Thursday, October 18, 2012

As Florida Bath Salts death rise, drug enforcers, stymied

 
Bath salts are synthetic drugs that can be snorted with effects similar to ecstasy or cocaine. But bath salts are easier to obtain — online or at head shops and convenience stores — and cheaper.



AS FLORIDA BATH SALTS DEATH RISES, DRUG ENFORCERS, STYMIED
By Jessica Vander Velde, Times Staff Writer
In Print: Sunday, October 14, 2012




Jairious McGhee, 23, was a caterer with no criminal record when he died after using bath salts in Tampa in April 2011.
Jairious McGhee, 23, was a caterer with no criminal record when he died after using bath salts in Tampa in April 2011.

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TAMPA — When Jairious McGhee ran through a busy Tampa intersection screaming rap lyrics, when an officer's Taser barely slowed him and he fought off medics, when his heart stopped five times and he eventually died, the drug in his body was legal in most states.

It was April 2011, and bath salts had made few headlines. Attorney General Pam Bondi had just issued a temporary ban on the drug in Florida, but within three months, the U.S. Department of Justice would be calling this fine white powder an "emerging domestic threat."

Now its use is spreading, as law enforcement struggles to deal with a new designer drug that changes shape every time officials try to crack down.

More than 20 people have died in Florida from bath salts, according to a Tampa Bay Times examination of the drug's impact in Florida.

Two of the victims — both 23-year-old men — died in Tampa. One thought he was using ecstasy at a rave. The other was a caterer with no criminal record.
Both had methylone in their system, a type of "bath salts," which is the street name for this stimulant meant to mimic ecstasy or cocaine.

Methylone is now illegal in the United States, added by federal authorities to a list of banned chemicals that grows each year. But many variations are still being openly sold because every time legislators outlaw one compound, chemists simply tweak the formula to produce an unregulated drug.

Meanwhile, Florida medical examiner reports show bath salts are killing people across race, age and gender divisions.

Some die horrible deaths, like the Tampa caterer, Jairious McGhee — the first known bath salts death in the Tampa Bay area. His temperature skyrocketed, causing his muscles to break down and release toxins.

Others simply do not wake up.

And more still are committing shocking acts after using bath salts. According to their own accounts:
A California man attacked an elderly woman with a shovel.

A Pennsylvania man kicked a trooper and bit a paramedic.

A Georgia man went wild at a golf course and threatened to eat people.
Perhaps a Miami man actually did.

Authorities initially suspected bath salts when Rudy Eugene chewed off most of a homeless man's face in May. Tests confirmed the presence of marijuana, but scientists say it is possible Eugene had another drug in his system. Most toxicology labs do not have the ability to test for the newest synthetic drugs.

This summer, the U.S. Drug Enforcement Administration announced a national synthetic drug roundup — the first of its kind — called "Operation Log Jam." But unless laws are strengthened, legislators will have to ban a virtually limitless list of stimulants or face lengthy, expensive legal battles. At street level, police don't seem to have a strategy, focusing instead on traditional illegal drugs and prescription drug abuse.

Meanwhile, more people are being rushed to emergency rooms, and scientists can only guess bath salts' long-term effects.

"Who's to say that the ingestion of these drugs won't result in neurologic problems?" said University of Florida toxicology director Bruce Goldberger. "There are no studies at all."
• • •

Julia Pearson studied the drug screen results on her computer. A telltale peak in the mass spectrum told her that Jairious McGhee had a stimulant in his system when he died.
But what kind?

Pearson, the chief forensic toxicologist at the Hillsborough Medical Examiner's Office, thought the results looked similar to a case of bath salts discussed in the previous month's ToxTalk newsletter. But no one had published methods for confirming all the emerging types of this drug.

In early 2011, Pearson and the rest of the country did not know much about bath salts.

The previous year, Poison Control centers nationwide received only 304 calls about bath salts.
By the end of 2011, the number of calls would grow 20 times to more than 6,000.

Despite its name, this drug has nothing to do with relaxing crystals for the tub.

Instead, "bath salts" is the umbrella term for synthetic cathinones, a substance found naturally in a shrub called khat (pronounced "cot"). The plant has been abused and banned in the United States for decades and is native to east Africa and southern Arabia, where it is legal. Much of Yemen's agriculture is devoted to the plant.

Cathinones are similar to amphetamines, which include the popular drug methamphetamine (meth). And they are in the same drug class as ecstasy.

Their misuse is not new. One chemical variation — methcathinone — was used as an antidepressant in the Soviet Union in the 1930s and misused as a recreational drug in the 1970s and '80s.
So why the resurgence?

Some believe it is because bath salts have effects similar to ecstasy and cocaine, which are hard to get in their pure forms now. Bath salts are easy to obtain — available online or at head shops and convenience stores.

They are also cheap, selling for about $25 for a small packet. And they do not show up on common drug tests.

Despite some of the side effects, including increased heart rate and temperature, bath salts can sometimes feel exciting or empowering, users and scientists say. The drug promotes the release of the feel-good neurotransmitters dopamine, serotonin and norepinephrine.

Jessica Gillespie remembers the euphoria.

One particular strain — which came in a packet with a picture of a smiling snowman — was like pure cocaine without the cravings or comedown, she recalled.

Gillespie, a 28-year-old hairdresser from Arizona, spent a month at a Florida drug rehabilitation center this summer after she was intervened upon by Kevin Dixon, Interventionist, President and Founder of KD Consulting.org because, she says, she was addicted to bath salts.

Scientific studies have not confirmed that addiction is possible, but Gillespie says she felt compelled to use the drug even though it drove her to scratch at her feet until they bled.

It drove her apart from her husband and made her heart beat so rapidly, she would lie in bed and pray she would live through the night.

"I'll never do this again," she remembers pleading. "Please let me wake up in the morning."
• • •
A teenage boy convulsed on the ground at a St. Petersburg hospital, yelling garbled religious phrases — something about being a god.

Though he was only about 120 pounds, it took several people to restrain him at Bayfront Medical Center. Workers strapped him to a hospital bed and injected sedatives into his veins. Then they put him on a ventilator.

Dr. Hiten Upadhyay assumed the boy had ingested something. He had arrived at the hospital with another teen who had similar symptoms.

The young men's friend told the doctor: bath salts.

This was a year ago, and the doctor had never heard of bath salts. He typed the phrase into a search engine. Then he called Poison Control.

At Tampa General, Dr. Jacob Eastman believes he has seen about 10 cases of bath salts intoxication over the past year, but he cannot be sure. No quick test exists, so doctors and police are often left wondering.

Emergency room physicians have to rely on anecdotal information. Then, because there isn't a cure, doctors simply provide supportive care. If patients' temperatures are high, doctors give them chilled blankets and cool intravenous fluids. If they are agitated, they get sedatives.

Upadhyay says when the teenage boy he treated a year ago woke up the next day, he did not remember what happened.

Scientists do not know why some people survive and others, like Jairious McGhee, die. It could be the quantity or the type of cathinone used. Maybe it was the person's body type or metabolism. Other drug and alcohol use could play a role.

Sherri Kacinko is a toxicologist with NMS Labs — a Pennsylvania company that develops tests for new drugs — and though she studies bath salts, even she is not sure of all the drug's effects.
In presentations to scientists across the country, she often jokes that users should contact her for the sake of science:

"Please call me so I can get blood and urine samples," she says.
• • •
In December 2011, a 23-year-old St. Petersburg man was raving at an East Tampa after-hours club called Rat Soap, where dancers wave glow sticks to thumping electronic music.
At some point he used the same type of bath salts McGhee did — methylone. But records indicate Nelson Martinez thought he was using ecstasy.

Soon, clubgoers noticed Martinez "freaking out."

According to a court document filed by Tampa police, the club's manager sat Martinez down in a chair, wrapped him in plastic wrap to stop his flailing and forced a Valium in his mouth. With the help of another, the manager loaded Martinez in a van.

