ATOD Recap week-endning September 7

Prescriptions for N.J. marijuana hard to get

Many of the doctors who recently registered with New Jersey's medical marijuana program are not accepting new patients, while some are charging nearly $500 in cash for visits before they will recommend the drug. That may explain why only 130 patients have signed up so far for the state's new program, say members of the Coalition for Medical Marijuana-New Jersey, a patient advocacy group that has been pushing for the alternative pain relief for more than five years. In Arizona, more than 700 patients applied to use marijuana when that state's program opened last year.
"I wondered what it would be like for a hospice patient to try to navigate the program and to find a doctor," said Vanessa Waltz, a coalition board member who telephoned all 148 doctors listed on the state Department of Health's website last month when the patient registry was launched.
Since then, the number has grown to 160 doctors - out of nearly 36,000 licensed physicians in the state. The program is not yet operational as no marijuana dispensary has received final approvals to sell to patients. A dispensary in Montclair, Essex County, is expecting to open this month.
Waltz, a breast cancer survivor who made the calls as a patient advocate, said that a lot of her voice mails were not returned and that she encountered a few rude receptionists who told her not to call again because their doctors were not in the program despite what the registry said.
She said she also spoke with several polite office staffers who told her they had been swamped with calls and had to withdraw from the program.
"It was very frustrating," said Waltz, who compiled a "white paper" with her findings. Of the 148 listed, more than 50 doctors across the state would have turned her away, while only 46 were willing to sign people up. The rest could not be reached.
An informal survey conducted by The Inquirer netted similar results. Of about 20 registered doctors in South Jersey, only three were readily available to give patients an appointment: Mark Angelo in Voorhees, Marshall Lauer in Collingswood, and Julius Mingroni in Blackwood.
Three physicians who practice in Williamstown, Gloucester County, were registered with New Jersey and with www.marijuanadoctors.com, a national organization of doctors who recommend the drug. They did not return calls, but their website said they will accept $150 in cash only for each of two to three required visits before they decide whether a patient is qualified to receive marijuana.

