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Friday, February 21, 2014

ATOD & Advocacy Recap - Week ending February 21, 2014

Driving Under the Influence, of Marijuana
If you are pulled over on suspicion of drunken driving, the police officer is likely to ask you to complete three tasks: Follow a pen with your eyes while the officer moves it back and forth; get out of the car and walk nine steps, heel to toe, turn on one foot and go back; and stand on one leg for 30 seconds. Score well on all three of these Olympic events, and there’s a very good chance that you are not drunk. This so-called standard field sobriety test has been shown to catch 88 percent of drivers under the influence of alcohol. But it is nowhere near as good at spotting a stoned driver. Click here to continue reading.

Banks Receive Federal Guidelines on Business Transactions from Legal Marijuana
The Obama administration has provided banks with federal guidelines for conducting banking transactions with legal marijuana sellers, enabling a legalized marijuana industry to operate in states that approve it. Guidance issued last Friday by the Justice and Treasury departments is the latest step by the federal government to make banks feel more comfortable working with marijuana businesses that are licensed and regulated, reports The Intelligencer / Wheeling News-Register. Currently, processing money from marijuana sales puts federally insured banks at risk of being charged with drug racketeering, so many banks have refused to open accounts for marijuana-related businesses. But legal marijuana sellers that are barred from utilizing banks cannot safely deposit cash, leaving them vulnerable to criminals and robbery. Also, state governments that allow marijuana sales want a channel to properly receive taxes from legal marijuana businesses. In response to the federal guidelines, the American Bankers Association said “guidance or regulation doesn’t alter the underlying challenge for banks. As it stands, possession or distribution of marijuana violates federal law, and banks that provide support for those activities face the risk of prosecution and assorted sanctions.” As the marijuana movement continues to gain momentum and more states move to legalize marijuana across the country, more banks will be forced to contend with this issue.

Heroin Addicts Seeking Treatment Face Insurance Roadblocks
As heroin use escalates across the U.S., addicts and their loved ones who are seeking treatment face a lack of services and strict constraints placed by insurance companies, according to health care and addiction professionals. Specialists say before insurance companies agree to cover inpatient services they require evidence that the addicted patient has tried one or more outpatient programs. Some insurance companies also demand proof that the individual has little or no outside support network, has already failed at a less expensive treatment facility or has a health condition that makes treatment a medical necessity, the Courier Post Reports. The demand for treatment is also quickly outpacing the available supply for help, often leaving those who are struggling with a heroin addiction without the services they need to be on a path to recovery. A study released late last year by the Substance Abuse and Mental Health Services Administration shows that while use of other drugs like methamphetamine is decreasing, heroin use continues to rise across the nation.

Fight Over Health Risk Warnings for Generic Drugs
Generic drug makers are fighting proposed FDA regulation that would require them to warn patients of each drug’s health risks. The Los Angeles Times reports that this regulation would also close a legal loophole and allow patients to sue not only brand-name drug manufacturers, but also generic drug makers. In 2009, the Supreme Court made a sharp distinction between brand-name drugs and lower-cost generics, the latter making up the majority of mediations that Americans buy. The court ruled that brand-name drug makers could be sued if they failed to warn patients that a drug carried a potential health risk. That decision upheld a $7-million jury verdict for a patient whose lower arm was amputated after she was injected with an anti-nausea drug made by Wyeth. A health risk of that drug was gangrene if injected into an artery. On the other hand, the high court dismissed a recent case with a generic drug that had also caused side effects that included disfigurement, burns and near-blindness. Justice Clarence Thomas reasoned that because federal regulations say generics must be exact copies of the approved brand-name drugs, their makers cannot revise or update warning labels when new risks come to light. He added that they cannot be sued for failing to warn consumers. In order to fix this problem, the FDA proposed in November to allow generic makers to change their warning labels when reports of new problems arise. The agency cited a need for them to be able to “independently update product labeling to reflect certain newly acquired safety information,” and also to have “independent responsibility to ensure its product labeling is accurate and up-to-date.” According to Ralph G. Neas, president of the Generic Pharmaceutical Association, this regulation “would be nothing short of catastrophic.” He claims it could raise health care costs and “create dangerous confusion” for doctors and patients. Generics have lowered many Americans’ health care costs, according to Neas, and he plans to fight the FDA with a national public education campaign. Meanwhile, the drug companies that manufacture the painkillers OxyContin and Opana are trying to block generic drug makers’ efforts to produce cheaper versions of the drugs. They argue these newer drugs will not have the tamper-resistant designs used in making the brand-name pills. The FDA’s original timing to complete the proposal has been postponed until March in response to complaints from the generic drug makers.

In fight against teen prescription drug abuse, one-two punch wins
Programs that aim to curb teen prescription drug abuse have vastly differing effectiveness, ranging from big drops in drug abuse to no measurable effect, according to a new study of 11,000 teenagers by researchers at Duke and Pennsylvania State universities. The best results came from pairing a school-based program with a home-based intervention, resulting in a 10 percent decrease in abuse rates. By contrast, most school-based programs were ineffective when used by themselves, with just one exception.  Click here to continue reading.