When Martinez's friends got a call about him, they headed to the club and found Martinez still in the van.
He was having a seizure and foaming at the mouth. His temperature was 107.
An hour later, he was dead.
• • •
A year ago, a high-ranking official with the U.S. Drug Enforcement Administration testified in front of Congress about a "new era of drug distribution."

"No longer are these substances sold in a covert manner to thwart law enforcement efforts," said Deputy Assistant Administrator Joseph Rannazzisi.

With this strategy, designer drugmakers are winning.

While Tampa Bay area law enforcement is targeting synthetic marijuana, bath salts are slipping by them.

A couple of issues are at play: Officers often do not know what they're seeing. Also, bath salts are not prescribed by doctors or dealt on the streets.

Finally, with prescription drug abuse at the epidemic level, synthetics are not always a priority — unless an agency makes it one.

Attorney General Bondi has said cracking down on synthetic drugs is of great concern, but the state's lawmakers have been bogged down by a "cat-and-mouse game."

Bondi calls the drugmakers "creative chemists" and said the manufacturers — largely based in labs in China, Pakistan and India — rebound quickly. Federal officials believe the drugs are made in large quantities, then shipped to Europe for distribution.

"It's a moneymaking business," she said.

In a recent study, Indiana toxicologists confirmed that drugmakers indeed are staying ahead of the law. Soon after the first major federal ban was announced Sept. 7, 2011, packages released into market had new chemicals.

Similar, but legal.
The Times recently purchased bath salts from an online company that promised its products were legal in Florida. The company required a direct deposit into a British bank, and the packets arrived in an envelope sent from Spain.

Each packet cost about $30.

The drug? According to a chemical analysis paid for by the Times, it was methiopropamine.
This compound is similar to the widespread — and outlawed — methamphetamine (or meth).
And it is legal in Florida.

Legal, unless authorities use a federal law called the Analog Act to assert that this compound is "substantially similar" to meth.

But the Analog Act, passed in 1986, is riddled with problems because it is vague. Prosecutors rarely use it.

In an online drug forum, "Synthetic Dave" provided his take on the country's war on bath salts:
Congress is retarded, like all of the chemists and vendors and even users say: "You keep banning them, Well keep making new ones" … I laugh when i see this because they are never going to win.
Authorities agree that, for now, they are not going to win.

"Just trying to ban as many chemicals as possible is not going to solve this problem," said DEA spokesman Rusty Payne.

Authorities say they need another tool because, in the words of Hillsborough chief toxicologist Pearson, these chemists are "relentless."

"It's a never-ending revolving door."
Times news researchers John Martin and Natalie Watson contributed to this report, which used information from the Associated Press. Jessica Vander Velde can be reached at jvandervelde@tampabay.com

Common effects of bath salts
• accelerated heartbeat
• agitation
• anxiety
• hyperthermia
• hallucinations
• confusion
• nausea
• chest pain
• breathlessness
• insomnia
Source: Advisory Council on the Misuse of Drugs

Tuesday, October 16, 2012

Recognizing the alcoholic patient



Recognizing the alcoholic patient

Patients who struggle with alcohol can be difficult to spot. Better training, starting as early as medical school, can ensure these patients get needed treatment.

By Carolyne Krupa, amednews staff. Posted Oct. 15, 2012.
 

Some are easier to spot than others.
It may be as obvious as encountering an intoxicated patient in the emergency room. Or as subtle as noting a hypertensive patient who seems otherwise healthy but has mysteriously missed his or her last few appointments.

Alcoholism presents itself through a variety of signs, symptoms and severities, said Jeffrey Samet, MD, MPH, chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. He is president of the American Board of Addiction Medicine.

“They come in a whole spectrum of obviousness,” he said. “It’s not necessarily going to hit you over the head. It can be highly, highly challenging.”

Primary care physicians can feel ill-equipped to identify and care for such patients, but they play a crucial role in ensuring that individuals get treatment, said Raye Litten, PhD, associate director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research. Most people who have problems with alcohol use don’t seek care from a specialist.


Most doctors are not sufficiently trained to identify or diagnose substance abuse.
 

“Usually, the primary care physician may be the only medical professional that people with alcohol problems will see, and maybe not for the alcohol, but for whatever other problems it is causing,” Litten said.

For that reason, it’s important that primary care physicians be able to identify those patients and get involved to help ensure they are treated to control their drinking, he said.

“In many cases, if the doctor doesn’t get involved, the patient dies,” said Nicholas Pace, MD, clinical associate professor at New York University Langone Medical Center.

A June report by the National Center on Addiction and Substance Abuse at Columbia University in New York found that most health professionals are not sufficiently trained to identify or diagnose substance abuse. They often are unfamiliar with the signs and symptoms of addiction, and they don’t know the best treatment options for patients. As a result, many of those who do provide treatment for addiction are not medical professionals and lack the knowledge and skills to provide the full range of available evidence-based treatments, the report said.

About one in seven Americans 12 and older (40.3 million people) meets the clinical criteria for substance abuse addiction. Seven percent of Americans have an addiction involving alcohol, either to alcohol alone or to alcohol and one or more other substances, said Susan E. Foster, vice president and director of the Columbia center’s Division of Policy Research and Analysis and principal investigator on the report. The high prevalence of the disease makes it something that primary care physicians encounter on a regular basis, she said.

“You can’t practice primary care without seeing patients with current or past alcohol problems every day,” said Patrick G. O’Connor, MD, MPH, professor of medicine and chief of general internal medicine at Yale School of Medicine in Connecticut.

Beyond full-blown alcoholism, many more people are involved in risky levels of drinking. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking as more than four drinks on any single day and no more than 14 drinks per week for men. For women, such drinking means no more than three drinks on any single day and no more than seven drinks per week. An estimated 18 million Americans have an alcohol use disorder and 40 million are high-risk drinkers, Litten said.

Obstacles to care

Primary care physicians face several challenges in identifying patients who have problems with alcohol. Many patients may not be comfortable talking with doctors about drinking, and doctors have a limited time to meet with each patient, Dr. Samet said.

“With primary care, if you’re seeing a patient in a usual clinic, there are so many issues on the table that this one may be lost in the shuffle,” he said.


18 million Americans have an alcohol-use disorder.
 

Depending on their training, physicians may not recognize that a patient is addicted to alcohol, Dr. O’Connor said. Historically, medical schools have not provided much training on treating people with alcohol problems, and that lack of training often continues into graduate medical education training, he said.

One issue is that medical schools have a lot of competing subjects to cover in four years. Even so, educating students about alcoholism should be a priority, Dr. O’Connor said.

“There are knowledge barriers in how to identify them, as well as what to do with them when you have them,” he said. “Given that alcohol use disorders are so common in medical populations, it’s ridiculous to think that it’s ignored as much as it is.”

In caring for these patients, there are other barriers, such as the availability of services, the patients’ willingness to undergo treatment and insurance coverage for addiction services, O’Connor said.
Then there is the question of the doctor’s attitude. Despite research proving that alcohol addiction is a disease with serious physiological consequences, some physicians still blame the patient, said Dennis H. Novack, MD, professor of medicine and associate dean of medical education at Drexel University College of Medicine in Philadelphia.

“There is a lot of misunderstanding and bias, even among physicians,” Dr. Novack said. “Until physicians see alcoholism as a chronic disease for which there is no cure, you can’t help the patient.”
Instituting some type of standardized screening process can make a difference, Dr. Pace said. The Alcohol Use Disorders Identification Test can help physicians identify patients with alcohol issues. It involves asking patients questions about how much they drink, what they drink and when they drink.

40 million Americans are high-risk drinkers.
 

Alcoholism is the big masquerader,” Dr. Pace said. “If the patient has several issues and a physician can’t figure out what’s really wrong, they should really think about alcohol and alcoholism. You have to keep in mind that you see the whole spectrum of the disease. It comes in all sizes, shapes and colors and really mimics so many other problems.”

Patients struggling with alcohol use may display a variety of symptoms, including indigestion, hypertension and liver problems, Dr. O’Connor said. Physicians should routinely screen patients for alcohol use, he said.