---

Better game plan needed for addiction treatment

Marti Hottenstein understands the never ending battle against a chronic disease in which everyone blames the patient. Her son, 24, died of a methadone overdose after trying to detox on his own. "I died with him," she said. Barri Pepe told Andy Reid (Philadelphia Eagles coach) about her daughter, 29, a decade in recovery from heroin addiction, at a Philadelphia Eagles dinner for volunteers last year. Reid's son Garrett, 29, died Aug. 5 after a long battle with addiction. "We know what it's like," said Pepe, who is 13 years clean herself and active in the recovery community.
A surprising number of people know: An estimated 23 million Americans, 9 percent of those age 12 and older, needed treatment for illicit drug or alcohol use in 2010, according to the National Survey on Drug Use and Health. Only one in 10 got the care. Half of them relapsed - about the same rate as those who fell off their treatment plans for diabetes, hypertension, and asthma.
"With asthma . . . sometimes it takes many times to get the message that you have to stay on these medications or the asthma will choke you to death," said Thomas Kosten, an addiction researcher at Baylor College of Medicine in Houston.
If you think of addiction as a chronic disease, he said, "treatment is very effective."
Advances in neurology and genetics over the last two decades have helped convince most researchers that drug and alcohol abuse is a chronic illness. But much of the public, politicians, and even physicians still see it as a moral failing, a belief that shaped a treatment system that is largely divorced from mainstream medicine and is funded like its poor stepchild.
"Addiction changes the brain," said Charles P. O'Brien, director of the Center for Studies of Addiction at the University of Pennsylvania School of Medicine. It creates the memory of a euphoric new reality, reinforced by myriad new habits, that is extremely difficult to get rid of.
"It's like when you learn to ride a bike at age 8 or 9. You never forget it," O'Brien said.
The big breakthroughs in addiction treatment for opioids - illicit drugs such as heroin and the far more common prescription painkillers such as Percocet and OxyContin - have been the development of medications that either suppress withdrawal symptoms or block the high entirely. They allow the long process of unlearning habits to move forward through intensive counseling, 12-step programs, and other forms of support. Research shows that taking such drugs greatly reduces the chance of relapse. Yet the vast majority of treatment programs don't use medications. And while the National Institute on Drug Abuse says that residential or outpatient treatment shorter than 90 days is of limited effectiveness - experts often recommend one to two years - surveys show that more than 80 percent of patients are discharged immediately after detox. Relapse is most common before the brain has been trained to sustain itself. Issues that were overlooked during years of drug use - from dental pain to court orders removing children from their mothers - often reappear then, at the worst time.
"All of a sudden I'm stopping using, which is really hard, every part of my body is saying 'use, use, use' and I'm saying 'no, I want a better life,' and all these things are crashing in," said Beverly Haberle, executive director of the Council of Southeast Pennsylvania, the regional affiliate of the National Council on Alcoholism and Drug Dependence.
A relapse when the body's high tolerance for drugs has begun to decline can easily result in a fatal overdose. Suicides are more common, too. Haberle's group is at the forefront of a national movement to open "recovery centers," where people get support and learn basic life skills - how to use a computer, apply for a job, find an apartment - that they never developed before disappearing into substance abuse.
"All normal living and everything related to it was irrelevant to me," said Doug Gould, 51, who lost 22 years to an alcohol addiction.
He credits the staff at the Livengren Foundation in Bensalem for "convincing me 100 percent that I was done." They ensured that his 14 days as an inpatient would be followed by residence in a recovery house, where he attended 12-step meetings five times a week and ended up living for the next year. Without all of that, Gould said, he "absolutely" would have returned to drinking. Instead, he celebrated 14 years clean on July 29, runs a version of a recovery house of his own in Levittown, and raises money for an organization that has gotten hundreds of people into treatment; the main event, 12 hours of "substance-free music," Soberstock, will be held Sept. 1 at Snipes Farm in Morrisville.
Getting approval for an inpatient stay for opiate detox may require wrangling with health insurers, said David Jones, medical director of the Mirmont Treatment Center in Media: "A lot of companies encourage that to be done outpatient in a physician's office." Cost-cutting "is an issue that we have to deal with," said Gary Tennis, secretary of the new Pennsylvania Department of Drug and Alcohol Programs.
Pennsylvania is widely seen as having one of the strongest laws in the nation for coverage of drug and alcohol addiction, mandating a full range of care for most commercial health plans and Medicaid. Still, it doesn't kick in until the substance abuse reaches a definition of addiction that would seem ridiculous for other chronic diseases, said Thomas McLellan, chief executive officer of the Philadelphia-based Treatment Research Institute. If that standard were applied to diabetes, he said, a patient would have to lose his eyesight or a finger before coverage began. So why are relapse rates for diabetes no better than those for addiction? In the absence of mainstream medical recognition, McLellan said, the recovery community developed Narcotics Anonymous and other forms of peer support to manage the illness. When more patients get full treatment, he predicted, relapse rates for addiction will be lower than those for other chronic diseases. Peer support is now starting to develop in other communities, such as diabetics.
Eventually, he said, "we will have better, cheaper, illness management for all the chronic illnesses, including addiction."
McLellan, who served as deputy director of President Obama's Office of National Drug Control Policy, said progress has vastly speeded up as a result of two federal laws: the Mental Health and Addiction Parity Act, signed by President George W. Bush in 2008, and the health-system overhaul signed by Obama two years later. Various provisions move substance-abuse treatment into the mainstream, from screenings at primary-care offices to insurance coverage at earlier stages of disease. More treatment would encourage drug companies to spend more money researching addiction medications, which have not been big moneymakers in the past. Better drugs would get more use.
The bottom line is that substance abuse would be seen - by everyone - as, simply, a disease. Karen Brown, whose son was in treatment 14 or 15 times before he was ready to get clean, said she hopes that news of Garrett Reid's death ultimately serves the same purpose. It shows that "the drug addict is your lawyer and your son and your professor in college," said Brown, an archaeologist who lives in Ridley Township. Marti Hottenstein, whose son, Karl, 24, died of an overdose in his Warrington apartment six years ago after failing to find a treatment center to admit him, put it this way:
"Do we turn a cancer patient away if they have lung cancer? No, we don't. How can you turn away someone who has a disease? This country needs to get educated."

---

Alcohol Doesn't Help Forget Bad Memories

..."We're not only seeing that alcohol has detrimental effects on a clinically important emotional process, but we're able to offer some insight into how alcohol might do so by disrupting the functioning of some very specific brain circuits," said NIAAA scientist Andrew Holmes, PhD, the study's senior author...

People often take up drinking to overcome or forget a traumatic experience. However, excessive drinking can rewire the brain and cause the opposite effect.

People often take up drinking in order to overcome or forget a traumatic experience. However, excessive drinking can rewire the brain and the opposite effect is possible. According to a new research, people who drink excessively tend to linger with a trauma longer than sober people.  According to the researchers from National Institute on Alcohol Abuse and Alcoholism (NIAAA) and UNC's Bowles Center for Alcohol Studies, alcohol alters function in key area of brain that governs people's personality. The research could help in learning about alcoholism and post-traumatic stress disorder.