Families Migrate West for Medical Marijuana
Colorado’s liberal marijuana laws and its market for a strain of marijuana called “Charlotte’s Web” has made it a destination for families whose children suffer with severe epilepsy, according to USA Today. In January, Colorado became the first state to allow recreational marijuana use for adults, and medical marijuana has been legal since 2000. An additional 19 states and Washington, D.C. also allow medical marijuana, but each state varies the diseases for which it is allowed. Realm of Caring, a Colorado Foundation, was started by the family that grows Charlotte’s Web. According to its executive director, the foundation has 100 patients whose families have moved to Colorado from 43 states and two countries. In total, the foundation has 200 children who are medical marijuana patients. The waiting list has more than 2,000 people. Charlotte’s Web is named after Charlotte Figi, the first child to try the strain two years ago. At that time, she suffered 60 seizures a day. Today, her parents say that she has none. It is taken in liquid form and is high in cannabidiol, an ingredient in marijuana considered to have medical applications. Cannabidiol is believed to act as a deterrent on parts of the brain that cause epileptic seizures. Organizations such as the Epilepsy Foundation and the American Epilepsy Society are conservative in their opinion. Families are not dissuaded from using medical marijuana, but are warned that there is not enough evidence to demonstrate safety and effectiveness. They urge patients to consult their doctor to determine what’s best for them. Adolescent substance abuse experts warn against using marijuana for any purpose, citing negative long-term effects on children, such as impaired brain function and addiction.

Kentucky Prescription Drug Abuse Law Has Unintended Consequences: Expert
Kentucky’s law designed to reduce prescription drug abuse has raised awareness about the problem, but has had some unintended consequences, according to an addiction medicine specialist in the state. The law, known as House Bill 1, was signed into law by Governor Steve Beshear in 2012. It requires that all pain clinics be licensed, specifies requirements for ownership and employment, and obliges Kentucky’s licensure board to develop regulations for pain clinics. It gives law enforcement easier access to the state’s prescription drug monitoring database. Doctors must examine patients, take full medical histories, screen for drug use, and check electronic prescription records before writing prescriptions for opioids, to make sure the patient isn’t “doctor shopping” to gain multiple prescriptions. The law also requires continuing medical education for doctors authorized to prescribe or dispense controlled substances relating to the use of the state prescription monitoring database, pain management, and addiction disorders. “HB1 has been very effective in calling attention to the problem of prescription drug abuse,” says Dr. William T. Fannin, who is board certified in addiction medicine, and has practiced family medicine in eastern Kentucky for more than 25 years. “Unfortunately, many physicians have decided not to prescribe opioids—it’s a knee-jerk reaction to the extra requirements of the law. What they are missing is that even if you decide not to prescribe painkillers, it doesn’t mean you won’t have any patients who are addicted.” Contrary to many doctors’ fears, using the state’s prescription drug monitoring database, known as KASPER (Kentucky All Schedule Prescription Electronic Reporting), is not burdensome, Dr. Fannin says. “There’s some confusion about how much time it will take. It’s a great system—it’s easy to use. It takes only about a minute to input the patient’s information, and only a few minutes to get an answer back. We check KASPER every time a patient comes in for the first time, is suspicious for illicit procurement, or comes in for refills. When a patient is scheduled, we do the screening the day before their appointment.” While the new law calls for continuing medical education for physicians who prescribe opioids, Dr. Fannin says it doesn’t go far enough. The training does not tell doctors what to do if a drug test comes back positive. “Doctors need advice on how often the drug screens should be done, for which patients, and what to do with the results,” he says. “The average physician isn’t trained or experienced on how to deal with a dirty drug screen, and some respond by kicking the patients out of their practice.” Most doctors didn’t get any focused training in medical school on pain management or addiction, he notes. “Whatever we learned was anecdotal, which we picked up through the doctors who trained us, and what we learned about pharmacology,” he says. “Doctors need more education so they can effectively treat pain and addiction.” Dr. Fannin’s experience with addiction is a deeply personal one. He became certified in addiction medicine six years ago, several years after his youngest son began struggling with addiction. He lost his son to an unintentional overdose in 2011. Dr. Fannin now treats between 200-250 patients in his substance abuse clinic. “The experience gave me empathy for my patients and their families. It changed many of my views on addiction. It is a disease that can be treated effectively. Experienced professionals and laypeople who deal with addiction know it’s not a smooth road to recovery. Recovery is a lifetime commitment—it can be a very rocky road.”

