ATOD Recap for Week-Ending September 28

Commentary: Prescription Drug Abuse and the Future of America

By R. Gil Kerlikowske |

Last month, I visited a fellow Medicine Abuse Project partner—Project Lazarus—an organization on the forefront of combating the prescription drug abuse problem. Project Lazarus is located in Wilkes County, North Carolina, an area of the country that has borne a disproportionately large part of the burden caused by medicine abuse. While there, I met a group of dedicated people working hard to reduce medicine abuse in the area and across the country—doctors, leaders and law enforcement officers. I have great admiration and respect for all of the people I met at Project Lazarus, but one individual in particular stood out for me.

Donna Reeves is a mother from North Carolina who tragically lost her daughter to a drug overdose in 2006. She spoke of the importance of involving a diverse range of people in the conversation about prescription drug abuse—emphasizing that this problem doesn’t just affect one demographic, but all age groups across the geographic and socio-economic spectrum. Perhaps most importantly, Donna highlighted the urgent need to educate parents on the signs of drug abuse, the tools available to help young people seek treatment and the existence of a life-saving overdose reversal drug, Naloxone. Donna’s message was heartbreaking, but it’s one we must hear: education is one of the most powerful ways to prevent drug abuse.

The Centers for Disease Control and Prevention classify prescription drug abuse as an epidemic. While there has been a marked decrease in the use of some illegal drugs like cocaine, data from the National Survey on Drug Use and Health (NSDUH) show that approximately one-fourth of people aged 12 and over who used drugs for the first time in 2010 began by using a prescription drug non-medically.

Alarmingly, the majority of new or occasional nonmedical users of pain relievers obtained the drug from family or friends for free or took them without asking. Chronic users were more likely to obtain the drugs from doctors or by buying them. What can we learn from this? We know that securing medicine in the home—and disposing of unneeded pills—can help prevent medicine abuse from ever beginning.

Securing medicines in the home and disposing of medicine properly is an important part of the solution, but it must be accompanied by prescription drug monitoring programs in every state, law enforcement efforts to thwart improper prescribing practices and, of course, education for parents, prescribers and patients.

If you have unneeded medicine in the home, please take advantage of National Prescription Drug Take-Back Day on September 29th, when the Drug Enforcement Administration will open sites across the country to receive unused prescription drugs—no questions asked. If you’re a parent, please take the time to talk to your children about the harm caused by medicine abuse, and educate yourself on the signs of abuse. Working together, we can build a better future for our country’s young people—free of the pain caused by medicine abuse.

Gil Kerlikowske, Director of National Drug Control Policy

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Report: Prescription Drug Monitoring Programs Need to be More Proactive

State prescription drug monitoring programs need to shift from a reactive approach to a proactive one, according to a new report by the Prescription Drug Monitoring Program Center of Excellence at Brandeis University. Brandeis experts assessed state prescription drug monitoring programs, and concluded all states should follow best practices to improve their effectiveness, PsychCentral.com reports.

“Being proactive is the key to success in the fight against prescription painkiller abuse,” researcher John L. Eadie said in a news release. “While doctors may routinely collect and report data to a state program that signals where and when prescription painkillers are likely being misused, the program might not share that information with others who can best use it.”
Co-researcher Peter Kreiner added that state programs should analyze the data they collect, and reach out to doctors, pharmacists, law enforcement officials, insurers and others who can prevent prescription drugs from falling into the wrong hands. “Where this is already taking place, it has proven to be very effective,” he notes.

The report outlines some best practices that all states should follow. According to the report, states that collect prescribing data for all controlled substances, including anti-anxiety medication, report lower rates of “doctor shopping” than other states. In the three states that use state-issued prescription forms with uniquely configured page numbers, the rates of deadly painkiller overdoses rose more slowly. These forms are designed to reduce fraud.

The report recommends proactively sending alerts about possible abuse to doctors and pharmacists; this practice has been associated with decreased sales of prescriptions, and low rates of doctor shopping. Other recommendations include having law enforcement agencies analyze trend data, to identify “pill mills,” and increasing doctors’ participation in and use of prescription drug monitoring programs.

