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Wednesday, November 28, 2012

Canada Allows More Oxycodone

It doesn’t take long for one to become dependent on pain medication with the amount of highly potent prescription opiates available. Acquiring a drug like OxyContin (oxycodone),even without a prescription, is not that difficult; a number of people will sell their unused medication for a pretty penny. Oxycodone is one of the most abused prescription narcotics and there is about to be a lot more of the drug available.

Six generic drug companies have just been given the approval by the Canadian government to manufacture oxycodone products. Apparently the Canadian health minister had been under pressure to forbid the generic version of OxyContin due to concerns about widespread abuse of the painkiller, but went ahead and approved more production of the drug, CBC reports.

Canadian Health Minister Leona Aglukkaq defended her move by saying that the drug is safe and effective when used as prescribed; announcing that drug manufacturers and pharmacists will be required to report spikes in sales, or changes in distribution patterns. Furthermore, the government will also require drug companies that manufacture oxycodone products to provide better education for healthcare professionals and the public regarding the dangers associated with the drug.

Montana Attorney General Steve Bullock sent a letter to Aglukkaq asking the government to reconsider its decision, saying this will make oxycodone easier to abuse, the Associated Press reports. Pointing out that features that OxyContin’s manufacturer, Purdue Pharma, had included to make the drug harder to abuse will not be included in generic versions.

“Studies have shown that the tamper-resistant changes OxyContin manufacturers have made to the drug have resulted in less abuse among addicts,” Bullock wrote. “I have concerns that allowing easier-to-abuse oxycodone in Canada could undo some of the work that both Canadian and U.S. government and community leaders have accomplished in combating this epidemic.”
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Monday, November 26, 2012

International Legalization Debate

Legalization is a hot-button topic these days in the wake of both Colorado and Washington legalizing the recreational use of marijuana. As a result, leaders in other nations have called for a debate regarding the impact of legalization on an international level. Four Latin American countries presidents have called for the international debate.

The presidents of Mexico, Belize, Honduras and Costa Rica have raised concerns about rising crime and violence related to the U.S. government’s drug wars, according to CBS News. Their report points out that it is no longer against the law in 10 Latin American countries to possess small amounts of marijuana; however, the production and distribution of marijuana remains illegal.

Mexican President Felipe Calderon stated that the legalization of recreational marijuana use in two states limits the United States’ “moral authority” to ask other countries to fight or restrict illegal drug trafficking, according to Fox News.

Calderon was joined by leaders of Belize, Honduras and Costa Rica in calling on the Organization of American States to study the new state laws’ impact. He stated that the United Nations (UN) should hold a special session on drug policy. The violence created by drug cartels in Mexico has been on the rise, which is mostly the result in large part because of drug consumption and arms smuggled from the United States, the article notes.

Many believe that legalization will reduce violence throughout North and South America. Nevertheless, legalization may also cause a steep rise in addiction which is a major concern among others and should be addressed.

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Wednesday, November 21, 2012

Drugged Driving Statistics Exceed Drunk Driving In California

Driving under the influence

Driving under the influence plagues this country on a daily basis. Everyday lives are lost as a result of people drinking and driving or driving and drugging. It turns out that more people test positive for drugs, illicit or legal, than those for alcohol in the state of California.


California study zeroed in on "drugged" driving

Almost twice as many drivers are likely to test positive for drugs that may impair driving, compared with alcohol, according to a new California study. 7.3 percent of drivers tested positive for alcohol, compared with 14 percent who tested positive for impairing drugs, including both illegal and prescription drugs, The Los Angeles Times reports.

Of those who tested positive for alcohol, 23 percent also did so for at least one other drug, according to the report. Marijuana was the most common drug found in the system of drivers. More than one-quarter of drivers who tested positive for marijuana also tested positive for at least one other drug. States which recently legalized marijuana should take note of this report.

1,300 drivers who voluntarily provided breath and/or saliva samples at roadside stops on weekend evenings took part in the survey conducted by the California Office of Traffic Safety.

“These results reinforce our belief that driving after consuming potentially impairing drugs is a serious and growing problem,” Christopher J. Murphy, Director of the Office of Traffic Safety, said in a statement.

