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.

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

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

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.”



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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.