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Wednesday, March 30, 2016

Los Angeles Sobering Center

For Americans who live on the streets, alcohol is often times a significant reason for keeping them on the street. Untreated alcoholism can lead to a number of dire circumstances: Loss of family, job and home are among the most common. Alcoholism also leads to a number of serious health problems that usually require expensive treatments, a bill that usually falls on the state and its taxpayers. Addressing homeless Americans living with addiction has become a top priority in some major cities, including Los Angeles.

L.A. County supervisors have plans to open a sobering center for the homeless living on skid row, The Los Angeles Times reports. The downtown center could relieve the yearly burden placed on first responders and the state health care system. The sobering center could end up stopping the city’s emergency room revolving door that homeless alcoholics go through multiple times per year. The county supervisors say that some homeless men and women cycle between the streets and L.A. County-USC Medical Center 50 times a year, they write:

"This is a scenario that plays out hundreds of times a month with no meaningful intervention for the patient and at great cost to the L.A. Fire Department and health care services."

The new facility will be located in a former mental health center on Maple Avenue, according to the article. County officials claim that the center will be able to treat as many as 8,000 patients each year, with the average stay being eight to 23 hours. The sobering center will cost $2 million to develop, $3.4 million a year to maintain and will be run by the Department of Health Services.

The director of community programs for the health department, Mark Ghaly, hopes that the center will keep the homeless from going to jail, according to the article. A realization that can come to fruition through urgent care centers working closely with the sobering center.

“It’s really the intersection of health and the criminal justice system,” said Ghaly.

Tuesday, March 29, 2016

FDA Calls for Generic Abuse-Deterrent Opioids

Abuse-deterrent opioids are prescription painkillers that have properties that make it more difficult (not impossible) for people to use the drugs in unintended manners, such as snorting or injecting. There has been a lot of criticism in recent years in light of the American opioid epidemic, that pharmaceutical companies have not done enough to mitigate the dangers of their products. While there are abuse-deterrent opioids on the market, there is nothing requiring drug companies to modify their drug formulations for combating abuse.

Part of the problem with abuse-deterrent opioids is that they are only available in brand-name narcotics, such as OxyContin ® (oxycodone). Brand-name prescription drugs are always more expensive than generic forms, and many health insurance plans will refuse to cover brand-name drugs whenever a generic is available.

Last week, the Food and Drug Administration (FDA) announced that a “black box” warning would be given to immediate-release prescription opioids. Additionally, the FDA called upon generic drug manufacturers to redesign their medications for inclusion of abuse-deterrent properties, HealthDay reports.

“For the millions of Americans who suffer from significant pain, and the health systems that serve them, generic opioids can be an appropriate and affordable option for patient care,” said FDA Commissioner Robert Califf, M.D, in a statement. “We recognize that abuse-deterrent technology is still evolving and is only one piece of a much broader strategy to combat the problem of opioid abuse. But strongly encouraging innovation to increase access to generic forms of abuse-deterrent opioid medications is an important element in that strategy.” 

With as many as 28,000 people losing their life from opioid overdoses each year, it is vital that drug manufacturers do their part in the fight to save lives. There are about 44 overdose deaths linked to prescription opioids everyday in the United States, according to the Centers for Disease Control and Prevention (CDC).

The American opioid epidemic, above all else, requires addiction treatment services. It could be argued, that making it harder to abuse drugs does little to combat the root problem - addiction. If you or a loved one is battling opioid addiction, please contact Hope By The Sea. We can help you turn your life around, living a life free from all mind altering addictive substances.

Wednesday, March 23, 2016

Black Box Warning Immediate-Release Opioids

The U.S. Food and Drug Administration (FDA) has caught a lot of flack in recent years about not doing enough to quash the prescription painkiller epidemic. That is not to say this criticism has been without merit, especially when you consider the fact that the agency approved new opioid medications in the midst of a crisis that claims over forty lives every day, such as Zohydro - a pure form of hydrocodone. While the FDA is not solely responsible for the opioid epidemic, they are in a position to stem the tide.

This week, the FDA announced that it will now require prescription opioids carry a “black box” warning label, CNN reports. The requirement will inform doctors and patients about the potential risk of: abuse, addiction, overdose and death. The label will only apply to immediate-release opioids, such OxyContin ® (oxycodone) and fentanyl; extended-release opioids which are usually taken twice daily have had black box warnings since 2013.

“Opioid addiction and overdose have reached epidemic levels over the past decade, and the FDA remains steadfast in our commitment to do our part to help reverse the devastating impact of the misuse and abuse of prescription opioids,” FDA Commissioner Robert Califf, MD said in a news release. “Today’s actions are one of the largest undertakings for informing prescribers of risks across opioid products, and one of many steps the FDA intends to take this year as part of our comprehensive action plan to reverse this epidemic.”