In the study, researchers taught sets of mice to fear a particular sound. They achieved this by giving an electric shock to the mice whenever the sound was played. One set of the mice was given twice the legal amount of alcohol while the other set wasn't given any alcohol.

During the course of experiment, researchers stopped giving electric shocks to the mice along with the tone. Gradually mice that weren't given any alcohol got used to the tone and learnt that it wasn't dangerous any more. However, the mice that were on alcohol, reacted with fear (freezing in a position) every time they heard the sound, even when it was no longer accompanied by a shock.

"There's a whole spectrum to how people react to a traumatic event. It's the recovery that we're looking at-the ability to say 'this is not dangerous anymore.' Basically, our research shows that chronic exposure to alcohol can cause a deficit with regard to how our cognitive brain centers control our emotional brain centers," said one of the authors of the study, Thomas Kash, PhD, assistant professor of pharmacology at the University of North Carolina School of Medicine.

Researchers compared the brains of mice that were on alcohol to brains of normal mice. They found significant differences in the brain structure, especially in the pre-frontal cortex- the region associated with cognitive function, social behavior, decision making and modulation of intense behavior. Researchers found that the nerve cells in this region of the brain were shaped differently.  A key receptor known as NMDA (N-methyl-D-aspartate) was also suppressed in the mice that had large doses of alcohol. The function at this particular receptor is associated with all the signs of alcoholism like dependence, craving and withdrawal.

"We're not only seeing that alcohol has detrimental effects on a clinically important emotional process, but we're able to offer some insight into how alcohol might do so by disrupting the functioning of some very specific brain circuits," said NIAAA scientist Andrew Holmes, PhD, the study's senior author.

"This study is exciting because it gives us a specific molecule to look at in a specific brain region, thus opening the door to discovering new methods to treat these disorders," said Kash.

The study is published in the journal Nature Neuroscience.

---

The price of a drink: the potential of alcohol minimum unit pricing as a public health measure in the UK

The UK has seen a dramatic increase in alcohol consumption and alcohol-related harm over the past 30 years. Alcohol taxation has long been considered a key method of controlling alcohol-related harm but a combination of factors has recently led to consideration of methods which affect the price of the cheapest alcohol as a means of improved targeting of alcohol control measures to curb the consumption of the heaviest drinkers. Although much of the evidence in favour of setting a minimum price of a unit of alcohol is based on complex econometric models rather than empirical data, all jurisdictions within the UK now intend to make selling alcohol below a set price illegal, which will provide a naturalistic experiment allowing assessment of the impact of minimum pricing.

---

Non-Addictive Painkiller? How Scientists Are Helping In The Fight Against Prescription Drug Abuse