In talking with patients, physicians should make it clear that their discussions are confidential, Dr. O’Connor said. They also should discuss what could happen if the patient pursues treatment. Alcohol counseling can be brief, similar to discussions on other health issues such as diabetes and hypertension.

“If you don’t address those issues, they will make other medical issues worse,” Dr. O’Connor said.
Excessive alcohol use raises blood pressure and can contribute to a litany of medical problems, Dr. O’Connor said. Hypertension can lead to cardiac arrhythmia; problems with the gastrointestinal system, liver and pancreas; and neurological problems such as dementia.

The NIAAA provides resources for physicians and the public. Its guide for doctors recommends asking patients how many times in the past year they have had more than five drinks at a time. Asking that single question can help physicians identify up to 82% of people who have alcohol problems, Litten said.

It’s important that physicians not be reproachful or judgmental of patients, but express concern for their health and welfare, said David Bronson, MD, a general internist and president of the American College of Physicians. If doctors immediately ask a patient about drinking, the patient may feel attacked. It’s important to frame the question as a series of other general health questions that the doctor would ask of all patients.

“You have to make them feel comfortable about it,” Dr. Bronson said. “It should be a routine for all of your patients.”

Educating young doctors about alcohol

Some medical schools are working to make sure students are exposed to the issues of alcohol addiction early in their training. For example, first-year students at Drexel University College of Medicine are required to attend an Alcoholics Anonymous meeting. Two AA members also come to the school to talk with students about their experiences in small group sessions.

“We want our students to understand and see AA as a resource, but we also want our students to understand what people with this disease are going through,” Dr. Novack said. “They have gone through hell and back, and they have a lot that they can share that I think can help break some of the biases of our students.”

At the GME level, Dr. Pace has been leading a course for first-year internal medicine residents on alcoholism and substance abuse for about 10 years. The four-day course is offered once a month to residents at four New York hospitals.

As part of the course, AA members meet one on one with residents. They tell their stories, and residents present those to the class at the end of the course. Students also attend an AA meeting and work with trained actors to practice interviewing patients about their alcohol use. They also meet a physician who has struggled with substance abuse addiction, and they hear how it affected careers and personal lives, Dr. Pace said.

All internal medicine residents at Lenox Hill Hospital are required to take the course, said Robin Dibner, MD, director of the hospital’s internal medicine residency program and clinical associate professor at NYU School of Medicine.

“I just felt that there was nowhere in medical school that they were learning about this,” she said. “I think it should be a major part of curriculum for all residencies.”

Nicole Lapinel, MD, chief medical resident at Lenox Hill, said the program was eye-opening. Being able to talk one on one with an AA member and hear stories made a strong impression.

“You got to know this individual — when they first recognized that they had a problem and how they went about seeking treatment,” Dr. Lapinel said. “Sitting there listening to their very personal stories — as a physician you don’t normally get that perspective.”

The American Board of Addiction Medicine also is working to fill gaps in expertise about alcohol and substance abuse addictions. In 2011, the board launched its first residency programs in addiction medicine. There now are 10 programs around the country, Dr. Samet said.

Specialized training will help ensure that more patients who need help can get treatment, Dr. O’Connor said. “There is a huge dearth of specially trained physicians in this area.”



Correction

This article originally incorrectly stated the title of Jeffrey Samet, MD, MPH. He is chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. In addition, the article gave an incorrect percentage of Americans who have an addiction involving alcohol. Seven percent have an addiction involving alcohol. American Medical News regrets the error.

Wednesday, August 22, 2012

Alcoholism Affects Men's and Women's Brains Differently

Alcoholism Affects Men’s and Women’s Brains Differently

By Associate News Editor
Reviewed by John M. Grohol, Psy.D. on August 11, 2012



New research has demonstrated that the effects on white matter brain volume from long-term alcohol abuse are different for men and women.

Researchers from Boston University School of Medicine (BUSM) and Veterans Affairs (VA) Boston Healthcare System also suggest that when they stop drinking, women recover their white matter brain volume more quickly than men.

Previous research has linked alcoholism with white matter reduction, according to the researchers, who explain that white matter forms the connections between neurons, allowing communication between different areas of the brain.

In this latest study, a research team, led by Susan Mosher Ruiz, Ph.D., a postdoctoral research scientist in the Laboratory for Neuropsychology at BUSM and research scientist at the VA Boston Healthcare System, and Marlene Oscar Berman, Ph.D., professor of psychiatry, neurology and anatomy and neurobiology at BUSM and research career scientist at the VA Boston Healthcare System, employed structural magnetic resonance imaging (MRI) to determine the effects of drinking history and gender on white matter volume.

They examined brain images from 42 abstinent alcoholic men and women who drank heavily for more than five years and 42 nonalcoholic men and women. The researchers found that a greater number of years of alcohol abuse was associated with smaller white matter volumes in the alcoholic men and women. In the men, the decrease was observed in the corpus callosum, while in women this effect was observed in cortical white matter regions.

“We believe that many of the cognitive and emotional deficits observed in people with chronic alcoholism, including memory problems and flat affect, are related to disconnections that result from a loss of white matter,” said Mosher Ruiz.

The researchers also found that the number of daily drinks had a strong impact on alcoholic women, with the volume loss 1.5 to 2 percent for each additional drink. Additionally, there was an 8 to 10 percent increase in the size of the brain ventricles, which are areas filled with cerebrospinal fluid (CSF) that play a protective role in the brain. When white matter dies, CSF produced in the ventricles fills the ventricular space.

The researchers also found that in men, white matter brain volume in the corpus callosum recovered at a rate of 1 percent per year for each year of abstinence. For people who abstained less than a year, the researchers found evidence of increased white matter volume and decreased ventricular volume in women, but not in men. However, for people in recovery for more than a year, those signs of recovery disappeared in women and became apparent in men.

“These findings preliminarily suggest that restoration and recovery of the brain’s white matter among alcoholics occurs later in abstinence for men than for women,” said Mosher Ruiz. “We hope that additional research in this area can help lead to improved treatment methods that include educating both alcoholic men and women about the harmful effects of excessive drinking and the potential for recovery with sustained abstinence.”

The research was published online in Alcoholism: Clinical and Experimental Research.
Source: Boston University Medical Center



APA ReferenceWood, J. (2012). Alcoholism Affects Men’s and Women’s Brains Differently. Psych Central. Retrieved on August 22, 2012, from http://psychcentral.com/news/2012/08/11/alcoholism-affects-mens-and-womens-brains-differently/42963.html

 

Monday, July 30, 2012

Consumption of Alcohol/Energy Drinks Linked with Casual Risky Sex

CONSUMPTION OF ALCOHOL/ENERGY DRINKS LINKED WITH CASUAL RISKY SEX


ScienceDaily (July 25, 2012) — A new study from the University at Buffalo's Research Institute on Addictions (RIA) has found a link between the consumption of caffeinated energy drinks mixed with alcohol and casual -- often risky -- sex among college-age adults.

According to the study's findings, college students who consumed alcohol mixed with energy drinks (AmEDs) were more likely to report having a casual partner and/or being intoxicated during their most recent sexual encounter.

The results seem to indicate that AmEDs may play a role in the "hook-up culture" that exists on many college campuses, says study author Kathleen E. Miller, senior research scientist at UB's RIA.
The problem is that casual or intoxicated sex can increase the risk of unwanted outcomes, like unintended pregnancies, sexually transmitted diseases, sexual assault and depression, says Miller. And previous research has linked energy drink consumption with other dangerous behaviors: drunken driving, binge drinking and fighting, for example.

"Mixing energy drinks with alcohol can lead to unintentional overdrinking, because the caffeine makes it harder to assess your own level of intoxication," says Miller.

"AmEDs have stronger priming effects than alcohol alone," she adds. "In other words, they increase the craving for another drink, so that you end up drinking more overall."

The good news: Miller's study found that consumption of AmEDs was not a significant predictor of unprotected sex. Drinkers were no less likely than nondrinkers to have used a condom during their most recent sexual encounter.

