals. I bought it from a gangly kid with yellow skin and bags under his eyes who lived in the dorms. His hair was stringy. There were papers on the floor and piles of clothes on all the furniture in the room. Above his desk was a poster of John Belushi from “Animal House,” chugging a bottle of Jack Daniels and wearing a sweatshirt that read COLLEGE. The rest of the story can be accessed here.




Thomas McLellan explains how Affordable Care Act will transform substance abuse treatment
Thomas McLellan, a Pennsylvania researcher who spent a year as President Barack Obama's deputy drug czar, predicted Friday that the Affordable Care Act will "transform" substance abuse treatment and lower health care costs, He spoke to 300 doctors, nurses, therapists and other health professionals at the annual Jon Nadherny/Calciano Memorial Youth Symposium at the Cocoanut Grove. A veteran addiction treatment researcher, he went to Washington after one of his sons died of an overdose of anti-anxiety medications and alcohol. He wrote the requirement for mental health and substance-use disorder services to be "essential," with the federal government picking up the tab for prevention. Please click here to read the rest of the story.




Limiting Access to Alcohol Reduces Violence
UC Riverside sociologists co-author book that advocates new approach to solving community violence

Alcohol plays a powerful role in U.S. social and cultural life — and has since colonial times — despite decades of research documenting it as more dangerous and physically destructive than heroin and cocaine, and a significant factor in violent crime. In a book published this month, “Alcohol and Violence: The Nature of the Relationship and the Promise of Prevention” (Lexington Books), University of California, Riverside sociologist Robert Nash Parker says that amending existing laws or adopting additional regulations to limit the availability of alcohol — a practice known as environmental prevention — would reduce community violence. So why would policymakers and politicians balk at such efforts? The rest of this article is available here.




Alcohol is Third Leading Cause of Global Disease and Injury, Study Finds
Alcohol is the third leading cause of disease and injury worldwide, even though the majority of adults do not drink, a new study concludes. Just over 40 percent of the world’s adult population consumes alcohol, said researchers at the Center for Addiction and Mental Health in Toronto, Canada. They noted alcohol causes liver cirrhosis and leads to traffic accidents, and has also been linked to several types of cancer, including female breast cancer. “Alcohol consumption has been found to cause more than 200 different diseases and injuries,” lead author Kevin Shield noted in a news release. Only high blood pressure and tobacco smoking caused more disease and injury, the study found. The researchers discovered wide regional variations in drinking patterns, MedicalXpress reports. For instance, drinkers in Europe and parts of sub-Saharan Africa consume the most alcohol, on average. People in southern sub-Saharan Africa frequently drink large quantities, drink until they become intoxicated, engage in prolonged binges, and drink mainly outside of meals. Drinking is lightest in North Africa, the Middle East and South Asia, the study found. North Americans drink more than 50 percent above the worldwide average, and binge drink more than people in Europe. Almost 30 percent of alcohol consumed in 2005 was “unrecorded,” meaning it was not meant for consumption, was home-brewed, or illegally produced. “The amount of unrecorded alcohol consumed is a particular problem, as its consumption is not impacted by public health alcohol policies, such as taxation, which can moderate consumption,” co-author Dr. J├╝rgen Rehm said. The study appears in the journal Addiction.



5 Things Parents Do That May Encourage Teen Substance Abuse
When a teenager starts using drugs, the finger-pointing begins. The first to get blamed is usually a parent, followed perhaps by a bad influence at school, an older sibling or a high-pressure coach or teacher. While there's no place for blame -- it's counterproductive and in most cases, misplaced -- there is room for understanding. Well-meaning parents sometimes do things that unwittingly encourage their teens to experiment with drugs and alcohol. Is there room for improvement in your parenting practices? Please click here to read the rest of this blog.



Study Examines New Treatment for Marijuana Dependence
A new potential treatment for marijuana dependence, and the success of network therapy, which engages family and friends in a patient’s substance abuse treatment, were two of the topics discussed at the recent annual meeting of the New York Society of Addiction Medicine. This is the second of a two-part report on the meeting, “Addiction Medicine 2013: Emerging Problems, Current Treatment.”Rest of the article is here.



Alcohol dependence pill approved in EU
Danish drug maker Lundbeck has been granted European marketing approval for Selincro (nalmefene) tablets to treat alcohol dependence. ‘Selincro represents the first major innovation in the treatment of alcohol dependence in many years,’ said Lundbeck executive vice president Anders Gersel Pedersen. ‘The approval of Selincro is exciting news for the many patients with alcohol dependence who otherwise may not seek treatment.’ The company expects to launch the product in mid-2013. According to Lundbeck, more than 90% of the 14 million patients with alcohol dependence in Europe are currently untreated. Nalmefene is an opioid receptor antagonist - it is designed to bind to the receptor and effectively deactivate it so that it cannot be triggered by the natural opioids produced during drinking. It is intended for use on an ‘as needed’ basis, with one tablet taken each day when the patient feels a risk of drinking. Nalmefene is similar in structure and reactivity to another drug, naltrexone, which has been marketed for treatment of alcohol problems for several years.