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Prescription Drug Overdoses May Contribute to Drop in Life Expectancy in Some Whites

An increase in prescription drug overdoses among young whites, and higher rates of smoking among less educated white women, may be contributing to the decline in life expectancy for white Americans with lower levels of education. The findings come from a report published in Health Affairs, which concludes that the life expectancy has fallen by four years since 1990 for the least-educated whites in the United States.

The study examined data from Americans without a high school diploma, The New York Times reports. In addition to prescription drug abuse and smoking, other possible reasons for the lifespan decrease include obesity, and an increase in the number of the least educated Americans without health insurance. The article notes that prescription drug overdoses have greatly increased since 1990, and have disproportionately affected whites, especially women. Smoking rates among both white and black women without a high school diploma have increased.

White women without a high school diploma lost five years of life on average between 1990 and 2008. By that year, the life expectancy for black women without a high school diploma had exceeded that of white women who had the same level of education. The study found white men without a high school diploma lost three years of life. In contrast, the life expectancy for both blacks and Hispanics with the same level of education increased. Overall, blacks do not live as long as whites; Hispanics live longer than both whites and blacks.

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Teens Can Buy Alcohol on eBay, Expose Reveals

Teenagers can purchase alcohol on eBay, according to an investigation by the news show “20/20.” The website prohibits the sale of all alcohol, except for some wines, but allows the sale of collectible alcohol containers, according to ABC News. The site’s alcohol policy states sellers of the containers “will take all appropriate steps to ensure that the buyer is of lawful age in the buyer’s and seller’s jurisdiction.”

The news show asked a 13-year-old to try to buy liquor on the website. He was able to place orders with two vendors. A third refused to sell his product without seeing a copy of an ID showing the buyer was of legal drinking age. After learning about the sales, eBay said it has taken action against the two vendors who sold the alcohol.

A study published in May found minors are often able to buy alcohol online, because many Internet alcohol sellers and shipping companies do not verify the buyer’s age. Researchers at the University of North Carolina at Chapel Hill recruited eight participants, ages 18 to 20, to try to buy wine, beer and other alcoholic beverages online. They were told to lie about their age when filling out order forms. If they were asked to verify their age by a delivery person, they were instructed to say they were not yet 21. Participants placed orders at 100 Internet websites, and most deliveries were made by FedEx or United Parcel Service. Of those orders, 45 were successfully made and received. Just 28 orders were rejected because the person placing the order was found to be a minor. The rest of the orders did not go through because there were technical difficulties, or because no one was home at the time of attempted delivery.

The researcher of that study, Rebecca Williams, told ABC News that it is unclear how many teens are using online retailers such as eBay to buy alcohol.

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Number of Young Adults Abusing Prescription Drugs is Declining: Report

A new government survey finds the number of young adults ages 18 to 25 who used prescription drugs for non-medical purposes in the past month declined 14 percent, from 2 million in 2010, to 1.7 million in 2011. Overall, the survey found a 12 percent decline in the number of Americans who abused prescription drugs.

The National Survey on Drug Use and Health (NSDUH) also found that non-medical use of prescription drugs among children ages 12 to 17, and adults 26 or older, remained unchanged.
According to the survey, rates of past-month drinking, binge drinking and heavy drinking among those who are underage, are all on the decline. Marijuana use is up slightly, from 5.8 percent in 2007, to 7 percent in 2011. Tobacco use among teens ages 12 to 17 is down.

“These results are encouraging, but we cannot afford to take our eyes off the ball. The abuse of painkillers in America continues to take too many lives, tear apart too many families, and place too much burden on communities across the nation,” said Gil Kerlikowske, Director of National Drug Control Policy. “The good news is that today’s findings prove yet again that we are not powerless against the problem of substance abuse in America.”

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Drug Tests Become More Common in Middle School

A growing number of middle schools are requiring that students submit to drug testing, The New York Times reports. Students are being asked to provide a urine sample to participate in sports, or even in extracurricular activities such as choir and drama. Some parents and civil liberties advocates are objecting to the tests, the article notes.