Regardless of their AmED use, participants in the study were more likely to use a condom during sex with a casual partner than during sex with a steady partner, consistent with previous research. A steady or committed partner is a less risky prospect than a casual partner whose sexual history is unknown, Miller notes, so using a condom may not feel as necessary.

To be published in the print edition of Journal of Caffeine Research and available online to subscribers of the journal, the study is part of a larger three-year research project by Miller, funded by the National Institute on Drug Abuse (NIDA).

The research included 648 participants (47.5 percent female) enrolled in introductory-level courses at a large public university. They ranged in age from 18 to 40 but mostly clustered at the lower end of the age spectrum. More than 60 percent were younger than 21.

According to the study's findings, nearly one in three sexually active students (29.3 percent) reported using AmEDs during the month prior to the survey.

At their most recent sexual encounter, 45.1 percent of the participants reported having a casual partner, 24.8 percent reported being intoxicated and 43.6 percent reported that they did not use a condom.

According to Miller, drinking Red Bull/vodkas or Jagerbombs doesn't necessarily lead people to get drunk and become intimate with strangers, but it does increase the odds of doing so. But she points out that these drinks are becoming increasingly popular with college-age adults and should be considered a possible risk factor for potentially health-compromising sexual behaviors.

The findings may provide a basis for educational campaigns or consumer safety legislation, such as warning labels that advise against mixing energy drinks with alcohol, Miller says.


Monday, June 18, 2012

How Alcohol Can Damage Your Liver


Drinking too much alcohol can have serious consequences for your health, especially your liver, which is involved with detoxification of the body after excessive alcohol intake.The controversy linked to alcohol intake has been raging for many years: on the one hand, alcohol when used in moderation, can help people to relax and has recently been found to lower the risk of mortality; on the other hand soaring statistics of alcoholism and all its attendant ills, particularly in a country such as South Africa, paint a scary picture of "demon drink".


Positive findings

A report published in the American Journal of Clinical Nutrition in 2011 by Akbaraly and his coworkers at the University College, and the Imperial College in London, as well as the University of Montpellier and other research organisations in France, showed that “Consumption of nuts and soy and moderate alcohol intake appeared to be the most important independent contributors to decreased mortality [death] risks”. The authors pointed out that moderate alcohol consumption is also part of the Mediterranean Diet, which is becoming increasingly popular worldwide to combat most diseases that plague populations with a Western dietary intake.

The most important factor that we need to keep in mind is the word "moderate" which was linked to alcohol intake in this study. A "moderate" alcohol intake is presently regarded as 1-2 drinks per day for men and 1 drink per day for women, and Not Every Day.

The dire consequences of excessive alcohol intake as practised by so many people throughout the world and also in South Africa, are listed below.

Dire consequences

Excessive alcohol intake has many dire social and medical consequences, including trauma, abuse, loss of income and a wide spectrum of disease conditions. For today, we will concentrate on those conditions which affect the liver. The liver is the one organ in the body that is most intimately involved with the detoxification of the body after excessive alcohol intake, and it is, therefore, the organ that often suffers the most damage.

Alcoholic liver disease

This is probably the most common manifestation of liver disease in many countries where alcohol is consumed in excessive quantities. A toxic byproduct of excessive alcohol intake, is acetaldehyde which causes damage to the structure and function of the mitochondria in human body cells, particularly in the liver ( Mahan et al, 2011).

Susceptibility

Some individuals and populations are more susceptible to alcoholic liver disease than others. The following factors have been identified as potential markers of susceptibility to alcoholic liver disease:

  • Genetic variations or polymorphisms of the enzymes that metabolise alcohol in the body
  • Gender - women are more vulnerable to alcoholic liver disease than men
  • Simultaneous exposure to drugs that can harm the liver
  • Infections with viruses that attack the liver
  • Poor dietary status, which is often associated with high alcohol intakes (see below).

(Mahan et al, 2011)

Three stages

According to Mahan and her coauthors (2011), alcoholic liver disease progresses in three stages, namely hepatic steatosis or fatty liver, alcoholic hepatitis and alcoholic cirrhosis.

Each one of these stages is characterised by many and varied metabolic disturbances, such as:

Fat deposition in the cells of the liver in Stage 1 - this dire consequence of excess alcohol intake can be reversed provided the patient stops drinking.

The following symptoms characterised Alcoholic Hepatitis:

  • Enlargement of the liver
  • Increased liver enzyme levels
  • Increase in a compound called bilirubin in the blood
  • Anaemia
  • Abdominal pain, loss of appetite, vomiting, weakness, diarrhoea, weight loss and/or fever

(Mahan et al, 2011)

Despite the severity of these symptoms, total abstinence and nutritional support can resolve Stage 2 symptoms and permit the patient to lead a normal life again, but without ever drinking alcohol again.

Once Stage 3 of alcoholic liver disease is reached, the prognosis becomes serious. Additional symptoms to those of Stage 2, such as bleeding from the digestive tract, encephalopathy (a reversible change in mental status when toxins are not filtered and removed properly by the liver), portal hypertension (increased blood pressure in veins that drain blood from the liver, because the blood flow through the liver is blocked), and ascites (accumulation of fluid, proteins and electrolytes such as sodium and potassium in the peritoneal cavity), are often present.

The prognosis of alcoholic liver disease after a patient has reached Stage 3 is to a great degree dependent on how much damage the liver has suffered, the type of nutritional and medical support the patient receives and total abstinence from all alcohol (Mahan et al, 2011).

Excessive alcohol Intake and malnutrition

In the above discussion, it was repeatedly mentioned that patients with alcoholic liver disease need nutritional support, which when coupled to total abstinence from alcohol may return even very sick patients to good health. The reason why nutritional support makes such a difference, is that most alcoholic suffer from extensive malnutrition. In most cases they are totally unaware of their malnourished state. According to Mahan and her coauthors (2011), the following nutritional deficiencies are associated with excessive alcohol intake:

  • Too little or too much energy - alcohol often replaces food in the diets of even moderate drinkers which can either lead to weight loss or weight gain. In heavy drinker who are addicted to alcohol, alcohol replaces nutrient-rich food which leads to deficiencies.
  • Poor protein absorption - because alcohol interferes with normal digestion and absorption, the liver is unable to absorb amino acids properly and can thus not produce all the proteins it, and the body require.
  • Fat metabolism is impaired and patients tend to deposit triglycerides in liver cells thus exacerbating the fatty liver condition.
  • Most alcoholic also develop insulin resistance and do not metabolise carbohydrates efficiently.
  • Probably the most serious and dramatic nutritional insults suffered by alcoholics, are vitamin and mineral deficiencies. Thiamine or vitamin B1 deficiency is the most common vitamin deficiency in alcoholics and can cause so-called Wernicke encephalopathy. Severe vitamin A deficiency can also occur leading to night blindness. In addition, deficiencies of folic acid, vitamins B6, C, D, E and K are common. In regard to minerals, alcoholics may suffer from low calcium, magnesium, phosphate and zinc intakes.

(Mahan et al, 2011)

It is evident from the above that moderate intake of alcohol can probably lower the risk of mortality, but that the moment this moderate intake increases to excessive levels, alcohol literally becomes "poisonous" and can do our bodies, especially the liver, great harm.

If you have been diagnosed with any symptoms related to alcoholic liver disease, stop drinking alcohol immediately, follow the instructions of your physician and consult a registered dietician urgently. The dietician will help you redress your nutritional deficiencies and provide you with an individual diet prescription that is tailored to your specific condition, the severity of your symptoms and the amount of damage your liver has suffered.

Alcoholic liver disease is one of the many negative consequences of excessive alcohol intake, so if you suspect that your moderate drinking is getting out of control, get help fast before you do irreparable damage to your liver.