Katherine Bindley @huffingtonpost.com

It almost sounds too good to be true: painkillers that could be more effective in relieving pain and less likely to result in dependence and addiction. But that's what researchers from the University of Adelaide and the University of Colorado are on their way to developing following a study on the potential of a drug called (+)-naloxone.
"It's a total game changer," said Linda Watkins, the lead author of the study, which was published last month in the Journal of Neuroscience. (+)-naloxone is a mirror image of the drug naloxone, used to treat opiate overdoses. Watkins and her team found that (+)-naloxone can alleviate pain more strongly when paired with opioids than the drugs would otherwise alone, while blocking some of the elements that lead to addiction.
Painkillers help millions of people who are battling cancer, recovering from surgery and suffering from chronic ailments, but they also represent a class of drugs that the CDC says are being abused at alarming rates. There were 14,800 painkiller-related overdose deaths in 2008 -- more than the number of heroine and cocaine overdose deaths combined. There's been a 300 percent increase in painkiller sales since 1999, and 12 million people admitted to using painkillers for non-medical reasons in 2010. In an Associated Press report published in April, one expert pointed out that an increase in prescription drug use is tied to multiple factors, including a greater willingness on the part of doctors to prescribe the drugs, and physically dependent users "doctor shopping" so that they can keep getting their fix. And as addiction specialist Dr. Drew Pinsky pointed out to The Huffington Post last fall, adults and teens alike misperceive prescription drugs as substances that can be used without consequences because they're often coming from doctors rather than street corners.
This latest research from Watkins' team could prove to be significant in the effort to curb prescription drug abuse, in part because it approaches drug physiology in a new way. Watkins noted that in the past, researchers have primarily studied drug abuse and drug rewards in terms of how they relate to neurons. The new research shows that there may be another key player, known as glia, that influences how the body responds to drugs. Glia are immune-like cells that behave very differently than neurons, and they could prove crucial in understanding how pain and reward messages are transmitted.
"You can think of them as volume controls," Watkins said. "They can turn up pain and they can turn up drug reward, because when they become activated by things like pain, by things like opiates, they start releasing substances that are excitatory, that drive neurons wild."  What Watkins and her team found in their research is that when they paired morphine with (+)-naloxone, the drugs effectively blocked a receptor attached to the glial cells, making the pain-relieving aspects of the drug stronger while apparently negating drug rewards.  In one study performed, rats were put into two rooms, one of which had saline and one of which had morphine. Conditioned behavioral response dictates that the rats would want to return to the room that had the morphine in it. But once the rats were given (+)-naloxone with the morphine, they no longer showed a preference for that room and were just as attracted to the saline one.
"Now you have separation of effects," Watkins said. "You can enhance the ability of opiates to be good in the clinical control of pain while at the same time decreasing the abuse potential."
There are two ways the abuse potential is decreased, she noted: it's directly reduced by eliminating the reward, and it's indirectly reduced if opiates work better with the addition of (+)-naloxone, allowing users to require less opiates in the first place.
"If you have less opiates, you have less side effects, less abuse potential," Watkins said.
The research is in its early stages, and there remain many more questions that need to be answered. As Maia Szalavitz pointed out in Time, "it is not clear whether preventing the high would hinder certain aspects of pain relief in humans. Subjective experiences of opioid use suggest that the 'high' — the relief of anxiety and sense of distance from the pain — is not totally separate from the actual physical pain relief, and multiple previous efforts to dissociate the two have failed." Szalavitz went on to argue that heroin was initially meant to be a less addictive form of morphine and that OxyContin was intended to be a less addictive painkiller. Those attempts at non-addictive opioids didn't pan out as hoped for.
Scientific American raised the issue over whether an addiction-proof painkiller might be of any help to someone already addicted to painkillers, noting that, "there’s a big difference between blocking the effects in a rat that’s only had a few days experience, and blocking them in a years-long addict. Reward related systems change very drastically after long-term exposure to drugs like morphine or heroin, and remember, this has not been tested in humans."
But Watkins believes an "addiction-proof painkiller" is something that could indeed become a reality. "It's early on, but the data are suggestive of that," she said. "It certainly is worthy of a lot more study to see whether this may actually turn out to be the case."  Watkins also noted research from other scientists that shows the potential for a longer-acting version of (+)- naloxone to also curb drug cravings.  "You can take a person through detox to get them off of drugs, but the real question is whether they will stay off the drugs," Watkins said.

---

Residency Program Teaches Doctors About Addiction Treatment

A national training program launched last year is seeking to address the scarcity of physicians trained in treating addiction. The program, sponsored by the American Board of Addiction Medicine (ABAM), aims to attract more doctors to the field, The Washington Post reports.
A report released this summer by the National Center on Addiction and Substance Abuse (CASA) at Columbia University found only about 10 percent of the 22 million Americans with a drug or alcohol problem receive treatment. The report concludes that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care. According to the CASA report, only about 1,200 of the 985,375 practicing doctors in the United States are trained in addiction medicine. The new addiction medicine training program is being offered at 10 academic medical centers across the nation. Participants have finished training in another specialty, such as internal medicine and family practice. They are completing one- or two-year residencies in addiction medicine.
The need for doctors trained in addiction medicine will grow as more Americans gain health insurance coverage under the Affordable Care Act, the newspaper reports. According to the Substance Abuse and Mental Health Services Administration, up to one-third of the 30 million Americans who may receive coverage under the law have a substance abuse or mental health problem. Funding for the new residencies remains a problem. The 10 medical centers participating in the program agreed to train 28 physicians in the first year, but fewer than half the slots were funded. When the program was announced in 2011, Dr. Kevin Kunz, ABAM Foundation President, said his group anticipated accrediting an additional 10 residencies in 2012.

---

Cigarettes Contain Surprising Ingredients, Documents Reveal

Tobacco industry documents, available online, reveal that cigarettes contain a wide array of additives, some of them surprising. They include cocoa, licorice, urea, and prune juice, according to The Wall Street Journal. As a result of litigation against tobacco manufacturers, an estimated 80 million pages of formerly secret documents have become available at legacy.library.ucsf.edu. One such document drawn up by a leading tobacco law firm lists 614 cigarette additives.
While cigarette formulas remain trade secrets, tobacco companies must now disclose which chemicals they add to their products, the article notes. Philip Morris lists more than 100 additives, while Reynolds lists 158 and Lorillard lists 137. Many of the additives are flavorings. Menthol, which provides a cool, minty taste, also has anesthetic effects. This helps new smokers get started, and provides a “medicinal” feeling, according to the newspaper. Sugar, which produces a milder smoke that is easier to inhale, also increases the addictive potency of the smoke.
Ammonia is added to unbind nicotine, and levulinic acid is used to increase the efficiency of nicotine binding in the brain. Cocoa is used not only for its aroma, but also because it contains a substance called theobromine, which helps open up the lungs to “receive” smoke. The documents also list ingredients in cigarette paper, including bleaches and glues, as well as chemicals to adjust the color of the ash.

