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Tuesday, October 21, 2014

Buprenorphine Maintenance Over Detox

Buprenorphine has become the standard in treating opioid addiction. Whether it is used for detoxification or for maintenance, many in the field of addiction believe that formulations of buprenorphine, drugs like Subutex and Suboxone, are more effective than methadone.

There are two schools of thought regarding buprenorphine treatment with regards to detoxification and maintenance. Some addiction professionals hold that the sooner a patient gets off all opioid related substances, the better. While some believe that there is a greater chance of long term abstinence if the transition is more gradual.

New research from Yale University indicates that buprenorphine maintenance therapy is more effective than detoxification when treating prescription opioid dependence, Health Canal reports. The researchers followed 113 patients with prescription opioid dependence over the course of 14-weeks.

The participants were separated into two groups, a maintenance group and a detox group. In both groups, patients received drug counseling and were attended to by doctors and nurses. The maintenance group received ongoing buprenorphine therapy over the 14-week period. The detox group received six weeks of stable doses of buprenorphine followed by three weeks of tapering doses.

Over the 14-week period the detox group tested positive for illicit opioid use more often than those in the maintenance group, lead researcher Dr. David Fiellin reported in JAMA Internal Medicine. The research showed that detox group patients were less likely to stay in treatment or abstain from using opioids after they stopped taking buprenorphine.

“For prescription opioid dependence, buprenorphine detoxification is less effective than ongoing maintenance treatment, and increases the risk of overdose and other adverse events,” Fiellin said in a news release. “It is very common for patients seeking treatment to request detoxification.”

“They want to be off of everything as soon as possible as opposed to considering long-term treatment, but unfortunately there’s no quick fix for the disease. The majority of patients will do better if they receive ongoing maintenance treatment.”

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Thursday, October 16, 2014

Study: Stimulants for School - Not Summer

Schools continue to be more demanding, even at the elementary level, students at some schools are required to learn multiple languages and take more advanced math courses than ever before. While a higher caliber of schooling may lead to greater success later in life, unfortunately, some students cannot handle the load and doctors end up prescribing stimulant medications to mitigate the issue. In many cases, students are not taking drugs like Adderall and Ritalin for a deficit, but rather as an aid to keep up with the increasing academic demands.

Children ages 4 to 17, who take ADHD medication, increased from 4.8 percent in 2007 to 6.1 percent in 2011, according to the Centers for Disease Control and Prevention

In fact, a new study indicates that children are 30 percent more likely to take drugs for attention deficit hyperactivity disorder (ADHD) during the school year than in the summer, USA Today reports. Findings that would imply that ADHD drugs, in many cases, are not taken to treat a disorder.

The study’s findings come from researchers at Yale, New York University and the University of Wisconsin-Madison, according to the article.

The study showed that children from wealthier families who live in states with stricter academic standards are more likely to use ADHD drugs only for school. Whereas the children from lower-income families in states with less strict school standards were more likely to take the drugs year-round.

Higher-income families are more likely to follow their own judgment about medication decisions, filling prescriptions when they believed the medication was warranted. Lower-income families follow their doctors' recommendations and fill prescriptions for the medication all year long, according to the article.

“As schools become more academic, as a consequence we’re seeing an increase in school-based stimulant use,” said researcher Marissa King of the Yale School of Management. “Kids are actually just trying to manage a much broader shift in the way the school day is structured.”

“Kids are having more pressure on them to have more sustained attention,” she said.

It is worth pointing out that the research showed that even when children from either end of the socioeconomic spectrum were treated by the same doctor, children with wealthier parents were more likely to use ADHD drugs only during the school year.

The findings appear in the American Sociological Review.

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Tuesday, October 14, 2014

Prescription Opioid Abuse Hindered by Marijuana Legalization

The fight against prescription opioid abuse in America can be hindered by the marijuana legalization movement, according to Michael Botticelli, the Acting Director of the White House Office of National Drug Control Policy. While marijuana activists continue to argue that pot is harmless, Botticelli says one in nine people who use marijuana will become addicted to the drug, the Associated Press reports.

The use of marijuana at an early age increases the risk of developing dependency on other drugs, including prescription painkillers and heroin, Botticelli points out.