- (Dr IV van Heerden, DietDoc, June 2012)

(Photo of woman drinking too much alcohol from Shutterstock)

References:

(Akbaraly et al, 2011. Alternative Healthy Eating Index and mortality over 18 y follow-up: results from the Whitehall II cohort. American Journal of Clinical Nutrition, Vol 94(1):247-53; Mahan LK et al (2011). Krause’s Food & the Nutrition Care Process. Ed. 13. Elsevier, USA; Unilever.)

Any questions? Ask DietDoc

Read more:

Do you have a problem with alcohol or drugs?
Alcoholism
When is it too much?

Sunday, June 10, 2012

Heroin and Other Opiates Use Rising in Colorado, Figure Show

HEROIN AND OTHER OPIATES USE RISING IN COLORADO, FIGURES SHOW

Federal and local data suggest an uptick in heroin use in Colorado, a troubling development for local drug enforcement agencies and treatment programs.

One new federal drug use survey, the Arrestee Drug Abuse Monitoring Annual Report, shows that street use of opiate drugs, including heroin and opiate-based prescription medicines such as oxycodone, has doubled between 2000 and 2011.

The report, released May 17 by the National Office of Drug Control Policy, tracks the blood test results of adult male arrestees in Denver and nine other U.S. cities. In Denver; Indianapolis; Sacramento, Calif.; and Minneapolis, the number of adult male arrestees testing positive for opiates, including heroin and prescription painkillers, rose from 3 percent to 4 percent in 2000 to 8 percent to 10 percent in 2011.

Most of the heroin in Denver comes from Mexican drug cartels selling black and brown heroin, said Tom Gorman, director of the Rocky Mountain High Intensity Drug Trafficking Area program.
Heroin use still lags behind methamphetamine, cocaine and marijuana, accounting for 3 percent of drug arrests in Colorado.

"It's out there," Gorman said. "It is increasing in our area. Heroin hasn't reached the level of other drugs yet, but pharmaceutical opiate abuse is skyrocketing. Those drugs are more expensive than heroin, and that moves people to go from opiates to heroin. It's the same kind of high, but cheaper."
New heroin users increasingly are under age 35, white non-Hispanics, and more likely to smoke heroin than inject it, said Bruce Mendelson, senior data consultant at the Denver Office of Drug Strategy.

Alcohol and marijuana still lead the list of the most-abused drugs in Denver, Mendelson said, followed by heroin. In 2010, heroin overdoses ranked third (behind marijuana and cocaine) in Denver metro emergency department visits related to illicit drug abuse.

During the first half of 2011, of Denver residents admitted for addiction treatment, nearly 18 percent were admitted for heroin and prescription opiate addiction treatment, surpassing methamphetamines, according to statistics from the Colorado Health Foundation and Denver Office of Drug Strategy. Heroin and opiate drugs have become the third-leading cause of deaths that are alcohol- or drug-related.

Data from drug-abuse-treatment programs also show an uptick in heroin use and a sharp rise in opiate pharmaceuticals, said Marc Condojani, associate director of community intervention programs at the state division of behavioral health.

"We had 1,676 heroin admissions in 2003, and then the numbers dipped for a few years, but then they went up again," Condojani said.

"In 2010, we had 1,755 treatment admissions for heroin. In the other-opiates category, we had 541 people admitted for treatment in 2003, and in 2010, there were 1,715. That's over a threefold increase. The alarming part, to me, is that people who are dependent on those prescription medications eventually look for alternatives. And that's usually heroin."
Claire Martin: 303-954-1477 or cmartin@denverpost.com


Read more: Heroin and other opiate use rising in Colorado, figures show - The Denver Post http://www.denverpost.com/news/ci_20823072/heroin-and-other-opiate-use-rising-colorado-figures#ixzz1xPQlY2b9
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Sunday, June 3, 2012

Baby Boomers Getting into Sex, Drugs, and Alcohol



Baby Boomers Getting into Sex, Drugs, and Alcohol

Perhaps it is the influence of coming of age in the 1960’s but according to the Senior Housing Newsa great deal of older adults are partaking in sex and are using drugs and alcohol as they coast into a new phase of life. A recent survey found the number of people 50 and older seeking treatment for addiction is rising drastically.

When it comes to sex, previous research has indicated that 80% of adults between the ages of 50-90 are sexually active. Between 2000 and 2009 the number of sexually transmitted infections in this age group has doubled.

Sex, drugs and rocking chairs
Aside from engaging sex, seniors are also consuming alcohol and using drugs. The Hanley Center, a drug and alcohol treatment center, predicts that without early intervention and treatment addiction levels will continue to increase which will lead to an addiction epidemic among older Americans.
For example, according to the Substance Abuse and Mental Health Services Administration, the number of older adults who reported illegal drug use within a year almost doubled between 2002 and 2007. In this study, 40% stated they didn’t begin to use drugs or alcohol until after age 48. Substances of choice included alcohol with (90%) and prescription drugs (49.5%). The survey also found the reasons this population used drugs or alcohol were depression, anxiety, financial stress and retirement concerns.

While this may be distressing news to some, the cannabis activist group Silver Tour is taking an active role is advocating the legalization of marijuana. Their rationale is that marijuana can help treat chronic pain and insomnia, both of which are common among older adults. While a 2009 report by the Substance Abuse and Mental Health Services Administration showed that in the 50-54 age range the number of people who use marijuana either recreationally or medicinally is 6.1% and less for people 65 and older one theory is that as the baby boomers age that statistic will increase significantly as the baby boomer generation is more tolerant of marijuana use.

Tuesday, May 29, 2012

Music Industry Address Drug, Alcohol Problems

MUSIC INDUSTRY ADDRESS DRUG, ALCOHOL PROBLEMS

The drug-related deaths of popular entertainers like Whitney Houston have focused attention on drug and alcohol abuse, both inside and outside the entertainment industry. Celebrities may be at special risk, but some in the industry say they are addressing the problem.

The shocking stories are familiar - lives cut short by alcohol and drug abuse. Cocaine contributed to Whitney Houston's death. She drowned in her bathtub in a Beverly Hills hotel earlier this year. Michael Jackson died not far from there in 2009 after his doctor administered a lethal dose of the sedative Propofol. British singer Amy Winehouse was troubled by addiction and died last year of alcohol poisoning.

Experts say alcohol and drug abuse is a problem in the general population. But entertainers are especially vulnerable because of the long hours on the road and the intense demands of performing.

“There's a lot of down time, a lot of traveling, a lot of boredom, a lot of sitting, a lot of doing nothing," said Bob Forrest.

Bob Forrest is a musician, a recovering addict and a drug counselor.

"And so you tend to - at least I did, and most of my friends - tend to, at the very least, drink excessively," he said.

Drug and alcohol abuse is a special risk for those who find fame and fortune as performers, says Neil Portnow. He is president of MusiCares, an industry charity, and The Recording Academy, which presents the Grammy Awards.

“And the way that it plays out sometimes is over a long period of time, where somebody can develop the thick skin to deal with the issues that come with fame and fortune," said Portnow. "And then sometimes it's pretty quick and sometimes it's pretty young. And so those folks are not always well equipped to deal with that.”

He says some people around the artist can be enablers and others may turn a blind eye to the addiction.

Psychiatrist Charles Sophy treats celebrities. He says many are in denial.

“[They say] No, it's not me, or I don't use that much, but my doctor gives it to me," said Sophy. "All of those denial places are going to be impediments and hold you up from connecting to treatment to get a better outcome."

Sophy says successful artists are creative and driven, and some have underlying emotional problems that fuel addiction and need treatment.

“For instance, is there an anxiety disorder? Is there a mood disorder? Is there an attentional disorder, something that drove their creativity to become successful and where they're at, but also will become an impediment for them," he said.

Some young musicians think drug use is part of being creative, says Billy Morrison, a guitarist who stopped using drugs.

“The availability and the so-called 'cool' factor - which is disappearing - play a bigger part in the entertainment business than other professions," said Morrison.

He says the industry is less tolerant of drug use now than a few years ago. Harold Owens, senior director of the Musicians Assistance Program of MusiCares, says the industry is dealing with it.

