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Tuesday, June 30, 2015

Reformulating Opioid Medications May Not Solve The Problem

In recent months there has been much debate regarding the efficacy of tamper-resistant opioid medications. Prescription drugs with abuse-deterrent properties are designed to make it more difficult for addicts to crush medications to be snorted or injected. While there is some evidence that reformulated OxyContin ® (oxycodone) has reduced overall use of the drug, there is data which suggests that the overall number of opioid overdose number has not decreased, ScienceDaily reports.

Many addicts that are presented with tamper resistant medications will often turn to other opioid drugs that do not host such properties. Sadly, a number of addicts have turned to heroin as a stronger and less expensive alternative. Reformulating existing opioid medications to make them harder to abuse may not do the trick, especially if addicts will just pivot to other narcotics, according to a new commentary in the Canadian Medical Association Journal (CMAJ).

"Misuse and diversion of opioids is a complex problem that requires a comprehensive solution; simply substituting one formulation for another will not work," writes Dr. Pamela Leece, Dalla Lana School of Public Health, University of Toronto, with coauthors. 

While the United States uses the vast majority of prescription opioid narcotics, Canada has seen a dramatic rise of opioid use in recent years. From 1991 to 2007, oxycodone prescriptions in Ontario rose 850%, according to the report. The number of opioid overdose deaths doubled between 1991 and 2004.

The authors conclude:

"Regulations requiring tamper resistance represent an expensive, technical approach that is influenced by pharmaceutical interests and cannot solve the opioid crisis. An evidence-based, multifaceted strategy is needed -- one that has real potential to curb opioid-related harms at a population level." 

The commentary can be read in the Canadian Medical Association Journal.

Wednesday, June 24, 2015

Medical Marijuana Does Not Lead to Increased Teenage Use

The legalization of marijuana for both medical and recreation use is a hot button topic in the United States. There are currently 23 states and D.C. which have approved medical marijuana programs, as well four states which have legalized the drug for adult recreational use. It is expected that those numbers will rise after the polls close in 2016.

Marijuana, no matter the purpose for its use, causes euphoria and can lead to addiction. It is for those reasons that many are opposed to states adopting more relaxed views about the drug; and many have concerns that such tolerances will lead to greater adolescent use. However, new research suggests that there is no evidence indicating that medical marijuana legislation leads to increased use among teenagers, Medical News Today reports.

"Our findings provide the strongest evidence to date that marijuana use by teenagers does not increase after a state legalizes medical marijuana," states study author Dr. Deborah Hasin, professor of epidemiology at Columbia University Medical Center in New York.

The findings arise from the national Monitoring the Future survey data, which involves more than one million students aged 13-18, and was analyzed by researchers. Between 1991 and 2014, there were 21 of the 48 contiguous states which passed medical marijuana laws, according to the article.

While there were higher rates of marijuana use among adolescents in medical marijuana states, the researchers found no evidence suggesting that the rates change after legislation was passed. This research is important, because of the dangers associated with adolescent marijuana use, which include:
  • Short-Term Impairments in Memory
  • Short Term Co-ordination Loss
  • Risks of Psychiatric Symptoms
  • Cognitive Impairments
  • Substance Abuse
If medical marijuana is not responsible for the increased use among adolescents, the researchers point out that it is important to identify the cause. "Because early adolescent use of marijuana can lead to many long-term harmful outcomes, identifying the factors that actually play a role in adolescent use should be a high research priority," notes Hasin.

The findings were published in The Lancet Psychiatry.

Tuesday, June 23, 2015

Over 25,000 Lives Saved by Naloxone

All over the country lives are being saved daily by the opioid overdose reversal drug naloxone - sold under the brand name Narcan ®. If naloxone is administered in a timely fashion, the drug can induce nearly instantaneous opioid withdrawal and can potentially save the lives of those who would have otherwise perished. In fact, a new government study has found that naloxone kits were responsible for nearly 27,000 drug overdose reversals between 1996 and 2014, HealthDay reports.

The American Society of Health-System Pharmacists reports that the drug can reverse the common symptoms of an overdose, including:
  • Depression of the Central Nervous System (CNS)
  • Depression of the Respiratory System
  • Hypotension
“U.S. and international health organizations recommend providing naloxone kits to laypersons who might witness an opioid overdose; to patients in substance use treatment programs; to persons leaving prison and jail; and as a component of responsible opioid prescribing,” the researchers wrote.

Paramedics and law enforcement are not the only ones saving lives; the friends and families of addicts who are equipped with Narcan ® nasal kits have saved thousands of lives. There are a number of organizations throughout the country who provide and train non-medical personnel to use naloxone, with more than 600 such groups; in 2013, the report found that there were 20 states that had no organizations in place to train friends and family members to use the life saving drug, according to the article. Research indicates that that allowing greater access to naloxone will only result in more lives saved.