“It’s hard to say at one level that we want to think about prescription drug abuse and heroin abuse without looking at how to prevent kids from starting to use other substances from an early age,” he said at a town hall forum on opioid abuse in Maine.

Unlike previous U.S. Drug Czars, Botticelli's story is different in light of the fact that he is in long-term recovery from a substance use disorder, with more than 25 years of sobriety. “My personal story is very illustrative of what we see with people who go on to significant addiction later in life,” he told the AP.

Maine, not unlike many other states, has been hit hard by the prescription opioid and heroin epidemic that continues to ravage the lives of American citizens. What’s more, Maine is also a state that leans toward marijuana legalization, a trend which could lead to young Americans starting the cycle of addiction early on - possibly leading to opioid abuse.

Prescription drug abuse has been a problem in Maine for years, which has led to a surge of heroin abuse, according to the article. In 2012 and 2013, dozens of pharmacies were robbed for the stock of prescription opioids.

Over the next five years, 19 Maine communities will receive $7.5 million to fight drug abuse, Botticelli said at the forum.

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Thursday, October 9, 2014

FDA Officials Defend Zohydro Approval

The Food and Drug Administration (FDA) officials are responding to the activist group FedUP!, a coalition of doctors, addiction professionals, and loved ones of the victims of the prescription opioid epidemic, who called for the FDA Commissioner’s resignation last week. FedUp! lashed out at FDA Commissioner Margaret A. Hamburg over her decision to defend the FDA’s approval of the pure hydrocodone drug Zohydro ER. The agency approved Zohydro despite their own panel of experts voting against the drug's approval -  citing high potential for addiction.

Three FDA officials say the drug’s approval was warranted and that it is misguided to advocate for restricting the use of one opioid, instead of confronting the widespread issue of abuse and inappropriate prescribing, The Wall Street Journal reports.

In the Journal of the American Medical Association (JAMA), FDA officials wrote, “The problem of opioid overdose demands well-informed policies. The actions taken by FDA may help to reverse the epidemic…Policies that focus on a single drug can divert focus from broader, further-reaching interventions… The concerns over Zohydro ER should be seen in the greater context of the opioid epidemic. Singling out one drug for restrictions is not likely to be successful.”

FedUp! is not the first or the only group who is against the FDA’s approval of Zohydro. Governors from five New England states, members of Congress and the Senate, and attorneys general from 28 states, have urged the FDA to amend its decision. Despite the outcry from multiple sectors, including highly informed experts in the fields of addiction and medicine, the FDA continues to stick to their guns.

In an attempt to show that the agency is making efforts to curb the epidemic, the FDA officials say the agency is addressing the need for painkillers with tamper-resistant features. Pointing out that “although this is an appealing policy solution, the science of abuse deterrence is uncertain and evolving… No marketed opioid with purported abuse-deterrence technologies has been shown to deter oral abuse – the most common route – or to reduce addiction or death.”

Whether approval of the drug Zohydro was the right decision, or not is irrelevant. Certainly, no one can argue that approving the drug has helped the prescription drug epidemic. While the FDA and officials fight over what to do, people continue to lose their lives. The list of addictive medications is too extensive, the incentives for doctors to over prescribe are staggering, and the options for patients who become dependent on these drugs are minimal.

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Tuesday, October 7, 2014

CDC Study: Heroin Overdose Deaths Double

The federal government’s crackdown on prescription drug abuse can hardly be considered a success. While use of prescription opioids like Vicodin (hydrocodone) and OxyContin (oxycodone) has decreased, owing mainly to the shutting down of “pill mills” and it being harder to “doctor shop;” unfortunately, the aforementioned efforts has led to a higher demand for heroin, a drug that is cheaper and in many cases stronger than prescription painkillers.

As one might expect, the increase in heroin use has led to higher death rates associated with the drug. A new study from the Centers for Disease Control and Prevention (CDC) has found that heroin overdoses doubled from 2010 to 2012, according to Reuters. The CDC stated that the increase in heroin overdoses is the direct result of years of over-prescribing prescription painkillers.

After the year 2000, the study showed that 75 percent of heroin users in treatment programs said they abused prescription opioids before switching to heroin. In the 1960’s more than 80 percent of heroin users said they hadn’t abused another drug before heroin. The link between prescription opioids and heroin use could not be more apparent after looking at those figures.