The FDA points out that 90 percent of prescription opioids are immediate-release pills. Immediate-release opioids are generally not as potent as extended-release; however, they are taken more often throughout the course of the day - generally every four to six hours. Despite being less potent, the risk of overdose and death are just as real. Extended-release opioids were given a black box warning first because they were considered to be sought after by addicts more often, according to the article. There are some concerns that the new requirement for immediate-release opioids will not be enough, considering that patients who are prescribed a drug with the disclaimer will have to go to the pharmaceutical company’s website to learn what the warning is about.

The FDA’s move is certainly important and should do some good, but will it be enough? Senator Ed Markey, of Massachusetts, a state that has been hit particularly hard by the opioid epidemic is not convinced that it will be, he believes the black box warning requirement is "too little, too late."

"Unfortunately, it has taken FDA far too long to address the grave risks of these drugs that have claimed the lives of thousands this year alone," Markey said in a statement.

Tuesday, March 22, 2016

Ignition Interlocks Save Lives

People who drive under the influence of alcohol are gambling with their life and the lives of others. Despite both heavy punishments and financial penalties, people continue to drink and drive. In a number of states, those convicted of drunk driving are now required to install ignition interlock devices in their vehicle before they can have their license reinstated. Ignition interlocks prevent vehicles from starting, if the driver has been drinking, even if their blood alcohol content is elevated from mouth wash.

New research indicates that states that require ignition interlocks saw 15 percent reduction in alcohol-related accident fatalities, Reuters reports. The findings come from National Highway Traffic Safety Administration data from 1999 to 2013. The study appears in the American Journal of Public Health.

“We were able to see a real improvement in states that require them for all drunk driving convictions,” said lead author Elinore J. Kaufman, a student with the Health Policy Program at the University of Pennsylvania in Philadelphia. 

The National Conference of State Legislatures reports that 23 states mandate ignition interlock for all drunk driving convictions, according to the article. All 50 states have some form of interlock legislation, but not every state requires the use of them. At the time of the study, only 18 states required those convicted of drunk driving to install interlock devices. The researchers compared alcohol-related crash deaths in those 18 states to the 32 states without interlock requirements.

“Between 2004 and 2013 more than 900 lives were saved, and if every state had this law it would be 2,600 lives,” Kaufman said. “Taking the decision out of the hands of people when they’re already drunk and making it easier on police can really make a big difference.”

At Hope By The Sea we understand that alcohol abuse happens for many reasons, but individuals can regain control of their lives and learn to live without using alcohol as a crutch or escape. Unfortunately, many individuals are unable to accept permanent separation from alcohol and continually try to have one drink or two, which restarts the cycle of addiction and quickly leads to self-destructive behaviors. Contact us to learn more about treatment and recovery.

Thursday, March 17, 2016

CDC Issues New Prescribing Guidelines

Prescription opioids are not going anywhere, anytime time soon, but there are steps that can be taken by doctors to mitigate the opioid epidemic we face. The use of prescription drug monitoring programs (PDMPs), in recent years, has given doctors and pharmacies the ability to determine which patients are “doctor shopping” - that is, when a patient visits multiple doctors every month for the same types of drugs. What’s more, the PDMPs also show which doctors are overprescribing opioids.

The efforts to curb prescription opioid abuse cannot stop at monitoring programs. Doctors need to be educated on how to spot signs of addiction. Screening patients for addiction will help doctors identify and refer patients to the proper services that can help them break the cycle of addiction. What’s more, the Centers for Disease Control and Prevention (CDC) has issued new prescribing guidelines for primary care physicians treating chronic pain, according to U.S. News & World Report. The guidelines recommend that doctors use opioid narcotics for people with:
  • Cancer
  • End-of-Life or Palliative Care
  • Serious Illnesses
The CDC suggests that primary care physicians perform urine screens on all patients before prescribing opioids, the article reports. The urine testing would not just apply to new patients, but preexisting patients as well. If a preexisting patient tests negative for opioids, it could mean that they are selling their medication, according to the article. If a new patient tests positive, it could be a sign of doctor shopping.

"It's a way to find out what level of opioids the patient might already be on," said Becky Vaughn, vice president of addictions at the National Council for Behavioral Health, who is familiar with the guidelines. "If someone already has a level of the drug when they come in to the doctor, then that obviously needs to be taken into account before a patient is given the medication." 