“Overdoses are often witnessed by other drug users and family members of drug users,” notes lead researcher Eliza Wheeler, DOPE Project Manager at the Harm Reduction Coalition in Oakland, California. “There is a reluctance to call 911 among people who use drugs, so people were managing overdoses on their own — unsuccessfully in many ways. So programs started educating people who are likely to witness overdoses in how to deal with them.”

The findings were published in the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Wednesday, June 17, 2015

New Conservative Support for Needle Exchanges

A recent outbreak of AIDS and Hepatitis C has led a number of conservative lawmakers to change their long held beliefs about the importance of needle exchanges in their home states, The New York Times reports. Intravenous drug use is a major problem, a rise in heroin use across the country and IV prescription opioid use has resulted in increased rates of disease transmission. This problem could be mitigated if addicts had greater access to clean needles.

Traditionally, House Republicans have had a tough stance on needle exchanges, banning them outright. However, as states grapple with increased IV drug use which has resulted in the outbreak of disease, such as Kentucky and Indiana, the need for needle exchanges becomes more apparent.

Governor Mike Pence of Indiana, a Republican, recently reversed his position of banning needle exchanges, allowing such programs in parts of his state, according to the article. Representative Harold Rogers of Kentucky, a Republican, was always an opponent to needle exchanges, but with the rise in IV heroin use in his district, a change in position was warranted.

“I would count this cautiously as a win,” said Daniel Raymond, Policy Director for the Harm Reduction Coalition, an advocacy group focused on health issues related to drug use. “I think that Congress is listening, including members from red states and purple states.”

A proposed bill put before the house would give officials the power to use federal grant money to provide support for state and local drug treatment programs that include needle exchanges. Although, the House annual health spending measure would still prohibit the use of federal dollars to buy sterile needles or syringes, the article reports.

The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both recommended needle exchange programs.

Tuesday, June 16, 2015

Many American Adults Want to Ban Powdered Alcohol

Despite the approval of powdered alcohol in March, a new poll suggests that sixty percent of American adults want a complete ban on powdered alcohol in their state. The potential for teenage misuse of powdered alcohol is what fuels adult concerns, HealthDay reports. A number of states have already taken measures to ban the use and sale of powdered alcohol, including Louisiana, South Carolina and Vermont.

Powdered alcohol, most notably Palcohol, created by the company Lipsmark, is sold in pouches and comes in a number of different flavors. When the powder is mixed with water, users can quickly create variations of popular mixed drinks. Opponents of Palcohol have fears that the product can be easily concealed by teenagers in their pockets.

"Given that several states are considering legislation about powdered alcohol, our poll looked at what the public thinks about this new product," Dr. Matthew Davis, director of the University of Michigan's C.S. Mott Children's Hospital National Poll on Children's Health, said in a news release. "The majority of adults agree that powdered alcohol may spell trouble for young people."

The poll found that:
  • 81 percent are concerned that it will be easy for minors to buy powdered alcohol.
  • 84 percent support banning online sales.
  • 85 percent believe powdered alcohol should not be marketed on social media sites.
  • 85 percent worry that powdered alcohol will increase alcohol use among minors.
  • 90 percent of adults are concerned that powdered alcohol will be misused by minors.
"In the U.S., parents, communities and health care providers already face serious challenges with underage alcohol abuse and its harmful effects on children's health. This poll indicates common concern among our communities over potential abuse and misuse of powdered alcohol, as well as the product's potential to exacerbate the problem of underage drinking," Davis said.

Several other states are considering legislation that would put a stop to powdered alcohol, according to the article.

Wednesday, June 10, 2015

Using Social Media to Quit Smoking

Young adults looking to quit smoking may consider using nicotine patches and gums to aid them in their efforts; these are smoking cessation programs which may prove fruitful. However, new research suggests that young adults who use social media may be twice as successful when compared to those using traditional methods, Science Daily reports.

"These finding suggest that the creators of public health campaigns need to evaluate how they use social media channels and social networks to improve health, especially with regards to younger demographics," said lead study author Bruce Baskerville, a senior scientist at the Propel Centre for Population Health Impact at Waterloo.

Researchers at the University of Waterloo looked at two smoking cessation programs. One was a telephone hotline for young adults, the other was a social media-based campaign called “Break It Off." The research team found that of the young adults who used Break It Off, 32 per cent of smokers had quit after 90 days of using the programs apps and web tools. Only 14 percent of those who used the telephone hotline had quit after three months in the program, according to the article.

"Traditional cessation services can have limited reach and this reduced visibility lessens their impact in a digital era," said Baskerville. "Because they are such heavy users of social media, these platforms provide an alternative and successful way of reaching smokers who are less likely to relate to other cessation programs."

Break It Off was launched in January 2012, a project of the Canadian Cancer Society. The program uses interactive website, social media, and a smartphone app to reach young adults, the article reports.