KEYT.com reports on this new study

If you are having trouble viewing the video, you can see it here.

As we begin the holiday season, it is important to remember that driving under the influence of alcohol or any drug will endanger your life and those around you. We wish all of our readers a peaceful and safe Thanksgiving.
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Tuesday, November 20, 2012

Social Media for Interventions

Social media websites are used more than any other websites to share information with one another across the globe. The most popular of these is FaceBook, with more users than anyone could have ever imagined. What if FaceBook could be used to not only share information, but, rather to give people guidance with behavior problems and mental health or substance abuse problems? Please take a moment read Dr. Nathan Cobb's thoughts on the subject.

Cobb is a Research Investigator at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy®, a practicing physician, and expert in the field of behavioral informatics. His prior work as a smoking cessation counselor and computer programmer for health risk assessments were a springboard for the development of QuitNet, one of the first Internet based behavior change interventions. Dr. Cobb’s current work leverages social networks to effect behavior change through social support and social influence. This includes both retrospective exploration of a 10 year database of interactions of participants in the QuitNet network, as well as novel interventions using social utilities such as FaceBook and alternative delivery mechanisms such as text messaging.

“This month Facebook announced that it had reached one billion active users. Not one billion accounts or registrants, but one billion individuals using the website every month. Of these approximately 200 million are in the U.S. and Canada – a staggering number. Each one of the users is connected to hundreds of their friends, actively exchanging information, sharing photos and news and even playing games together. 

Two studies published at the same time in the American Journal of Preventive Medicine suggest that Facebook can do more. It can be used to deliver evidence-based health behavior interventions. Particularly interesting was the study by Sheanna Bull and colleagues where they used Facebook with youth to increase condom use and potentially prevent sexually transmitted diseases. Not only did their randomized control trial show that it’s possible to build an effective intervention within Facebook, but they also showed that a well-designed intervention will spread from friend to friend more efficiently than something that lacks interest or utility. 

Taken together, these facts suggest that we may be on the cusp of a tremendous change in how we deliver health behavior interventions. An intervention that can reach people where they live and work, but can also involve and spread through their own social network, would have tremendous impact. An accompanying editorial that I wrote with Dr. Amanda Graham lays out some of this potential. But equally important, here at Legacy we have similar work underway, including a randomized control trial funded by the National Cancer Institute to evaluate how a Facebook app may spread through a quitter’s network and involve their friends. 

We think that health behavior change interventions in the future will be inherently social, leveraging the Internet to involve your friends, family and co-workers, but also exposing you to people you have never met. What role Facebook will ultimately play is unknown, but as of today, the future is incredibly exciting.”

In the scheme of recovery, maybe it doesn't matter where a person starts to seek help, but that the person starts somewhere!

Wednesday, November 14, 2012

Boston Drug Epidemic

Metropolitan areas are constantly struggling with illicit drug use due to the availability of such drugs. In the past decade we have seen a rise in prescription drug abuse like never before, which has somewhat shadowed the more notorious hard drugs such as methamphetamine and heroin. A new report has shown that the Boston area is being hit hard by the abuse of illicit drugs.  

A nonprofit group concludes that communities throughout Massachusetts are experiencing an epidemic of substance abuse. The Boston area has had a particularly high number of emergency room visits involving illicit drugs.

The Boston region ranked first among major metropolitan areas in emergency department visits involving illicit drugs, according to a report by the Massachusetts Health Council which cites a study by the Substance Abuse and Mental Health Services Administration in 2009.

Massachusetts Gov
ernor Deval Patrick called the report worrisome, according to the Associated Press. The problem was the easy availability of potent heroin, he said.

Communities need to remain vigilant against the dangers of illicit drugs and the heavy toll that they can put on communities across the nation.

