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.

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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.

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

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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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Baby Boomers Getting into Sex, Drugs, and Alcohol

Baby Boomers Getting into Sex, Drugs, and Alcohol

Submitted by My Addiction on Jun 1, 2012

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.

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