“We get a lot of calls from managers," said Owens. "Managers, agents, they're concerned about their artist. One more time, their artist has relapsed and they need some guidance.”

He says MusicCares helps addicted entertainers get into good treatment programs.

Those who work with celebrities say the key to dealing with drug abuse is early intervention, effective treatment and a support system. They say recovery can be a lifelong process.

Thursday, May 24, 2012

CHILDREN PAY COST OF FAMILY ALCOHOL ABUSE

Children are the victims of alcohol-related harm in more than one-fifth of Australian households, a new study shows.

CHILDREN  PAY COST OF FAMILY ALCOHOL ABUSE
BY: Melissa Davey
CHILDREN are the victims of alcohol-related harm in more than one-fifth of Australian households, a study has found, adding weight to calls for the price of alcohol sold in bottle shops to be increased to discourage large quantities being consumed in homes.
Most were harmed by family members or by other relatives, and the rest by the drinking of family friends, neighbours, coaches, religious leaders or others, according to the study published in the latest edition of the international journal Addiction.
The lead author of the study, Anne-Marie Laslett, said children were commonly exposed to heavy drinking by their parents and others at social occasions, and that younger parents tended to drink heavily more often than those who became parents later in life.

''The realities of parenting are that people make a lot of changes to their lives to accommodate having children and do their best, but I don't think we really know as much as we could about how much drinking in private homes and spaces actually affects our children,'' said Professor Laslett, who is a research fellow at the Turning Point Alcohol and Drug Centre at Monash University.
While a study co-authored by Professor Laslett last year, The Range and Magnitude of Alcohol's Harm to Others, found alcohol was a risk factor in about 20,000 cases of child abuse in Australia, she said more studies were needed on drinking and child abuse in the wider population.
''We tend to mainly look at information about kids in the child-protection system who are victims of alcohol abuse, and we stigmatise those groups … but when we look at our own lives, we might find our drinking habits are not necessarily healthy to us or the children around us either.''
Researchers interviewed 1142 parents throughout Australia and found the most common form of harm that occurred to children through others drinking was verbal abuse, including yelling and criticism.

Three per cent of respondents said their children had witnessed domestic violence, while 1 per cent reported their children had suffered physical harm.
''I think we now need more research to find out how the kids are affected, if they suffer long-term and if that could inform policies such as increasing alcohol price, as evidence shows increasing price decreases the amount people drink.''

Director of the National Drug and Alcohol Research Centre at UNSW, Michael Farrell, said children could be affected by others' drinking, even in situations that might not be serious enough for child protection agencies to get involved. While alcohol could exacerbate aggression in those with a history of violent behaviour, he said, ''anyone who drinks too much can find themselves acting in an aggressive … manner''.


Read more: http://www.smh.com.au/national/health/children-pay-cost-of-family-alcohol-abuse-20120513-1ykz1.html#ixzz1vnjPqD9G

Monday, May 21, 2012

In the aftermath of OxyContin

In the aftermath of OxyContin

There has been little sign of the feared health crisis among addicts and at treatment centres after the powerful drug was taken off the market, but is it just the calm before the storm? Sharon Kirkey reports



By Sharon Kirkey, Ottawa Citizen 

More than two months after one of the most abused drugs in modern medicine - OxyContin - was taken off the market, there are signs that Canadian drug users are trying to adapt and fill the void that's been left.

On websites, drug users are sharing recipes on how to crack the code for OxyNEO - a new version of the drug - which becomes gel-like in water so that it can't be pulled into a syringe.
In Toronto, public health officials say they are trying their best to encourage clients not to try to break OxyNEO down, "because we don't really know what the impact is of injecting a gel formulation into someone's veins," says Dr. Rita Shahin, an associate medical officer of health with Toronto Public Health.

In Ottawa, where police believe the street supply of OxyContin is drying up, use of fentanyl - a heavy-hitter opioid stronger than oxycodone, the active ingredient in OxyContin, that has always been a part of the city's drug-trade equation - is growing.

"We've seen an increase in the number of seizures, particularly at the street level, and a lot of trafficking in fentanyl patches," says Ottawa Police Staff Sgt. Mike Laviolette.
What there hasn't been, however, is the all-out health disaster predicted by many.
There is no evidence yet of mass withdrawal some had feared would unfold in First Nations communities in Northern Ontario - where leaders say staggering numbers of people are addicted to opioids, from seniors to 11-year-old children.

Provincewide weekly surveillance in Ontario has so far found no sudden significant run on detox or addiction treatment services, or increases in overdoses. There are anecdotal reports suggesting some people are switching to fentanyl, as well as heroin, "but it's not significant, it's not a major increase just yet," a health ministry spokeswoman said.

Some fear this could be just the calm before the storm. They say that if the lessons learned from the abuse of OxyContin aren't implemented, the same problems could play out once more.

Advocates of the drug's replacement, OxyNEO, say it is the figurative tamper-proof cap that was needed. They say it will dissuade people from the two most self-destructive behaviours associated with OxyContin abuse - snorting and injecting, which deliver heroin-like hits to the brain and a potentially higher risk of fatal respiratory arrest along with it.

But there are worries, too, that the new "tamper-resistant" formulation could create a false sense of security - that some doctors will believe that OxyNEO can't be misused or abused, a situation that could lead to more liberal prescribing of the powerful opioid.

OxyNEO has the same analgesic properties as OxyContin. It still can be abused simply by swallowing heavy doses - something one doctor suggested many addicts will do, rather than trying to follow the complicated online instructions for extracting the oxycodone.

And while OxyNEO tablets were hardened to make them more difficult to crush, snort and inject, many people who are addicted to OxyContin or other prescription opioids simply swallow the tablets whole.
"And if you're swallowing the tablet whole," says Dr. Irfan Dhalla, a general internist at St. Michael's Hospital in Toronto, "it really won't make any difference whether you're swallowing OxyContin or OxyNEO."

Initially, OxyContin was actually marketed as having a lower risk of abuse than other opioids.
Prescriptions and sales soared, and the more prescriptions were filled, the more leaked to the streets.
The drug has been implicated in playing a role in an increase in overdoses and deaths and a "public health crisis" involving what became, according to the College of Physicians and Surgeons of Ontario, one of the most easily obtained prescription opioids on Toronto's street drug scene.
Observers say the new formulation may lessen the risk of overdose due to tampering.
But, according to Health Canada, no available evidence exists to show that these "abuse-deterrent formulations" lead to less drug abuse and related harm.

An official told Postmedia News that OxyNEO hasn't been allowed to claim that it is less abusable than other extended-release opioid formulations.

Purdue Pharma says it conducted a number of studies before OxyNEO was launched. "Most of the misuse and abuse of long-acting prescription opioids is about defeating the controlled-release formulation," said Randy Steffan, vice-president of corporate affairs for the pharmaceutical company.

OxyNEO tablets were tested "after various physical manipulations," he said, including being crushed with a hammer.

"OxyNEO may be the first of a new generation of controlled-release opioids designed to help discourage misuse and abuse of prescription opioids," Steffan said.
He added that Purdue "is committed to collecting post-marketing data in Canada."
But some observers want Health Canada to do its own monitoring for the prevalence of abuse and diversion as OxyNEO replaces OxyContin on the Canadian market. They also want strict controls over how the drug is marketed to doctors.

"So far Health Canada doesn't really seem to have learned any lessons from OxyContin," says Dr. Joel Lexchin, an emergency room physician and professor in the School of Health Policy and Management at York University in Toronto.

In a recent article in the International Journal of Risk and Safety in Medicine, Lexchin and coauthor Jillian Clare Kohler (an expert witness on OxyContin marketing practices for a Nova Scotia law firm involved in an OxyContin class-action lawsuit), describe how the company's U.S. branch pleaded guilty to the "misbranding" of OxyContin.