Middle schools that conduct drug tests are located in states including Alabama, Arkansas, Florida, Missouri, New Jersey, Ohio, Texas and West Virginia. Some school administrators, coaches and teachers said drug testing deters young students from substances of all kinds, including alcohol, marijuana and steroids. There are no known cases of middle school students testing positive for performance-enhancing drugs, and only a few positive results have been found for marijuana, the article notes.

“Drug testing is a multibillion-dollar industry,” Dr. Linn Goldberg, head of the Division of Health Promotion and Sports Medicine at the Oregon Health and Science University, told the newspaper. “They go to these schools and say it’s great. But do the schools actually look at the data? Schools don’t know what to do.” He added, “There’s little evidence these programs work. Drug testing has never been shown to have a deterrent effect.”

A 1995 United States Supreme Court ruling states that drug testing for high school athletes is constitutional. In most cases, outside drug testing companies conduct the tests. Students are given little or no notice about them. Specimens are sent to a lab, and families are notified if the result is positive. In some cases, schools require a second test to confirm the finding. Law enforcement generally is not notified if a test is positive. School punishments can range from a warning, to removal from a team or activity.

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Addiction Experts Push for More Medical Approaches to Treatment

Addiction experts are advocating for a more medical approach to addiction treatment, instead of relying on 12-step programs, according to the Los Angeles Times. In 2011, the American Society of Addiction Medicine, the largest professional society of doctors dedicated to treating and preventing addiction, released a new definition of addiction, calling it a chronic brain disorder, not just a behavior problem.

Last summer, the first group of medical residents started training in 10 newly accredited addiction medicine residencies around the country. In addition, more drugs to treat addiction are being studied, the article notes.

Gil Kerlikowske, Director of the Office of National Drug Control Policy, recently said in a speech that addiction “is not a moral failing on the part of the individual. It’s a chronic disease of the brain that can be treated.”

Only about one in 10 people who need treatment for addiction to drugs or alcohol receive it, according to a report released recently. Many who do receive treatment do not receive evidence-based care, according to the National Center on Addiction and Substance Abuse at Columbia University. The report noted that sold evidence is lacking on the effectiveness of 12-step programs.

“Drug abuse treatment developed outside mainstream medicine,” said Dr. Walter Ling, an addiction specialist at UCLA, told the newspaper. “We’re still suffering from that.”

Scientific research shows that addiction is a medical problem that affects the brain, according to the article. National Institute on Drug Abuse Chief Dr. Nora Volkow says new medicines to treat addiction will encourage doctors to treat their patients’ substance abuse problems, treating it as they would other chronic illnesses such as diabetes or high blood pressure. “You are killing two birds with one stone — giving tools to improve outcomes for the patient and giving tools to the physician, increasing the likelihood they will incorporate substance abuse disorders into their practice,” she said.

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Doctors Should Screen Adults for Alcohol Misuse, U.S. Panel Says Primary care MDs also urged to counsel risky drinkers

A U.S. government advisory panel recommends that primary care doctors ask patients about their drinking habits and provide counseling to those who misuse alcohol.  The U.S. Preventive Services Task Force found that screening and intervention can help adults aged 18 and up who drink more than the recommended amount of alcohol cut back. However, the panel concluded there was not enough research on people under 18 to recommend for or against screening and counseling.  The panel also recommended screening and intervention for pregnant women, although the evidence for effectiveness in this group was less strong than for the general population of adults.

The draft recommendations, released Monday, echo the task force's 2004 guidelines on alcohol screening.

"The overarching message is the same as it was back then. At least in the adult population, the evidence shows that clinicians can help men and women who are drinking in ways that are not healthy to change those habits," said Dr. Michael LeFevre, task force co-vice chair.

An estimated 30 percent of people in the United States misuse alcohol. Alcohol misuse, which includes binge drinking as well as alcohol dependence, is the third-leading cause of preventable deaths in the nation.  The U.S. National Institute on Alcohol Abuse and Alcoholism recommends that women and people older than 65 drink no more than three alcoholic drinks per day and no more than seven drinks per week, and that men limit their consumption to four alcoholic drinks per day and 14 drinks per week.