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Monday, November 12, 2012

PTSD Research Honors All Veterans

Today is Veterans Day. Many will honor our Veterans by participating in community events, volunteering at a Veterans Administration hospital, visiting a cemetery to honor the fallen, or reaching out to thank Veterans for their years of service. There will be a few who really don't know the history of Veterans Day.
"On the 11th hour of the 11th day of the 11th month of 1918 an armistice between Germany and the Allied nations came into effect. On November 11, 1919, Armistice Day was commemorated for the first time. In 1919, President Wilson proclaimed the day should be 'filled with solemn pride in the heroism of those who died in the country’s service and with gratitude for the victory'".
We sometimes confuse Veterans Day with Memorial Day. Veterans Day is not to be confused with Memorial Day; Veterans Day celebrates the service of all U.S. military veterans, while Memorial Day is a day of remembering the men and women who died while serving.

PTSD research is another way to honor our Veterans

It may seem odd to consider scientific research as an honor to our Veterans, but when you think about this it is true. Many scientist work tirelessly to perfect research in the field of medicine to discover new ways to save lives on the battlefield discovering new surgical techniques and procedures to immediately react to the visible wounds. However, just as many research scientist work to study the invisible wounds like post traumatic stress disorder (PTSD).  Many people often wonder why some people are affected by PTSD and others are not. Perhaps even in our own families we have wondered about this, recognizing that brothers and sisters will volunteer for service and one or more may return with PTSD and the others do not.

New study looks at brain anatomy as it relates to PTSD

On November 5, 2012, the results of a new study were published in the Archives of General Psychiatry: Amygdala Volume Changes in Posttraumatic Stress Disorder in a Large Case-Controlled Veterans Group.  Here are some details of the study:
  • The lead author was Dr. Rajendra Morey, assistant professor of psychiatry at Duke University
  • The setting for this study was the Durham Veterans Affairs Medical Center
  • 200 patients, all combat veterans, were studied. All had served in Iraq or Afghanistan after September 11, 2001 
  • 99, roughly one-half, of the patients had a current diagnosis of PTSD
  • 100 of the patients had also been exposed to trauma, but did not have a diagnosis of PTSD
  • The authors also controlled statistically for the important potential confounds of alcohol us, depression, and medication use. 

The study's findings

According to the Courier Journal article, the study indicated:
"In combat veterans with post-traumatic stress disorder, the area of the brain that controls fear and anxiety responses is much smaller than normal, according to a new study. The finding is the first to provide evidence that a smaller amygdala is associated with post-traumatic stress disorder (PTSD), but it's not clear whether this smaller size is caused by PTSD or whether people with a smaller amygdala are more likely to develop PTSD."

One step closer...

Research is like most things in life...it happens one step at a time.  As Dr. Morey points out in the study's conclusions: Our results may trigger a renewed impetus for investigating structural differences in the amygdala, its genetic determinants, its environmental modulators, and the possibility that it reflects an intrinsic vulnerability to PTSD.

Learn a bit more about Veterans Day from The History Channel 

If you are having trouble viewing the video, you can see it here.

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Wednesday, November 7, 2012

Depression Is An Expensive Risk Factor For Employer Insurance Plans, But Less Than Obesity Or Physical Inactivity

Do you know someone who suffers from depression? While we all can sometimes feel sad, unhappy, or as we often say, "down in the dumps," clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time. For the majority of adults their everyday life includes "going to work," whether they are an employee or self-employed, clinical depression will have an impact on productivity. And it is important to remember that while bottom-line productivity is important, a new study now examines the cost of depression as a health risk factor and how it relates to health insurance expenditures for employee health plans.

Considering health risk factors

Much of the Affordable Care Act is yet to be put in place, but one important part of the Act encourages employers to be pro-active in health care preventative measures. A new study was published online in the November issue of Health Affairs: Ten Modifiable Health Risk Factors Are Linked To More Than One-Fifth of Employer-Employee Health Care Spending.

Study's details

This study was conducted by lead researcher Ron Z. Goetzel, a research professor and the director of Emory University's Institute for Health and Productivity Studies and a vice president of consulting and applied research at Truven Health Analytics, in Washington, D.C. According to the study's abstract:
"An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs."
Goetzel and his colleagues looked at the correlation between modifiable health risk and increased healthcare costs at seven organizations over three years.
  • The study surveyed 92,400 employees
  • The employers administered health assessments through the MarketScan database from 2005 to 2009.
  • Researchers did adjust for age, sex, health plan, location, industry type and other factors. 
  • Health risk factors studied were: High blood glucose, high blood pressure, obesity, tobacco use, physical inactivity, high cholesterol, poor nutrition, high alcohol use, stress, and depression.