Sales representatives gave false information about the drug to some doctors, they wrote, claiming that because it was long-acting it would produce less of a "high," and thus was less likely to be abused. Purdue paid more than $600 million in fines, one of the largest payouts of its kind.
Lexchin says Health Canada has the power under the Food and Drugs Act to require that Purdue have a prominent statement in all of its promotions of OxyNEO warning of the potential for abuse, and that drug company sales reps should be required to deliver the same message to doctors.
The company says warnings are prominently contained in OxyNEO's monograph - the official product information document for doctors - that all information in its promotional materials is consistent with the monograph and approved by the Pharmaceutical Advertising Advisory Board, and that company representatives "comply with the requirement of delivering full and factual information on products" in accordance with the industry's code of ethical practices.
Experts say the issue is wider than a single drug. Canadians are among the highest users of prescription opioids in the world. In the past decade alone, our opioid consumption has more than doubled.

"It goes beyond just chronic pain - it involves people being sent home from hospital with large amounts of painkillers, or people going to the dentist to get a tooth pulled and sent home with 38 Tylenol No. 3s," says Dr. Peter Selby, clinical director of the addictions program at the Centre for Addiction and Mental Health.

"They're doing home palliative care now. What happens to all these opioids? Who else has access to them when the person dies? How are they keeping (the drug) in the home?"
There's nothing inherently evil about opioids, Selby says. "It's how we deliver them and how we use them that got us into trouble."

Perhaps nowhere is that more true than in First Nations communities.
In January, Chief Matthew Keewaykapow of Cat Lake First Nation in northwestern Ontario declared a state of emergency, saying the opioid addiction rate was approaching 70 per cent of his community members.

In February, Nishnawbe Aski Nation (NAN) Deputy Grand Chief Mike Metatawabin warned First Nations communities to brace for a health catastrophe - a mass, involuntarily opiate withdrawal due to the replacement of the "ultraaddictive" OxyContin.

So far, it hasn't been what he expected.
"We're just seeing trickles now - some abuse of alcohol, some reports of withdrawals," Metatawabin told Postmedia News this week.
But "right now the underground supply (of OxyContin) is still there," he said, "so we haven't seen what we were anticipating yet."

"I was told it would maybe occur sometime in April or May. We're into May now. I'm going to see what happens this month," he said.
"If it happens, it's going to hit hard."

In a move to restrict diversion and abuse, six provinces have decided to remove OxyNEO from their drug benefit formularies and to approve new requests on a case-by-case basis only.
"It's going to be very difficult to prescribe," says Dr. Edward Sellers, who chaired a Health Canada scientific advisory panel on opioid abuse. "The hoops to go through to get that - most physicians just won't be prepared to do that."

The OxyNEO formulation has been available in the U.S. for al-most two years. According to Sellers, the initial data from the drug company "are more or less showing what one would expect - you make a hard formulation that is hard to crush, and you can't inject it, then there is going to be less tampering." Presumably, he said, less tampering will mean fewer deaths.
"Can OxyNEO be abused or is it addictive? Well, it's got an opiate in it, of course it can be," said Sellers. However, he said, many of the risks associated with the original product have been "substantially mitigated."

Preliminary data from three ongoing studies released by Purdue Thursday at the American Pain Society's annual scientific meeting in Honolulu show a reduction in the street price of the new formulation of OxyContin across the U.S., a drop in OxyContin-related reports to poison control centres and a 50-per-cent decrease in OxyContin abuse rates among opioid addicts entering addiction treatment since the new formulation was introduced in 2010, the company said in a statement. During the same period there was a 134 per cent increase in abuse of the painkiller, Opana.

The company says further analysis showed a 74 per cent drop in abuse through "no-oral routes" - injecting, snorting and smoking - as well as a 30 per cent decrease in oral abuse.
Dhalla, of St. Michael's Hospital in Toronto, who has also seen some of the preliminary data, isn't convinced that simply replacing OxyContin with OxyNEO will result in fewer deaths. According to an FDA spokeswoman, the agency has not conducted an independent study or review.
"I'm skeptical of anything that is put out by a (drug) manufacturer, particularly if it hasn't appeared in a top-ranked peer-reviewed journal," says Dhalla, an assistant professor in medicine and health policy, management and evaluation at the University of Toronto.

In a recent editorial published in the British Medical Journal, Dhalla says that opioids - drugs prescribed to millions of patients for chronic, non-cancer pain - carry significant risks that aren't completely known.

"I think it's fair to say that we don't really know what the benefit-to-harm ratio is - we don't really know whether benefits outweigh risks, or vice versa, when these drugs are used for years at a time, as they quite frequently are," he said.
"Hopefully we'll eventually get through this problem, and we'll look back on this period and say, 'Whoa, that was a strange and unfortunate episode in the history of medicine.'"


Read more: http://www.ottawacitizen.com/health/aftermath+OxyContin/6651184/story.html#ixzz1vVTewCKT

Friday, May 18, 2012

Prescription Drug Monitoring Programs May Share Data

Prescription Drug Monitoring Programs May Share Data


by George Ochoa
Pharmacy Practice News


To combat prescription drug abuse, prescription drug monitoring programs (PDMPs) have been authorized in 48 states. PDMPs collect and analyze prescribing and dispensing data within a state for enforcement and abuse prevention as well as research and education, according to the Alliance of States with Prescription Monitoring Programs. Now, recently introduced legislation takes the concept a step further. The Interstate Drug Monitoring Efficiency and Data Sharing Act of 2012 (ID MEDS; H.R. 4292, S. 2254) would establish uniform national standards for exchange of information among PDMPs.

Unless states can share information, they can miss individuals who cross state lines to obtain prescription drugs for illicit purposes. “Sharing information across state lines can help physicians identify doctor shoppers [who] may travel to several states to obtain multiple prescriptions for a controlled substance,” Sarah Kelsey, legislative attorney, National Alliance for Model State Drug Laws, Santa Fe, N.M., said in an interview.

ID MEDS was introduced by Sens. Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.) and Reps. Harold Rogers (R-Ky.) and Frank Wolf (R-Va.). “Our bill would strengthen states’ ability to monitor and track prescription drug dispersion, which is a big step forward in the fight to prevent abuse,” said Mr. Portman in a statement. Brian M. Meyer, MBA, director, Government Affairs Division, American Society of Health-System Pharmacists (ASHP), noted in an email that the ASHP House of Delegates passed a policy in 2011 supporting interoperability among state PDMPs, as provided for in the new legislation.

Outpatient Pharmacies Affected

Laws regarding PDMPs vary among states, but in many cases they do not affect the administration of medications to inpatients in hospitals, according to Ms. Kelsey. Mr. Meyer added, “Model legislation from NABP [National Association of Boards of Pharmacy] exempts licensed hospitals for the purpose of inpatient care or the dispensing of a prescription at time of discharge.”

The PDMP in New York “primarily impacts us in our outpatient pharmacy where we comply with [New York state law] just as any pharmacy does,” said Timothy Lesar, PharmD, director of clinical pharmacy services, Albany Medical Center, in Albany, N.Y. “This does not really impact inpatient services.”

Other sources, however, pointed to several potential areas that PDMPs could have a broader impact on hospitals. Jennifer Fass, PharmD, CPh, clinical assistant professor, College of Pharmacy, Nova Southeastern University, in Ft. Lauderdale, Fla., noted that PDMPs can be used by clinicians “to conduct patient searches for those individuals whose care they are directly involved in.” Karl F. Gumpper, RPh, BCPS, FASHP, director, Section of Pharmacy Informatics & Technology, ASHP, said by email that there are several areas in which hospitals could make use of PDMP information, including medication reconciliation, emergency room visits and data access in the case of hospitals with retail pharmacies.

Ms. Kelsey cited another potential in-hospital application of PDMPs: “In an [emergency room] situation, where the doctor likely would not know a patient’s history, a [PDMP] can be a useful tool to assist in determining whether a particular individual may be seeking drugs for a non-legitimate purpose,” she said.

A paper by Dr. Fass and Patrick C. Hardigan, PhD (J Manag Care Pharm 2011;17:430-438) found that both hospital and community pharmacists in Florida were in favor of implementing a PDMP in Florida. Among hospital pharmacists, 74.2% agreed or strongly agreed with the statements that a PDMP “should be implemented in Florida”; similar numbers were reported for chain (84.0%), independent (77.9%) and other (71.1%) pharmacists.