"My impression is that more primary care physicians are screening [for alcohol misuse] than in 2004," LeFevre said. However, the rates of misuse and dependence are about the same as eight years ago, added LeFevre, director of clinical services at the University of Missouri School of Medicine, in Columbia.

For the current recommendations, the task force looked at an analysis of 23 studies published between 1985 and 2012 on screening and behavioral counseling interventions among people who misuse alcohol. The analysis appears online Sept. 25 in the Annals of Internal Medicine.  Among the strongest pieces of evidence were studies that found that adults drank 3.6 fewer drinks a week one year after counseling, and that 12 percent fewer adults reported heavy drinking episodes one year after intervention.

"Even though we are relatively certain that there is benefit, the changes in behavior are not as dramatic as you might hope for," LeFevre said. There is also not a clear connection between decreased consumption and improved health, he added.

The analysis found no difference in the rates of disease or death among the adults who received screening and intervention, although some studies found that risky drinkers who got counseling spent less time in the hospital.

Dr. Domenic Ciraulo, psychiatrist-in-chief at Boston Medical Center who was not involved in the current recommendations, said he is in complete agreement with the task force findings.

However, while many primary care physicians already do some sort of alcohol screening, their accuracy depends on the person giving the test and the type of test, Ciraulo said.  One of the tests the task force recommends, called AUDIT, involves 10 multiple-choice questions about alcohol consumption and takes two to five minutes to complete.

"It can be given on paper or computer, and in the right environment, [doctors] can get pretty reliable results," Ciraulo said.

The task force also recommends screening with a single question: How many times in the past year have you had five or more drinks in a day? A lot of busy clinicians use it, LeFevre said.  But these questions can't really distinguish between the occasional binge drinker and people addicted to alcohol, so everyone will end up in counseling, LeFevre said.  Of course, unlike the occasional binge drinker, people addicted to alcohol will need more and longer therapy, Ciraulo said. And no matter where a patient falls on the spectrum, making sure that the doctor, or nurse or counselor who does the intervention is well-trained and has the right personality is key, Ciraulo added.  The task force found that the most effective amount of counseling for people who are risky drinkers is several sessions between six and 15 minutes each, whereas single visits under five minutes are less effective.  Although the panel reviewed different types of counseling, including stress management and action plans, it did not make specific recommendations.

The task force will accept comments about the recommendations until Oct. 22.

More information: The U.S. National Institute on Alcohol Abuse and Alcoholism has more about the health effects of alcohol.

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Newest Synthetic Drug to Cause Concern is Called “Smiles”

The latest synthetic drug to cause concern among law enforcement officials is called “Smiles,” or 2C-I, Fox News reports. The drug has been linked to the deaths of two North Dakota teens.
According to the Drug Enforcement Administration (DEA), 2C-I is abused for its hallucinogenic effects. It is taken orally in tablet or capsule form, or snorted in its powder form. “2C-I is used by the same population as those using Ecstasy and other club drugs, high school and college students, and other young adults in dance and nightlife settings,” the DEA reports. The drug is chemically similar to the drug 2C-B, which is a Schedule I hallucinogen. This means it is illegal to manufacture, buy, sell or possess the drug. The DEA states 2C-I can be treated on a case-by-case basis as if it were a Schedule I controlled substance, if it is distributed with the intention for human consumption.

A 17-year-old North Dakota teen took 2C-I mixed with melted chocolate, according to the news report. He began hyperventilating, and hit his head on the ground. Several hours later, he stopped breathing and died. The previous evening, an 18-year-old was found dead in the same town, from a similar overdose. The drug can cause nausea and vomiting, as well as terrifying hallucinations and feelings of panic and fear, the article notes.