The Competition Drug
THIS is America’s college town par excellence. Kids from all over the world flock to Boston to learn. I have a son who is a freshman here. Last autumn, as he entered school, I listened to warnings about the dangers of binge drinking. I think they missed the point.  The real epidemic involves so-called smart drugs, particularly Adderall, an amphetamine prescribed for attention deficit hyperactivity disorder (A.D.H.D.) but so freely available as to be the pill to take whenever academic pressure requires pulling an all-nighter with zero procrastination to get a paper done. Click here to read the rest of this NY Times op-ed.




The Brain Adds New Cells During Puberty To Help Navigate The Complex Social World Of Adulthood

Two Michigan State University neuroscientists report in the current issue of the Proceedings of the National Academy of Sciences.  Scientists used to think the brain cells you're born with are all you get. After studies revealed the birth of new brain cells in adults, conventional wisdom held that such growth was limited to two brain regions associated with memory and smell. The rest of the article is here.



Advocacy Group: Push for Peer Recovery Support Services in Essential Health Benefits
Recovery groups should advocate for inclusion of peer recovery support services as part of essential health benefits that will be covered under the Affordable Care Act (ACA), according to Faces & Voices of Recovery. Peer recovery support services are delivered by individuals who have “lived experience” with addiction and recovery. Faces & Voices of Recovery, an advocacy group, has produced an issue brief that explains how recovery advocates can support inclusion of these non-clinical services that help people achieve long-term recovery from addiction. The ACA requires states to set up state health insurance exchanges, which will act like marketplaces, where each person can choose a plan that suits them. Through these exchanges, states must offer a core of what are called essential health benefits–services that will be reimbursed or covered by the new exchanges. Services for mental and substance use disorders must be included.  Each state can decide what specific services will be offered. If peer recovery support services are offered as an essential health benefit, they will be covered by insurance or Medicaid, and organizations that provide the services will be reimbursed for providing the services. According to Faces & Voices of Recovery, scientific evidence is growing to support the beneficial effects of peer recovery support services. To find out more about how you and your organization can advocate for inclusion of peer recovery support services, visit the Faces & Voices of Recovery website.



Positive Results for Pre-Employment Drug Testing Rose 5.7% in First Half of 2012
Positive pre-employment urine drug screening in the United States rose 5.7 percent in the first half of 2012, compared with all of 2011, according to a survey by Quest Diagnostics, a medical lab research company. In contrast, the positive rate from random drug testing in the general workforce decreased 5.8 percent, The Huffington Post reports. “Employers are having some difficulty finding employees who can pass their drug tests,” said Dr. Barry Sample, Director of Science and Technology for Quest. The drug most commonly used by job applicants continues to be marijuana, followed by amphetamines. The survey found 2 percent of the 3.4 million urine drug tests were positive for marijuana, compared with 0.86 percent for amphetamines. Dr. Sample said the company found no correlation between states that have decriminalized or legalized marijuana, and positivity rates for pre-employment drug tests.



Drug Testing of Middle-School Students May Help Prevent Substance Abuse: Study
Random drug testing of middle-school students may help prevent substance abuse, a six-year study of New Jersey students suggests. Students who were randomly tested for drugs were less likely to use them in later years, according to the study, conducted by the Partnership for a Drug-Free New Jersey and Fairleigh Dickinson University. The researchers found drug use by students in grades 6-8 is relatively rare, Newsworks reports. The study found that only about 1 percent of 8th graders say they have ever used illicit drugs, and only about 14 percent indicate that they have ever drunk alcohol, other than in circumstances where it’s allowed, such as religious ceremonies. Among students who were tested for drugs and alcohol, 6 percent said they had ever consumed alcohol. Lead researcher Dan Cassino said when middle-school students are tested for drugs, they realize drug use can get them in trouble. He noted expanding random drug testing, while it might be effective, would be costly. “We still see a spike around the junior year of high school,” Cassino said. “Once the kids get a car and get a job, all bets are off, and the rates of drug and alcohol use go through the roof; but that spike is much smaller among students who actually were randomly drug tested at some point.” “These results show that student drug testing changes the environment of the school community and show they serve as an effective prevention strategy for the abuse of drugs and alcohol in their future,” Angelo M. Valente, Executive Director of the Partnership for a Drug-Free New Jersey, said in a news release. “This study proves random drug testing in New Jersey middle schools helps prevent substance abuse.”



The Secret Under Your Addiction
Many people suffer from addictions. The usual problem makers include alcohol, street drugs such as heroin, cocaine, crack, and methamphetamine. Prescription drugs compete with street drugs and these include all of the oxy’s, as in oxycodone, as well as the hydro’s, as in hydrocodone. Addictions are stubborn and they are maintained because the desired effects work. People who have addictions are not a sub-class of human beings. They are your brother, sister, mother, father, friend, co-worker, boss, neighbor, postal worker, grocery clerk, school teacher, and physician. Every occupational group has individuals within those groups for which addictions have become an issue. After a point employment may cease or become interrupted due to the use of the drug or the inevitable legal consequences for which addictions are known or by death. Rest of the blog is here.