---

Colleges Try New Tactics In Battle Against Binge Drinking

...One estimate, from the National Institute on Alcohol Abuse and Alcoholism, blames binge drinking for more than 1,800 college student deaths a year, mostly from drunken driving. Research shows that frequent binge drinkers are more likely to miss classes, get hurt, engage in risky sex and have problems in class...


Catherine Sedun remembers binge drinking among students when she attended college about a decade ago. Despite an influx of programs to combat the problem in recent years, she says it remains a top concern on many campuses.

"These students work so hard to get into these universities, and once they get here, a lot of them spiral out of control with their freedom," she said. "It's time to party."

In an attempt to save students from themselves, Sedun, a high school teacher and a graduate student at Northwestern University, headed the Red Watch Band program at the Evanston campus last year. The program teaches students to recognize the warning signs of alcohol poisoning - vomiting; cold, clammy skin; the inability to wake up - and to call for medical help.
 It's part of a wave of college initiatives meant to quell the chronic problem. The percentage of college students who binge drink - defined as five drinks for men and four drinks for women in two hours - has held steady at about 40 percent for most of the past decade, consistently more than non-college students, federal surveys show. Combining alcohol with energy drinks has fueled students' ability to drink more and longer.

One estimate, from the National Institute on Alcohol Abuse and Alcoholism, blames binge drinking for more than 1,800 college student deaths a year, mostly from drunken driving. Research shows that frequent binge drinkers are more likely to miss classes, get hurt, engage in risky sex and have problems in class.

They're also happier than nonbinge drinkers, according to a recent study at one school, but researchers say that seems to be because of their social status. Most often they're white males involved in athletics and fraternities.  Acknowledging that some students are going to drink no matter what, many schools are practicing "harm reduction" - trying to save students from their own worst behaviors.

At Northwestern, the issue has particular resonance. Nineteen-year-old freshman Matthew Sunshine died of alcohol poisoning in 2008 after a party in his dorm hall. As part of a settlement with his family, the school agreed to review its alcohol policy. The next year, Northwestern started the Red Watch Band program, developed at Stony Brook University in New York, where Sunshine's mother worked.  NU also has joined the Learning Collaborative on High-Risk Drinking, in which 32 schools across the country are trying short-term changes to alcohol policy and monitoring the results. As part of its efforts, Northwestern employs BASICS, an assessment of students who get involved in alcohol-related medical or police incidents, and lowered the time for treatment from 30 to 20 days, according to Lisa Currie, director of health promotion and wellness.

"There is no magic bullet," she said. "It's small improvements ... that work together."

Some freshman are subject to the new procedures even before they get to school. At DePaul University in Chicago, for example, students are required to take an online self-assessment to analyze their alcohol use before they get to campus.  Loyola University Chicago and the University of Illinois at Chicago also use the online program, called e-CHUG, or electronic Check-Up to Go.

Meanwhile, schools are working to offer alcohol-free events, like the Beer Free Zone at UIC, and NU Nights at Northwestern, which offered a showing of the movie "Chicago" with related dance lessons, or bingo with prizes such as iPods.  Harper College in Palatine offers a new class about drug and alcohol abuse in college, taught by a teacher who admits drinking once affected her own performance in school. Some schools even offer alcohol-free spring breaks.

At the University of Illinois at Urbana-Champaign, binge drinking has been notorious on dates such as Halloween and Unofficial St. Patrick's Day, a daylong drunkfest sponsored by bars that were losing money when March 17 fell within spring break. In response, the school and city have tried to crack down on such events, including steps to limit alcohol availability and installing surveillance cameras.

All these efforts are a response to a study by the National Institute on Alcohol and Alcoholism that identified binge drinking as a top problem on campuses across the country a decade ago.  Since then, a survey of 747 college presidents reported by the Center for Science in the Public Interest found that nearly all colleges had implemented some form of alcohol education, with efforts targeting high-risk populations such as first-year students, sorority and fraternity members, and athletes. Thirty-four percent of colleges banned alcohol for all students, and 4 in 5 colleges offered an option for alcohol-free residences.