While the agency guidelines, if implemented, are likely to be effective, physicians are not required to heed the recommendations. Hopefully, primary care physicians will get on board, considering that they are on the front line of this insidious epidemic.

Tuesday, March 15, 2016

Medical Students and Alcohol Abuse

alcohol abuse
People who work in vocations that are accompanied by a lot of stress will often times turn to drugs and alcohol to cope. That could mean having a couple drinks at the end of the work day or having 12. Naturally, people who drink excessively to cope with their mental toil are at a heightened risk of a substance use disorder developing. Perhaps even more concerning, research has been conducted that indicates that people in college preparing for careers that can be stressful, such as law students, will drink more than their peers who are studying other fields.

It's not just law students, a new study has found that medical students are more likely to abuse alcohol than their peers in different courses of study, Science Daily reports. The findings come from a survey of 12,500 medical students. The study was conducted by researchers from the Mayo Clinic, and was published in the journal Academic Medicine.

Medical school places huge workloads on students which can be cause for some to burnout. The researchers linked emotional exhaustion or feelings of depersonalization to alcohol abuse, according to the article. Other factors for heightened alcohol use include:
  • Educational Debt
  • Being Younger Than Most Peers in Medical School
  • Being Unmarried
"Our findings clearly show there is reason for concern," said Liselotte Dyrbye, M.D., Mayo Clinic internist and senior author of the paper. "We recommend institutions pursue a multifaceted solution to address related issues with burnout, the cost of medical education and alcohol abuse." 

Attending any institution of higher learning can cost a lot of money when all is said and finished. Those who then go on to become doctors can rack up even more serious debt. People who graduated from medical school in 2014 had an average of $180,000 in debt, the article reports. The cost of medical school jumped by over 200 percent between 1995 and 2014.

If you are a student whose alcohol use has gotten out of hand, please contact Hope by the Sea. We can help you break free from alcohol, and help you learn how to cope with stress without having to turn to mind altering substances.

Wednesday, March 9, 2016

Synthetic Marijuana Proves Difficult to Screen

synthetic marijuana
Synthetic drugs continue to make headlines despite the continued effort from both government officials and law enforcement to put a lid on the problem. Arguably, synthetic marijuana continues to be the most popular synthetic drug; however, unlike traditional cannabis which has relatively predictable side effects - synthetic marijuana does not. Synthetic marijuana is made by spraying chemicals on plant material, which users then smoke. There is no oversight or human testing conducted before the insidious products are shipped out for personal use.

Synthetic marijuana is sold under a number of names, the most common being Spice and K2. Users can purchase packets of the drug online, usually without any form of identification - meaning teenagers can acquire it with relative ease. The most common negative side effects associated with synthetic marijuana use, according to the National Institute on Drug Abuse (NIDA), include:
  • Extreme Anxiety
  • Confusion
  • Severe Paranoia
  • Hallucinations
You may ask yourself why people would put themselves at risk of experiencing such troubling side effects, aside from being easy to obtain - most standard drug tests do not screen for the chemicals used to make synthetic marijuana. The difficulty in testing for synthetic drugs makes them ideal for a number of people who cannot get away with using traditional drugs. Perhaps even more concerning, law enforcement officials are finding it hard to prove that synthetic drug use is the cause of traffic accidents, The Seattle Times reports. While synthetic marijuana use is not a major problem in Washington, partly because traditional cannabis is legal, those who are drug tested for employment have been turning to these dangerous drugs.

In some cases of vehicular traffic deaths, prosecutors have had to charge defendants with lesser offenses because proving synthetic drug use is difficult, according to the article. There have been a number of cases of synthetic marijuana users experiencing blackouts behind the wheel, which has resulted in injuries to others.

“Synthetic marijuana products are very dangerous drugs. We don’t know what’s in them, they’re not tested for safety or efficacy, and the effects are entirely unpredictable. Of all the abused drugs out on the market, synthetic marijuana scares me the most,” said Dr. Alexander Garrard, clinical managing director of the Washington Poison Center.

Tuesday, March 8, 2016

How to Get Doctors to Stop Overprescribing?

If you think that doctors understand that they are one of the major enablers of the prescription opioid epidemic, you may be troubled to learn that many doctors are prescribing opioids the same way they always have. In fact, new research suggests that even when the government warns doctors who are overprescribing, their prescribing practices rarely change, Reuters reports. The research was published in Health Affairs.

With 44 people losing their life to prescription drug overdoses every day, it is hard to believe that some doctors are unaffected. If a doctor is found to be prescribing more narcotic medications than their peers, a government agency may send the physician a letter with the hope that it will bring about change. Unfortunately, researchers at the Mailman School of Public Health at Columbia University found that the letters did not lead to prescription reductions, according to the article. While the findings are troubling to say the least, the researchers hope their study will result in the development of methods that will force physicians to heed the request of the government.