The findings were published in Nicotine & Tobacco Research.

Tuesday, June 9, 2015

Officials Use Website to Determine Prescription Drug Prices

A website, which on the surface appears to provide a valuable tool for addicts looking to find the going price of certain prescription drugs, may actually prove more valuable for law enforcement. StreetRx is the name of a website where people can anonymously post how much they paid or sold prescription drugs for on the black market, The Denver Post reports. Law officials and academics can use the site to track prescription drug price trends; the site also gives undercover officers an edge when conducting prescription drug stings on the street.

StreetRx helps officers make decisions about undercover buying and selling. In order for undercover officers to seem legitimate to dealers, they need to have an understanding of what addicts are currently paying for a particular drug, according to the article. The site has about 2,500 unique visitors a day, many of which are posting drug prices.

”The biggest value for us is, if an undercover agent is posing as an addict or a dealer, he has to know what he should be offering to be credible,” said John Burke, head of the Warren County Drug Task Force in southwest Ohio.

The website was founded five years ago by Dr. Richard Dart, director of the Rocky Mountain Poison and Drug Center. StreetRx gives officials a better understanding of market forces, showing them which policies are having an effect on the prescription drug epidemic. When OxyContin was reformulated, incorporating abuse-deterrent properties, both the street popularity and price of the drug decreased, the article reports.

"They changed the formula so you can't crush it easily," Dart said. "If you get it wet, it gets gummy. Not good for intravenous abuse, which delivers a drug more quickly and at greater strength. A drug taken orally is only partially absorbed. It was a huge success."

Friday, June 5, 2015

Prescription Drug Tracking Systems

In the United States, efforts to combat prescription drug abuse have made it more difficult for addicts to “doctor shop,” the act of going to multiple doctors for the same types of drugs. Before the advent of prescription drug monitoring programs (PDMPs), it was quite simple for addicts to see multiple doctors in single day. PDMPs have practically eliminated the problem, with active programs in 49 states. Left with no other options prescription drug addicts started going to the emergency room to get their drugs. As a result, some states have developed prescription drug tracking systems for emergency rooms, NPR reports.

Hospitals emergency rooms have implemented tracking systems which flag potential abusers in New Mexico, Texas and Wyoming. The Cheyenne Regional Medical Center in Wyoming has removed the decision to prescribe painkillers to patients from the doctor on duty, according to the article. Monthly meetings are held by the hospital’s doctors and administrators to determine whether patients who are flagged for what appears to be unhealthy behavior will be designated as abusers.

Acquiring the label of abuser means two things: First, the individual's electronic medical records will host bold red letters indicating that the patient has been flagged. Second, the hospital will mail a certified letter to the identified abuser, the letter states that the hospital will no longer prescribe painkillers to them for anything other severe emergencies, the article reports.

A similar program in New Mexico not only reduced emergency room visits, it actually saved the hospital money. Dr. Eric Ketcham, who helped create the prescription drug tracking system at San Juan Regional Medical Center in Farmington, New Mexico, said that that ER visits dropped by 5 percent annually and the hospital saved about $500,000 a year because many people getting prescriptions lacked insurance.

"We assumed we would probably lose money," Ketcham says. "We thought of it as a public health initiative."

Thursday, June 4, 2015

First-Ever Report on Worldwide Addiction Statistics

Around the world people use drugs (both illegal and legal) and alcohol, but there has never been comprehensive report conducted on how much addictive substances are abused. A team of researchers in Australia analyzed worldwide data to develop the first-ever report on worldwide addiction statistics, NPR reports. The goal was to develop a baseline of drug and alcohol use, and to draw out comparisons of use among the different world regions.

The authors point out that they could only pool data from U.N. member states, but, lead author Dr. Linda Gowing, a professor at the University of Adelaide's School of Medical Sciences, says "we thought it would be extremely useful, and a good start, to have it all in one place." Compiling data on illegal drug use was the most difficult, simply due to the fact that such use is often done away from the public eye.

The researchers' analysis indicated that there are about 240 million people worldwide that are dependent on alcohol and more than a billion people smoke tobacco (20 percent of all humans). The report showed that around 15 million people use drugs via injection - like heroin. The numbers were drawn from the World Health Organization (WHO) and the United Nations Office on Drugs and Crime, according to the article.

The study indicates that alcohol has a greater impact on society than tobacco use. Alcohol takes a greater toll on “productive years of life lost,” said Gowing. Alcohol impacts work and relationships, and reduces quality of life. People who abuse alcohol die younger, and have poor health over a longer period of time. The report showed that people in Eastern Europe consume the most alcohol, and that people in Asia drink the least.

“One thing that stands out is countries that are predominantly Muslim have a much lower rate of alcohol consumption,” Gowing said.

The findings were published in the journal Addiction.
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