Still, success has varied. At some colleges, nearly 70 percent of the students were identified as binge drinkers; at others there were none.

It will take much harder work to make a dent in the problem, according to researchers such as Toben Nelson at the University of Minnesota, especially at big schools with an emphasis on sporting events, which had the most problems. Harm reduction and screening help, he said, but research shows that telling students why they shouldn't drink does little to change their behaviors.

He says colleges could do much more to limit the availability of alcohol, which saturates college culture. He points to a success story at the University of Nebraska at Lincoln, which lowered its percentage of binge drinkers from the 60s to the 40s by limiting alcohol and requiring registration for parties so police could make sure they weren't getting out of hand.

Research by the Harvard School for Public Health found that underage students in states with extensive laws restricting underage and high-volume drinking - such as keg registration, 0.08 driving laws and restrictions on happy hours, pitchers and advertising - were less likely to binge drink.  Schools may always have binge drinkers, Nelson said, but it's defeatist to say nothing can be done to cut down on the severity and bad effects.

"You're not going to stop it," Nelson said. "The idea is to reduce it and keep a lid on it."

Source: The Chicago Tribune

---

Introducing the “You Matter” Campaign for Young Adults in Emotional Distress or Suicidal Crisis

SAMHSA announced a new online campaign to promote the National Suicide Prevention Lifeline, You Matter.  The campaign focuses on the positive message that the lives of young adults matter, even as they face trying times or difficult problems. Through a blog and social media, You Matter aims to build awareness and trust in the Lifeline among young adults by providing a safe, online space where they can connect with the Lifeline. The campaign showcases hopeful peer-to-peer messages and also supports friends of young adults ...

---

Study Finds Elevated Death Rates Shortly After Hospitalization for Substance Abuse

A new study finds elevated rates of suicides and overdose deaths in the month after people have been released from the hospital for substance abuse treatment. Researchers found death rates were substantially higher for those who had been out of the hospital for less than one month, compared with those who had been out for at least one year. The study of almost 70,000 people who had been treated for some type of substance abuse found overdose deaths and suicides were most common during hospitalization, Reuters reports. Even after discharge, the death rates remained high, the article notes. In the first month, there were 21 drug-related deaths per 1,000 people each year, compared with 4.2 per 1,000 people a year or more later.
“Like prison-release, hospital discharge marks the start of a well-defined period of heightened vulnerability for drug-treatment clients,” Elizabeth Merrall of the MRC Biostatistics Unit in Cambridge wrote in the journal Addiction.
According to Dr. Patrick G. O’Connor of the Yale School of Medicine, who was not involved in the study, some drug users may start binging once they are released from the hospital, or may lose some of their drug tolerance in the hospital, which makes it easier to overdose. Hospitalization may not be enough for some people struggling with substance abuse, he noted. They also may need jobs, housing and psychiatric care. “For drug users who leave the hospital, we need to be able to provide instantaneous and tight linkages for these patients to at least three services: primary care services, social services and drug treatment services,” he noted.

---

Nicotine Patch and Prescription Drugs Help With Quitting Smoking, Study Finds

Using nicotine patches or prescription medication helps smokers quit, a new international study concludes. Previous studies have produced conflicting evidence about the effectiveness of smoking cessation aids in real-life settings, according to Reuters. The study of more than 7,400 smokers found those who used some smoking cessation treatments were four to six times more successful in quitting, compared with those who tried to quit on their own. About 2,200 of the smokers in the study used a prescription drug or nicotine replacement therapy to help them stop smoking.
Among smokers who did not use any medication, 5 percent were able to stay smoke free for at least six months, compared with 18 percent of those using nicotine patches, 15 percent of those using the antidepressant buproprion (Wellbutrin) and 19 percent who used varenicline (Chantix). The researchers took into effect how long and how heavily participants smoked, and concluded that buproprion and the nicotine patch were associated with a four-fold increase in quitting rates, compared with those who used no medication. They found varenicline was associated with an almost six-fold increase in quitting success.
“The disappointing reality is that even when people use these medications to help them quit, relapse is still the norm. It’s better than nothing, but it’s by no means a magic bullet,” lead researcher Karin Kasza of the Roswell Park Cancer Institute in Buffalo told Reuters. The study appears in the journal Addiction.