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Generic Drug Company Recalls Pain Medicine With Hydrocodone

Generic drug company Watson Pharmaceuticals announced it is recalling two lots of a drug that contains hydrocodone and acetaminophen. The pills may contain doses of the medicines that are higher than intended, Reuters reports. The voluntary recall follows a patient complaint that the pills were darker and thicker than usual. The recalled pills are supposed to contain 10 milligrams of hydrocodone and 500 milligrams of acetaminophen.

Too much hydrocodone can lead to sedation and breathing problems. Too much acetaminophen can cause liver damage, especially in patients who are taking other products containing acetaminophen, as well as patients with existing liver problems and those who have more than three alcoholic drinks a day.

In a news release, Watson said no reports of injuries related to the recalled products have been received to date.

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Thus Far in 2012 More Than One-Half of U.S. States Have Had Media Reports of Buprenorphine Misuse or Diversion

There were a total of 186 media reports of buprenorphine misuse or diversion from January 1 to August 31, 2012, according to an update of an informal analysis first conducted by CESAR in 2011. The most common types of media reports were of persons possessing (56%) or selling (25%) buprenorphine, often along with other drugs such as prescription opioids and benzodiazepines, marijuana, heroin, and cocaine.

There were also reports of smuggling into correctional institutions (14%), diversion by theft and fraud (8%), and use by children (3%). More than one-third (35%) of the media reports involved other drugs and approximately one-fifth (19%) involved other crimes, including trafficking of other drugs, burglary, and robbery.

Massachusetts had the highest number of media reports (39), followed by New York (24), Maine (19), Pennsylvania (15), Kentucky (14), and New Hampshire (14).

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Bans on Smoking in Bars May Reduce Alcohol Abuse, Study Suggests

Laws that ban smoking in bars and restaurants may reduce alcohol abuse, a new study suggests. Researchers found people identified as problem drinkers who live in states with smoking bans have a higher rate of remission, compared with problem drinkers who live in states without laws that ban public smoking. Currently, 29 states have enacted public smoking bans in bars or restaurants, according to HealthCanal.com.

“Smokers are three times more likely to abuse alcohol or meet criteria for dependence,” Yale University researcher Sherry McKee said in a news release. “We wanted to see if separating smoking and drinking changed drinking behavior. It does.”

The researchers used data from the National Epidemiological Survey on Alcohol and Related Conditions to compare remission rates of people with alcohol use disorder in states that enacted smoking bans during the study period, to people who lived in states without bans between 2001-2002 and 2004-2005. They found in states with no smoking bans, half of those with an alcohol use disorder experienced remission. The rate of remission in states with smoking bans was 61 percent.

The study appears in the journal Drug and Alcohol Dependence.

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University of Shmacked

By JENNIFER CONLIN, NY Times

THE first “I’m Shmacked” college video appeared a year ago. Featuring Temple University students bubbling up a bong, throwing back shots and eating pizza before a hip-hop concert in Philadelphia, it gave viewers a rare glimpse inside at least one part of that school’s social life, a college culture that obviously includes, not too surprisingly, drugs, drinking and dancing.  Since then, Jeffrie Ray, 19, who is on leave from the School of Visual Arts in Manhattan, and his partner, Arya Toufanian, a 20-year-old junior at George Washington University, have produced 23 more “I’m Shmacked” YouTube college party videos from campuses as varied as Tulane, Syracuse and N.Y.U. to Penn State and Ithaca College. 

Their popularity is evident from the stats on their “I’m Shmacked” Facebook page — over 46,000 likes — and on YouTube — more than 500,000 views alone on the West Virginia University video (which highlights among other antics, students smashing car windows, in between beer bongs, as part of a St. Patrick’s Day charity party). 

A lot is packed into these three- to four-minute clips set to a wide variety of music. And it is not just girls making out (there is a lot of that), guys pouring booze over one another’s heads (and balconies), and students doing flattering albeit somewhat profane shout-outs for their college or university. Woven into the scenes of debauchery are bucolic shots of the campus with flags waving in the breeze, the football stadiums or hockey arenas filled with athletes and cheerleaders, and the local university swag shops. 