Addicted on Staten Island
Late last month, Corey Epstein, a peripheral cast member on the reality television series “Jerseylicious,” was arrested along with 20 others in a drug sweep on Staten Island that grew out of a 16-month investigation called Operation Silent Hill. Mr. Epstein was charged with selling three oxycodone pills to an undercover officer, in front of his house on Nehring Avenue in New Springville, an area that had been largely rural until the 1970s, when malls and what has since become the vernacular architectural style of Staten Island — the deep-backed, two-family split level with a high, occasionally baroque stoop — imbued it and so much of Staten Island with a sense of inanimate prosperity. Click here to continue reading.

Advocates’ Calls for Tougher Rx Pain Meds Resisted
Advocates say the need to curb the abuse of prescription (Rx) opiates is more urgent than ever, due to a growing epidemic of Rx overdoses from pain medication in Massachusetts and across the country, according The Boston Globe. The abuse of prescription painkillers is heavily linked to heroin abuse and the pharmaceutical industry has developed pills that are strongly resistant to being crushed, and are therefore difficult for addicts to abuse. But industry battles over patents, concerns over waning profit margins and federal bureaucracy have kept such abuse-resistant pills from being widely available in the market. Currently the federal Food and Drug Administration allows only one painkiller – an expensive reformulation of the brand-name OxyContin – to be marketed as abuse-resistant. Meanwhile, other opiate medications that are widely prescribed, and well-known to abusers, are still easily pounded into powder form and can be snorted or dissolved for injection. Detective Sergeant Charles Peterson of the Yarmouth Police Department, a 20-year veteran of narcotics enforcement, is among the supporters of proposals in Congress to require that drug companies market only abuse-resistant versions of oxycodone and other prescription opiate pain-relief pills. “Do we look at public safety, or do we look at profit?” said Peterson. He added that any opiate addiction, “could have been prevented through either regulation of the pharmaceutical industry or restructuring of the opiate-based drugs themselves. They’re not going to go anywhere that would affect their bottom line unless they get pushed that way.” A recent report from the DEA called prescription drug abuse one of the nation’s fastest-growing drug problems.

Heavy Drinkers Found to Reduce Drinking with Anti-Epilepsy Drug
New research shows that an anti-epilepsy drug may help heavy drinkers reduce their alcohol consumption, says HealthDay. In a study that included 138 heavy drinkers, one half took the drug topiramate (Topamax) for 12 weeks at a maximum dose of 200 milligrams a day. The other half were given an inactive placebo. Both groups had brief counseling to help them decrease their drinking. At the end of the 12-week study, placebo group patients were five times more likely to have had a heavy drinking day than those in the Topamax group. Also, compared to the placebo group, more than twice as many patients who took the drug had no heavy drinking days during the last four weeks of the study. In a press release from the University of Pennsylvania, the study’s lead author, Henry R. Kranzler, MD, professor of Psychiatry, director of Penn’s Center for Studies of Addiction, says that the results represent an important next step in understanding and treating problem drinking. He added, “Our study is the first we are aware of in which topiramate was evaluated as a treatment option for patients who want to limit their drinking to safe levels, rather than stop drinking altogether.” Researchers suggest that this could help lead to personalized treatments for heavy drinkers, as well as additional research to support patients who struggle with heavy drinking.

Sick, injured or merely different? Rising ADHD cases fuel running battle among mental health experts
In second grade, Paul couldn’t stay in his seat — and his rigorous South Florida private school had lots of seat work. After counseling with the principal, a series of visits to therapist followed. They probed issues from allergies to home stability before concluding that Paul, who is now 13, had attention deficit hyperactivity disorder. While the family scrambled to learn more, the school tried to adapt. But there was no way Paul could stay at a desk for 40 minutes. He was soon struggling with reading comprehension, and his parents and teachers feared he would be left behind. Click here to continue reading.

Fraternities Exposé -- Alcohol, Assault and Lawyering Up
Caitlin Flanagan has done it again. In her cover story for the March issue of The Atlantic, one of America's finest writers takes on one of the most heavily fortressed bastions of the American male -- the college fraternity -- and Flanagan most assuredly scores some direct hits. This year-long investigation into a host of lawsuits involving injury, sexual assault and death reveals that fraternities are not only more powerful than the colleges and universities that host them, but are especially adept at shifting blame, disavowing members and leaving the parents (and often their homeowner insurance policies) holding the bag. Click here to continue reading.

Regulation, Suboxone Clinics & Unintended Consequences Re: Prescription Drug Abuse and the Affordable Care Act
As we all know, prescription drug abuse is a significant problem in Kentucky; so significant that the Kentucky Legislature enacted the toughest and most cumbersome requirements for prescribing controlled substances in the United States.  By authorizing the Kentucky Board of Medical Licensure (“KBML”) to promulgate additional standards for prescribing through its regulatory process, Kentucky’s physicians have become the most regulated and policed of any in the country and probably the entire Western Hemisphere.  In 2013, the number of Kentucky deaths from overdoses of controlled substances actually declined for the first time in many years.  Some have suggested that the decline is a direct result of the stringent prescribing regulations, but this is pure speculation. Click here to continue reading.

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