---

Mother’s Smoking in Pregnancy May Cause Brain Changes in Child That Lead to Obesity

A new study may help explain why children born to mothers who smoked during pregnancy are at increased risk of obesity. Researchers found children whose mothers smoked while pregnant have structural changes in their brains that may increase preference for fatty food.
“The fact that prenatal smoking is associated with a high risk of obesity in offspring has been known, but the potential mechanism that may lead to this risk was not fully understood,” researcher Dr. Zdenka Pausova of the Hospital for Sick Children in Toronto told HealthDay. “Our study suggests that maternal smoking may cause structural changes in the part of the brain that processes reward and may increase preference for fatty food.” She noted that smoking in pregnancy is just one of many factors that may lead to teenage obesity.
The study included 378 teenagers, 180 of whom had mothers who smoked more than one cigarette a day during their second trimester of pregnancy. Babies born to mothers who smoked weighed less when they were born, compared with babies whose mothers didn’t smoke. They were breast-fed for shorter periods of time, and were more likely to be heavier as teenagers, the researchers report in the Archives of General Psychiatry. Brain scans showed that teenagers whose mothers smoked in pregnancy had a significantly lower volume in the part of the brain involved in rewards, called the amygdala. The researchers found the more fat the teens ate, the lower their amygdala volume.

---

Risk of Alcohol-Related Harm Greatest During First Few Weeks of College

College freshman, relishing newfound freedom away from home, are at greatest risk of alcohol-related harm during their first few weeks of school, according to an expert at Penn State’s Prevention Research Center. “We see a spike then because anxiety is high, and the rigors of coursework haven’t yet taken hold,” Michael Cleveland told the Orlando Sentinel. New college students often are not aware that excessive drinking can lead to fatal alcohol poisoning, as well as accidents, assault, date rape, violence and academic failure, the article notes.
A study conducted by the Harvard School of Public Health found 44 percent of college students binge drink, and many suffer alcohol-induced blackouts. Every year, college drinking leads to 1,825 deaths among students age 18 to 24, according to the National Institute on Alcohol Abuse and Alcoholism. Drinking also contributes to 599,000 injuries, 696,000 assaults and 97,000 cases of date rape on college campuses annually.
A study published last year in the journal Addictive Behaviors, which included 77,000 incoming freshmen, found students drank more in the fall than in the summer, and also drank more alcohol in a shorter period of time. “Once college starts, students who do drink get less careful about pacing themselves,” said study author Scott Walters. Penn State’s Cleveland published a study earlier this year that found a program that uses parents and peers to help prevent college freshmen from becoming or staying heavy drinkers shows promise. The researchers studied two sets of interventions, one using parents and one using peers. They found that students who did not drink before starting college, and who received the parent-based intervention, were unlikely to become heavy drinkers in the first semester.
Students who drank heavily the summer before starting college were more likely to cut down on drinking if they received intervention either from parents or peers. If they received both interventions, there was no effect.

---

Marijuana and Nonmedical Use of Psychotherapeutics Have  Highest Rates of Past Year Abuse or Dependence Among U.S. Residents

An estimated 7.1 million persons aged 12 or older met the criteria for past year illicit drug abuse or dependence in 2010, according to data from the most recent National Survey on Drug Use and Health (NSDUH). Of these, 63.0%—more than 4.4 million—were classified with marijuana or hashish abuse or dependence, 33.5% met the criteria for abuse or dependence on psychotherapeutics used nonmedically (primarily pain relievers), and 14.1% abused or were dependent on cocaine. These findings parallel those of national treatment admissions, which show that the majority of illicit drug admissions are for marijuana and that admissions for marijuana and opiates other than heroin (i.e., prescription pain relievers) have been increasing in recent years.

Please attached see CESAR FAX for additional details.

---

More Than Half of Fatal Car Crashes Involve Alcohol or Drugs

A new study shows 57 percent of fatal car crashes involve a driver who tested positive for alcohol or drugs. Alcohol was the most common substance detected, followed by marijuana and stimulants, Reuters reports. One in five of the 20,150 fatally injured drivers between 2005 and 2009 had multiple substances in their system at the time of the accident. Men and people driving at night were the most likely to have used alcohol or drugs, according to the study.
Study co-author Joanne Brady of Columbia University in New York told Reuters that not all states test for the same drugs at the time of a crash, or have a policy to test consistently at all. She added it is not definitely known how multiple substances might interact to affect a driver’s ability to focus on the road. The findings appear in the journal Addiction.