“Even though we weren’t able to show that the letters were effective, this information is still useful for policymakers,” lead researcher Adam Sacarny said in a news release. “Based on these results, we’re now experimenting with different letter designs and making other changes to see if another approach can yield reductions in overprescribing.” 

The findings come from an analysis of Medicare data from 2011-2013, the article reports. The researchers found 1,525 doctors and other care providers who prescribed significantly more narcotics than their peers, being responsible for 406 percent more prescriptions than their peers. The research indicated that of the heavy prescribers, they were made up of:
  • About 60 percent were general practitioners.
  • 20 percent were nurse practitioners.
  • 20 percent were specialists.
The risky prescribers were split into two groups, one of which received a letter from the Centers for Medicare and Medicaid Services, according to the article. The researchers saw little difference in the prescribing practices of both groups after 90 days.

Wednesday, March 2, 2016

How Marijuana Affects Emotional Process

With November quickly approaching, the more we understand about marijuana the better. A number of states, including California, have marijuana legalization on the ballot. If passed, it will mean that adults over the age of 21 years of age will be allowed to purchase and use cannabis legally. As of right now, there are four states which have recreational use laws, they include Alaska, Colorado, Oregon and Washington. This November, the four states likely to join the pack are Arizona, California, Maine and Nevada.

While marijuana legalization remains to be a hot button topic because there is still a lot we do not understand about the short and long term of effects of marijuana use, the silver lining is that the states that have taken a more relaxed stance on the drug have paved the way for new research on the drug.

New research, conducted at Colorado State University, sought to determine the effects of marijuana on the emotional process, Science Daily reports. The researchers found that marijuana use can affect one’s ability to recognize, process and empathize with emotions, such as anger, happiness and sadness. The findings were published in PLOS ONE.

The researchers connected 70 legal cannabis users to electroencephalograms (EEG) and showed them pictures of faces depicting four separate expressions, according to the article. The expressions include:
  • Angry
  • Fearful
  • Happy
  • Neutral
The participants who used cannabis responded more to the negative expressions, and they had a diminished response to positive expressions. The research showed that marijuana users were less able to empathize with their emotions, when compared to the controls, the article reports. Cannabis users had more trouble "implicitly" identifying emotions. Lucy Troup, assistant professor of psychology at CSU, points out that:

"We're not taking a pro or anti stance; but we just want to know, what does it do? It's really about making sense of it."

Tuesday, March 1, 2016

Disguising Fentanyl As Oxycodone

Two of the most commonly sought after prescription narcotics that people abuse are oxycodone and Percocet, opioid painkillers that are highly addictive. As doctors prescribe such drugs with more caution, many users are finding it more and more difficult to acquire the drugs, forcing them to turn to the street for either diverted medication and/or heroin. Naturally, whenever one buys something from black markets, there is little guarantee they will get what they thought they were buying.

A couple weeks ago we wrote about researchers who are working on developing a vaccine that render the extremely powerful opioid narcotic fentanyl useless by destroying the drug before it crosses the blood brain barrier. It would seem that such a tool could not come any sooner, considering new reports of people disguising fentanyl as less potent opioids, the Associated Press reports. Fentanyl can be manufactured with relative ease in clandestine laboratories, and is 80-100 times more powerful than morphine.

If people are not aware that they are using fentanyl, it can be a recipe for disaster due to the heightened potential for a fatal overdose. Recently, Tennessee officials have 24 cases where pills labeled as oxycodone or Percocet that were actually fentanyl, according to the article. What’s more, federal agents seized 900 pills marked as oxycodone in Cleveland, which they later discovered to actually be fentanyl. 

"These pills are truly a fatal overdose waiting to happen," said Carole Rendon, acting U.S. Attorney in Cleveland. 

You might ask yourself, why would someone mark a more potent drug as being something less strong? It turns out that while fentanyl is a lot stronger, oxycodone fetches a much higher price; an incentive that can be deadly to unsuspecting addicts.

"People might otherwise say, 'I know I can abuse this much of oxycodone,' and they may be in for a really, really bad surprise when they find out that's fentanyl and not oxycodone," Dr. Thomas Gilson, the Cuyahoga County, Ohio medical examiner. 

The nation is in the grips of an opioid epidemic, and while it may be more difficult to acquire the highly sought after prescription opioids, there are always going to be people who figure a way around such obstacles. The risks are too high, if you struggle with prescription opioid and/or heroin addiction, please contact Hope by The Sea to begin the journey of recovery.

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