“I think we are doing something positive for the schools: I have had about 30 kids say they ended up at a school because of my video,” said Mr. Ray, who is known as Yofray and who plans to finish filming “parties” at the end of this school year (he is recording video of a different campus each week), when he will move onto other campus scenes. “I want to gather videos of the sports and academic life to make them into a longer film. The students at these schools also work hard, and I want to show that, too,” he said, adding that he plans to interview professors and students about their institution’s more serious sides. 

“Kids don’t want to read anymore,” said Mr. Toufanian, referring to college brochures. “Seeing a video is a much more fun way to learn about a school.” Mr. Toufanian, the business side of the duo (Mr. Ray is the videographer), has secured a two-year contract with DGI Management in New York that he hopes will help the “I’m Shmacked” brand move into other platforms, with books being one. 

But not everyone sees these college videos as slightly wacky promotional tools. Just ask students and administrators at the University of Michigan, which early this month was “Shmacked” (a contrived word from Mr. Ray’s high school in Pennsylvania) for the second time (the first being last November), during “Welcome Week.” 

 “I was horrified when I saw it,” said Melanie Kruvelis, a junior who wrote an opinion article in The Michigan Daily student newspaper that went on to say the word “shmacked” must be “Yiddish for getting drunk and throwing away the futures we don’t have.” 

To Ms. Kruvelis, who has seen students desperately take down Facebook images before their first job interview, getting caught on a video “for 30 seconds you might not even remember after shotgunning a beer” seems stupid. “It’s not my parents’ age when you could hide the party photos in a drawer,” she added. “To do this on a video that can go viral, you must have a train-wreck mentality.”  Mary Jo Desprez, the administrator at the collegiate recovery program at Michigan, which helps students who have alcohol and substance issues stay sober, agrees. “These kinds of images of partying in college limit students’ imagination of what fun can be without drugs and drinking,” she said. “It glorifies alcohol, especially as they are not just sitting casually around a keg but pouring bottles of vodka down their throat. We need to have a more complicated conversation about this on campuses, even though this is only about 1,000 of our 27,000 students partying like this, because it can resonate.”

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Critics of ballot initiatives to legalize recreational marijuana in Oregon, California and Colorado are focusing on mothers, according to Reuters.
Opponents are using grassroots meetings to try to convince parents to vote against the measures. “If people tell you it’s not a gateway drug – it’s baloney,” Colorado state Representative Kathleen Conti said at a recent gathering of parents and other residents.
“Talking about the impact to kids is critical and crucial to our success,” says Roger Sherman, who is leading Colorado’s anti-legalization campaign. “Suburban women are one of our strongest core constituencies for our campaign.” Anti-legalization groups are talking about the risk to youths, although the measures would not allow marijuana sales to teenagers. The article notes there is conflicting data on whether making marijuana legal for adults would lead to increased use by teens.

Colorado’s teachers union came out against the measure, saying it would hurt students. The main group backing the measure in Colorado, called the Campaign to Regulate Marijuana Like Alcohol, says that when marijuana is sold underground, it is entirely uncontrolled. Mason Tvert, the group’s co-director, called it the “worst possible policy” for protecting teenagers.
Polls suggest there is substantial voter support for initiatives in Colorado and Washington that would allow recreational use of marijuana. Voters in Oregon are split.

All of the measures would legalize the possession of small amounts of marijuana for anyone over age 21, and would allow taxable retail sales of the drug. The measures would conflict with federal law, which outlaws marijuana. The governors of all three states are opposed to the measures.

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Current Tobacco Use among Adults in the United States: Findings from the National Adult Tobacco Survey

A new report was released online and will later appear in the November issue of the American Journal of Public Health. The report assesses use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes among U.S. adults. Data were obtained from the 2009 –2010 National Adult Tobacco Survey. The article also includes state prevalence estimates for use of cigarettes and any tobacco.

The report concludes that tobacco use varies by geography and sociodemographic factors, but remains prevalent among U.S. adults and shows the continuing need for evidence-based strategies that are proven to reduce all forms of tobacco use. Report authors note that evidence-based strategies, such as tobacco price increases, media campaigns, and smoke-free policies, in concert with full access to clinical cessation interventions, have been shown to decrease tobacco use and reduce the health burden and economic impact of tobacco-related diseases in the United States.