---

Emergency Rooms Learning to Deal with Teens, Young Adults on Designer Drugs

Emergency room doctors are learning the signs of designer drug use in teens and young adults as the substances continue to grow in popularity, The Miami Herald reports. Signs that someone has been using “bath salts,” or synthetic marijuana, known as “K2” or “Spice,” include a glassy look, or psychotic behavior, such as acting as if they are seeing things or hearing voices, according to Dr. Peter Antevy, an emergency room doctor at Joe DiMaggio Children’s Hospital in Hollywood, Florida.
“These don’t show up on any drug tests, unfortunately,” Antevy told the newspaper. “And kids don’t like to admit they’ve taken them, especially if they’re in front of their parents. The only way I know is by asking, simply, ‘Are you on K2? Are you taking Spice?’ They’ll look at me and say, ‘Yes.’?”
The American Association of Poison Control Centers reported 3,821 calls regarding synthetic marijuana and 2,078 calls regarding bath salts as of July 31of this year.
The article notes the long-term effects of these drugs have not been fully studied. This research is especially difficult to conduct, because drug makers are continually changing the chemical makeup of the substances to evade laws banning them. “They’re able to change one molecule on this drug and then you can call it something different, so the regulators can’t disallow them,” Antevy said. “They’re skirting the law.”
In July, President Obama signed legislation that bans synthetic drugs. Synthetic drugs are readily available online. The law outlaws sales of synthetic drugs by both retail stores and online retailers. In December, the National Institute on Drug Abuse released new information indicating that one in nine high school seniors had used Spice or K2 over the past year, making synthetic marijuana the second most frequently used illicit drug, after marijuana, among high school seniors.

---

Popular Students Still Exert Peer Pressure to Smoke, Study Suggests

The most popular students are more likely than their classmates to smoke cigarettes, according to a study of teenagers at seven predominantly Hispanic/Latino high schools in California.
“Popularity is a strong predictor of smoking,” study author Thomas Valente of the University of Southern California’s Keck School of Medicine told HealthDay. “We haven’t done enough to make it cool not to smoke.”
The study found that students who think their friends are smokers, even if they aren’t, are more likely to smoke. The more popular students are, the earlier they are likely to start smoking, the researchers write in the Journal of Adolescent Health. Among adults who smoke, 68 percent began smoking regularly at age 18 or younger, according to the American Lung Association. People who begin smoking at an early age are more likely to develop a severe addiction to nicotine than those who start when they are older. Of teens who have smoked at least 100 cigarettes in their lifetime, most of them report that they would like to quit, but are not able to do so. The study included 1,950 students in ninth and tenth grades who were asked about their smoking habits, how many students they thought smoked cigarettes, and how they thought their close friends felt about smoking. They also were asked who their friends were, so the researchers could identify their social networks.
Students’ popularity was measured by how many of their classmates named them as a friend. Teens who thought their close friends smoked were more likely to smoke. Those who smoked tended to be friends with other smokers.

---

CVS Caremark to sponsor The Partnership at Drugfree.org campaign to curb Rx abuse

CVS Caremark announced that it has joined with a group of public and private sector partners and will sponsor the "The Medicine Abuse Project," a multiyear effort by The Partnership at Drugfree.org to raise awareness and curb the abuse of prescription drugs and over-the-counter medicines. The project's goal is to prevent half a million teens from abusing medicines over the next five years.

"It is startling that 1-in-6 teens has taken a prescription drug without a prescription and that the majority of teens who abuse medications get them from the homes of family and friends," CVS Caremark president and CEO Larry Merlo said. "As a pharmacy innovation company, we have a responsibility to educate people about medication abuse. These efforts are an important part of CVS Caremark's purpose to help people on their path to better health."

Steve Pasierb, president and CEO of The Partnership at Drugfree.org added, "Our new research underscores that Americans drastically underestimate the negative impact that prescription drug and over-the-counter medicine abuse is having on teens today.  We are deeply grateful to CVS Caremark for enthusiastically joining this collaborative Project to effectively address the intentional abuse of medicines. With the support of CVS Caremark and their reach into communities across the nation, we are taking action and helping turn the tide on this growing epidemic." The Medicine Abuse Project will encourage parents to talk with their kids about the dangers of abusing prescription and OTC medicines and will provide information on safeguarding and properly disposing of unused medications. Part of the Project is a National Prescription Drug Take-Back Day, facilitated by the Drug Enforcement Administration, which will take place on Sept. 29, with collection sites across the country where consumers can safely dispose of their unused medications.

"Every day our pharmacists talk to customers about how to take their medications as directed so they can get and stay healthy," added Merlo, who himself is a pharmacist.  "This effort to counsel patients and families about the dangers of inappropriately taking medications, as well as how to safeguard medications in the home, is equally important."

CVS Caremark will be participating in The Medicine Abuse Project by posting information on the company's websites and social media channels; linking to the campaign's website; providing information at CVS/pharmacy locations; and taking part in The Partnership at Drugfree.org's awareness-building events.