The study found that deaths from heroin rose from 1 to 2.1 deaths per 100,000 people between 2010 and 2012; while deaths from prescription opioid declined from 6 to 5.6 deaths per 100,000.

“The rapid rise in heroin overdose deaths follows nearly two decades of increasing drug overdose deaths in the United States, primarily driven by (prescription painkiller) drug overdoses,” the CDC researchers wrote.

The CDC believes that increasing access to medication-assisted treatment and the use of the opioid overdose antidote naloxone is needed to help curb the growing problem.

“Reducing inappropriate opioid prescribing remains a crucial public health strategy to address both prescription opioid and heroin overdoses,” CDC Director Tom Frieden, MD, MPH, said in a news release. “Addressing prescription opioid abuse by changing prescribing is likely to prevent heroin use in the long term.”

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Thursday, October 2, 2014

Teenage Traumatic Brain Injuries Lead to Harmful Behaviors

Traumatic brain injury
Traumatic brain injuries (TBI) are quite common amongst teenagers, especially those who play sports. A TBI is defined as a blow to the head that causes one to be knocked out for at least five minutes, or spending at least one night in the hospital due to symptoms associated with such an injury. New research indicates that teenagers who have had a TBI are at increased risk of using marijuana, drinking alcohol and smoking, HealthDay reports.

The researchers studied data from more than 9,000 teenagers from middle-school to grade 12. The findings varied between males and females who experienced TBI’s.

Girls were:
  • Three times more likely to smoke than girls without a brain injury.
  • More likely to endure bullying.
  • More likely to suffer from anxiety or depression.
  • More likely to think about suicide.
“This is a wake-up call. Concussions are brain injuries, and we need parents and physicians to become more vigilant,” said lead author Gabriela Ilie of St. Michael’s Hospital in Toronto. “Our brains define who we are, and a lot of our behaviors and thoughts and emotions depend on our brain circuitry operating properly.”

Boys were:
  • Twice as likely to smoke daily in their late teens.
  • More likely to engage in harmful activities.
“Both boys and girls were more likely to engage in a variety of harmful behaviors if they reported a history of TBI, but girls engaged in all 13 harmful behaviors we looked for, whereas boys were at higher risk of engaging in only nine,” Ilie said in a news release. “Sex matters when it comes to traumatic brain injuries.”

The findings clearly showed that TBI’s affected girls more than boys, but both were affected more as they aged.


The findings appear in the journal PLOS ONE.

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Tuesday, September 30, 2014

E-Cigarette Warning Labels Questioned by Critics

Not much is known about e-cigarettes and the dangers which accompany the devices. Many argue that they are healthier than traditional tobacco products, but there is still a high risk of nicotine addiction. The federal government has not mandated that e-cigarettes have warning labels, yet big tobacco companies which own their own e-cigarette products have begun placing warning labels on the devices.

Critics of the tobacco industry are questioning the motives of big tobacco companies who have issued strong voluntary warning labels on their e-cigarettes, according to The New York Times. In many cases the e-cigarette warnings are stronger than the warnings they place on their traditional tobacco products.

The makers of Marlboro, Altria, which also makes the e-cigarette MarkTen, has placed a label on the devices which reads, “nicotine is addictive and habit forming, and is very toxic by inhalation, in contact with the skin or if swallowed.” The makers of Vuse e-cigarettes, Reynolds American, have created a warning label that states the devices are not intended for persons “who have an unstable heart condition, high blood pressure, or diabetes; or persons who are at risk for heart disease or are taking medicine for depression or asthma.”

William Phelps, a spokesman for Altria, said its MarkTen warnings reflect “a goal to openly and honestly communicate about health effects.”

“Is this part of a noble effort for the betterment of public health, or a cynical business strategy? I suspect the latter,” said Dr. Robert K. Jackler, a professor at the Stanford School of Medicine who studies cigarette and e-cigarette advertising.

It is interesting that the warnings on the back of Marlboro's packs fail to mention the addictive nature of cigarettes, or that the use of cigarettes can lead to fatal health problems like heart disease and cancer.

“Why wouldn’t you warn about ‘very toxic’ nicotine in your cigarettes when you do so on e-cigarettes?” said Dr. Jackler.

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