Key findings include:

• Findings indicate that approximately 1 in 4 US adults was a current tobacco user during 2009–2010.
• The report finds tobacco use is most prevalent among Americans with less education, less income and those who are lesbian, gay, bisexual, or transgender. 
• By race/ethnicity, prevalence of any tobacco use ranged from 10.9 percent among non-Hispanic Asians to 37.2 percent among non-Hispanic others (i.e., America)
•  Young adults aged 18 – 24 had the highest prevalence of tobacco use and prevalence among men was nearly double that of women. 
• Prevalence of any tobacco use ranged from 14.1 percent in Utah to 37.4 percent in Kentucky.

An abstract of the article is available on the journal’s website at http://ajph.aphapublications.org/.

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Report Finds African-American Youth Exposed to More Magazine and Television Alcohol Advertising than Youth, in General

African-American youth ages 12-20 are seeing more advertisements for alcohol in magazines and on TV compared with all youth ages 12-20, according to a new report from the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health.

The report is available on CAMY’s website, www.camy.org.

The report analyzes alcohol exposure by type and brand among African-American youth in comparison to all youth. It also assesses exposure of African-American youth to alcohol advertising relative to African-American adults across various media venues using the most recent year(s) of data available.

Alcohol is the most widely used drug among African-American youth, and is associated with violence, motor vehicle crashes and the spread of sexually transmitted diseases. At least 14 studies have found that the more young people are exposed to alcohol advertising and marketing, the more likely they are to drink, or if they are already drinking, to drink more.

“The report’s central finding—that African-American youth are being over-exposed to alcohol advertising—is a result of two key phenomena,” said author David Jernigan, PhD, the director of CAMY. “First, brands are specifically targeting African-American audiences and, secondly, African-American media habits make them more vulnerable to alcohol advertising in general because of higher levels of media consumption. As a result, there should be a commitment from alcohol marketers to cut exposure to this high-risk population.”

The report finds certain brands; channels and formats overexpose African-American youth to alcohol advertisements:

• Magazines: African-American youth saw 32 percent more alcohol advertising than all youth in national magazines during 2008. Five publications with high African-American youth readership generated at least twice as much exposure to African-American youth compared to all youth: Jet (440 percent more), Essence (435 percent more), Ebony (426 percent more), Black Enterprise (421 percent more), and Vibe (328 percent more).
• Five brands of alcohol overexposed African-American youth compared to all youth and to African-American adults: Seagram’s Twisted Gin, Seagram’s Extra Dry Gin, Jacques Cardin Cognac, 1800 Silver Tequila, and Hennessey Cognacs.
• Television: African-American youth were exposed to 17 percent more advertising per capita than all youth in 2009, including 20 percent more exposure to distilled spirits advertising. Several networks generated at least twice as much African-American youth exposure to alcohol advertising than all youth: TV One (453 percent more), BET (344 percent more), SoapNet (299 percent more), CNN (130 percent more) and TNT (122 percent more). 
• Radio: African-American youth heard 26 percent less advertising in 2009 for alcohol than all youth on stations with the most advanced measurement data available; however, they heard 32 percent more radio advertising for distilled spirits. In these markets, four station formats delivered more alcohol advertising exposure to African-American youth than to African-American adults: Contemporary Hit/Rhythmic (104 percent more), Contemporary Hit/Pop (14 percent more), Urban (13 percent more) and Hot Adult Contemporary (43 percent more).

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Some Pain Sufferers Struggle to Get Medicine as States Enact Opioid Restrictions

As a growing number of states enact restrictions designed to clamp down on prescription drug abuse, some pain sufferers say they are not able to get the opioids they need, The Wall Street Journal reports. The issue has pitted drug enforcement and public health officials against some doctors and their patients who are legitimately prescribed pain medicine, according to the article.
Some doctors have stopped writing prescriptions for opioids in reaction to state laws that make physicians criminally liable for writing prescriptions for painkillers that lead to overdoses. In some states, regulations of pain clinics have forced “pill mills” to close, leaving people who need pain medication with fewer prescribers. Pain patients seeking medication call their search for medication “the pharmacy crawl,” the newspaper notes.