Study's findings

According to a GlobeNewswire article the researchers found:
  1. The two health risk factors that contributed the most per capita per year to excess medical costs were obesity ($347) and physical inactivity ($178.6). Those were followed by depression ($128.2), tobacco use ($106.2), high blood glucose ($104.1), high blood pressure ($80.8) and stress ($38.3). 
  2. Persons with biometric values related to obesity, high blood pressure and high glucose had higher health care costs compared to those not at risk. Similarly, individuals with who were depressed, had high stress, smoked or were physically inactive also had higher medical costs.
  3. Physical inactivity and poor stress management also were cited as significant independent drivers of costs, and were also directly related to all the other risk factors in this study. 

Some final thoughts...

Hard numbers are always helpful. It is estimated that depressed employees make up 11% of the workforce. While medical costs associated with depression as a risk factor are high, these costs come in third behind obesity and physical inactivity.  If your employer offers any health promotion programs, carefully consider taking advantage of these programs. If you have a co-worker who you think would benefit from health promotion programs, encourage their participation.

Many years ago Benjamin Franklin offered this advice: An ounce of prevention is worth a pound of cure!  The same holds true today...

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Monday, November 5, 2012

What Are The Risks Associated Opioid Analgesics?

If you are a regular reader of our blog, then you know that we often write about the dangers involved in becoming addicted to prescription drugs particularly when they are prescribed for an acute or chronic pain. The headlines offer warnings of the dangers of opiate based prescription drugs and we know that many people will try opioids in this form simply because that are readily available, they are a legal form of the drug and many don't recognize the dangers; however, once addicted the individual will often turn to hard illegal drugs because they are cheaper and their source for the prescription form dries up. These headlines can work to make people fearful that if they receive a prescription for pain they will risk the chance of developing an addiction to opioids. Interestingly, experts often debate how many people actually do become addicted to opiate based prescription drugs.

Reviewing the research

This past month a new article was released online in the journal Addiction. Three researchers completed a  review of the literature: Development of dependence following treatment with opioid analgesics for pain relief: a systematic review.   This review was conducted by Silvia Minozzi, Laura Amato, and Marina Davoli from Department of Epidemiology, Lazio Regional Health Service, Cochrane Drugs and Alcohol Group, Rome, Italy.

Review methods

The aim of this review was to assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.
  • Reviewers examined 17 previous studies
  • These studies included date from 88,325 participants
  • Most studies included adult patients with chronic non-malignant pain
  • Two studies included patients who were being treated for cancer
  • One study included patients with a previous history of drug dependence
This systematic review prompted the researchers to conclude: Taken together, the studies found that 4.5 percent of people developed a dependency on the painkillers. This rate seems low, so it is important to remember it is an average and the researchers offer that the rate of developing a dependency ranged from 0 to 31%!

Other experts weigh in on the review's conclusions

As we said the online Addiction article was published on October 18, 2012; therefore, now some addiction experts in the United States have had time to read the article and offer some of their own observations. For example, according to Reuters news:
  • Addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine: "If you're a person that doesn't have a history of addiction and doesn't have any major psychiatric problems, narcotics are relatively safe as long as your doctor doesn't give you too much and uses the right medication."
  • Joseph Boscarino of the Geisinger Clinic in Danville, Pennsylvania, who studies pain and addiction offered: '"I think the jury's still out" on how worrisome prescription opioid addiction is.'

Some cautionary thoughts...

When research is conducted we always hope that it is extensive and thorough. Often new research or a review of previous research offers new facts or a revision of previously accepted facts. So what is the average person to do?  First, understand that opioids are addictive. Second, if you had a history of addiction and you are in recovery, then you need to share this information with your doctor so that he/she can prescribe appropriate pain medication. Third, if someone else in your household suffers from opioid addiction, then carefully monitor your prescription making sure that no one else is using your pain medication.

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