Other Tools for Fighting Abuse

Health-system pharmacies are not limited to the use of PDMPs when it comes to combating prescription drug abuse. “There is usually a sign-off sheet that pharmacy and nursing complete,” Dr. Fass said. “Many of these substances are contained in computer systems … where individuals must log in to administer these substances. Hospitals usually have policies in place to monitor and prevent diversion among health care professionals.” Dr. Lesar added, “We use required chain-of-possession documentation, review of all discrepancies, and statistical data monitoring for unit-based cabinet withdrawal rates.”

Not all states are waiting for legislation to permit information exchange. Two existing platforms allow states to exchange PDMP data: the Prescription Monitoring Information Exchange (PMIX) and the NABP PMP InterConnect. According to Ms. Kelsey, “Some states are already sharing their [PDMP] data and others are working toward doing so.”



--------------------------------------------------------------------------------

Mr. Gumpper, Ms. Kelsey, Dr. Lesar and Mr. Meyer reported no relevant financial conflicts of interest. Dr. Fass reported a grant from Nova Southeastern University.



Monday, March 26, 2012

Prescription Drug Abuse a Big Problem in Ohio

Prescription drug abuse a big problem in Ohio
March 25, 2012

By PAT ROSS - Administrative Assistant, Columbiana County MHRS Board , Salem News

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LISBON - Ohio Governor John Kasich has made prescription drug abuse and addiction a project he has taken to heart. The recent death of pop superstar Whitney Houston, and the overdose deaths of other celebrities like Amy Winehouse, Michael Jackson, and Heath Ledger have put renewed focus across the nation of the troubling prescription drug abuse problem.

Kasich said, "Prescription drug abuse and addiction is an epidemic that I've taken head on. It's killing people, killing families, and killing communities. Corrupt doctors are preying on people and too many people are looking the other way. We're going to bring it to an end, and I've taken a number of steps to crack down on this crime. We also need to help those who've fallen into the grips of addiction so they can get treatment and get back to work."

While Houston's exact cause of death has not been released, officials say prescription drugs, including Xanax, Ativan, and Valium, which are used to treat anxiety and sleep disorders - and alcohol were found in the her Beverly Hills hotel room. The combination of these drugs with alcohol can make a potentially deadly cocktail.

Anti-anxiety medication were linked to the deaths of Winehouse, Jackson, and Ledger.

These drugs, as well as opiates such as OxyContin and Vicodin, and alcohol are all central nervous system depressants. When any of these - alone or in various combinations- are consumed in excessive amounts, the respiratory system can shut down, and death can occur.

The brain essentially falls asleep. Like alcohol, narcotic painkillers and anti-anxiety medications can be addictive.

Ohio does indeed have an opiate problem:

- From 2000 2008, there was more than a 300 percent increase in overdose deaths where opiates were listed on death certificates. (Source: Ohio Department of Health)

- In 2010, over 776 million doses of opiates were prescribed in Ohio. That equals 67 doses for every man, woman, and child in the state. (Ohio Automated Rx Reporting System)

- Prescription painkillers accounted for nearly 37 percent of unintentional overdose deaths in 2008. (Ohio Department of Health)

Last year, more than 1,000 individuals gathered in Columbus for Ohio's Opiate Epidemic: A Summit on Policy, Prevention, and Treatment.

The Summit brought together physicians, professionals from health care, addiction, prevention, and treatment, judges, prosecutors, and law enforcement professionals to gain a common understanding of the problems and best practice solutions to address opiate abuse, addiction, and diversion.

At the Summit, Governor Kasich announced the creation of a project designed to develop community opiate task forces in 10 Ohio communities and the Recovery to Work project that will help to provide treatment and vocational rehabilitation services to individuals in need.

Orman Hall, Director of the Ohio Department of Alcohol and Drug Addiction Services, (ODADAS) points out: "Oxycodone is virtually identical to heroin. Also alarming is the fact Americans account for 4.5 percent of the world's population, but we consume 99 percent of all the hydrocodone (Vicodin), and we consume 81 percent of all of the oxycodone (Percoset), which is OxyContin."

In the late 1990s, according to Hall, there were fundamental changes in chronic pain guidelines that resulted in rapid and dramatic escalation of prescription opiates. Dr. Douglas Teller, internal medicine and addiction medicine specialist for Kettering Health Network, adds that today's fast-paced society - in which deadlines loom and the pressure to succeed is great - has, in part, made Americans accustomed to quick fixes for pain management.

Experts warn that children can gain access to their parents' unused sedative or painkiller prescriptions and abuse them. All it takes is a naive teenager to drink alcohol, says Teller, and then pop Xanax and Vicodin to turn careless drug experimentation into respiratory arrest and death.

Eric Wandersleben, communications manager for ODADAS has this mantra: "Educate. Communicate. Safeguard." "Talk to your kids about the dangers of drugs. Whitney Houston's untimely death provides the perfect opportunity for parents or caregivers to sit down with their children and have that conversation," says Wandersleben. "They need to know the facts, the risks and the consequences." He also presses for proper disposal of unused prescription medications to make sure they don't get into the wrong hands. Each year, Columbiana County holds "Take Back Drugs" days where several sites are provided for proper disposal of drugs.

In Columbiana County, the number of adults receiving treatment for opiate abuse and addiction through the publicly funded treatment system has risen steadily over recent years, mirroring the state-wide epidemic.

In Fiscal Year 2008, 165 people were treated for opiate disorders. In only the first half of Fiscal Year 2012, 316 were in treatment.

The Columbiana County MHRS Board's priorities include prevention of substance abuse and the provision of effective treatment for persons with addictions. For more information, please call the MHRS Board at 330-424-0195, or visit the Board's website: www.ccmhrsb.org.

The ADAPT (Alcohol and Drug Abuse Prevention Team) Coalition, which is partially funded by the MHRS Board, is a great source of information for parents and community members who are interested in preventing youth substance abuse.

Contact ADAPT at 330-424-1468 or visit the ADAPT website at www.adaptcoalition.org.

Wednesday, March 21, 2012

Prescription Drug Abuse in Florida: An Epidemic of Deaths

Prescription Drug Abuse in Florida: An Epidemic of Deaths

Did you know:

-An average of 7 persons die everyday in Florida because of lethal overdoses from the illegal, non-medical misuse of one or more prescription drugs.

-An additional 7 persons die daily with at least one prescription drug detected often in combination with alcohol or other drugs. That is a total of 14 deaths per day in Florida related to prescription drug abuse.

-There were 5,275 persons who died in Florida during 2009 and another 2,579 in the first half of 2010 with at least one prescription drug in their system identified as either the cause of death or present in the decedent.

-Most of the deaths were preventable.

-Treatment admissions for prescription opioid addiction increased 5 1/2 times in Florida over the past decade. Among those aged 12 to 30, the number of prescription opioid treatment clients rose from 488 in 1999 to 7,649 in 2009, a 1,467-percent increase.

-The rate of hospital emergency department cases for non-medical oxycodone misuse among those aged 21-25 in South Florida is nearly double the national per capita rate.

-Florida leads nation in sale of oxycodone with over 400,000,000 pills sold annually.

-Benzodiazepines (e.g., Xanax, Klonopin, Valium) and muscle relaxants (e.g., Soma) are also frequently linked to overdose deaths and medical emergencies across Florida.

-As one of only 12 sales without an operating Prescription Drug Monitoring Program, Florida is a source supplier of illegally diverted controlled medications for the nation.

-Among Florida 12th graders in 2010, 11 percent have misused a prescription pain reliever non-medically in their life; 3.4 percent have done so in the last month.

-The number of infants treated for withdrawal symptoms in Florida hospitals increased 173-percent between 2006 and 2009; 635 cases were reported in the first half of 2010.


Published by United Way of Broward County Commission on Substance Abuse