Some pharmacies in Florida have stopped carrying opioids, or can’t obtain them from wholesalers, after the Drug Enforcement Administration closed part of a Walgreen’s distribution center earlier this month because the agency said some painkillers were ending up on the black market. Pain clinics in Texas that write more than half their prescriptions for painkillers must register with the state’s medical board. After that requirement was enacted two years ago, some pain clinic operators unsuccessfully tried to get around the law by marketing themselves as diet centers or wellness clinics. Now, some of these clinics are demanding that customers bring people with them to buy other kinds of medications, to help keep the facilities from rising above the 50 percent threshold for reporting painkiller prescriptions.

This week, the National Alliance for Model Drug Laws, a nonprofit that helps states create laws to prevent prescription drug abuse, is meeting to talk about how to balance the fight against improper opioid prescribing, with maintaining patients’ access to needed pain medication.

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Medicare Regularly Refills Pain Pills Without New Prescriptions: Government Report

A new government report finds that Medicare routinely refills pain medications without new prescriptions that are required by federal law.

The report found 75 percent of contractors who processed prescriptions for the Medicare Part D program incorrectly refilled some drugs classified as Schedule II controlled substances. These include strong painkillers, as well as other drugs that are considered at high risk for abuse, according to the Associated Press. Federal law prohibits the refilling of prescriptions for Schedule II drugs, which cannot be dispensed without a prescription that contains the name, address, and signature of the prescriber.

The incorrectly dispensed refills were worth $25 million in 2009, noted the report by the U.S. Department of Health and Human Services Inspector General. ‘‘Paying for such drugs raises public health concerns and may contribute to the diverting of controlled substances and their being resold on the street,’’ the report stated.

The Centers for Medicare and Medicaid Services responded that the report mistakenly categorized partial ‘‘fills’’ dispensed to patients in long-term care facilities as refills. Partial fills occur when a pharmacist dispenses only part of a prescribed medication at one time. The report said it found little evidence of that, the AP noted. The report concludes that almost 400,000 Schedule II prescriptions were wrongly refilled, representing about 2 percent of all Schedule II prescriptions billed under Medicare Part D in 2009. Of those wrongly refilled prescriptions, more than 25,000 were also missing some required information, such as the name, address or signature of the prescriber.

To cut down on improperly refilled Medicare prescriptions, the report recommends that federal health officials automatically flag requests for reimbursement for controlled drug refills, and refuse to pay them. The Centers for Medicare and Medicaid Services should work more closely with providers, and follow up with those who have a large number of refills, the report recommends. The agency responded that working with individual providers and pharmacies is not an efficient use of resources, the AP reported.

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Supreme Court Will Hear Case About Blood Alcohol Test for Drunk Driving

The Supreme Court announced it will hear a case that centers on the question of whether police must obtain a warrant before forcing suspected drunk drivers to submit to a blood alcohol test. The case centers on Tyler McNeely, who was pulled over for speeding by a Missouri highway patrolman, and was taken to a hospital. About 25 minutes after McNeely was pulled over, a technician measured his blood-alcohol content at 0.154 percent, nearly twice the legal limit.
The Missouri police in the case argued they should not have to wait for approval to give a blood test, because alcohol dissipates quickly in the bloodstream, Reuters reports. In a decision earlier this year, the Missouri Supreme Court rejected that argument. It ruled the blood test violated the Fourth Amendment, which protects against unreasonable searches and seizures. The court found there were no special circumstances to justify obtaining the blood test so quickly. A decision against Missouri could interfere with a longstanding practice by police to help combat drunk driving, according to Lewis Katz, a criminal justice specialist at Case Western Reserve University School of Law in Cleveland.

In court papers, McNeely, who is being represented by the American Civil Liberties Union, said at least 27 states had laws banning the warrantless, nonconsensual drawing of blood.

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