New Report Confirms Laws Regulating Alcohol Availability Help Reduce Associated Problems

A newly released report shows that increasing the number of hours and days when alcohol can be sold in bars, restaurants, and liquor stores leads to greater alcohol use and related harms, especially motor-vehicle crashes. National, state, and local policies that remove previously banned alcohol sales on weekend days (usually Sundays) or that increase the hours of sale by 2 or more hours contribute to excessive drinking and many dangerous outcomes, including driving after drinking and alcohol-related assault and injury.

The Task Force on Community Preventive Services, an independent, nonfederal body of public health experts, recommends maintaining limits on the days or hours during which alcohol can legally be sold, based upon a state-of-the-art systematic review process of all available studies on the topic. [Read more…]

Recreational Use of Prescription Drugs Among Teens

Twenty percent of high school students in the United States have taken a prescription drug, such as OxyContin, Percocet, Vicodin, Adderall, Ritalin, or Xanax, without a doctor’s prescription, according to the 2009 National Youth Risk Behavior Survey (YRBS). This is the first year the survey assessed prescription drug abuse among high school students. The 2009 YRBS shows that many high school students engage in risk behaviors that are harmful to their overall health and increase their risk of disease and injury.

The Centers for Disease Control (CDC) and YRBS’s recently released issue brief, “Unintentional Drug Poisoning in the United States” highlight a serious public health problem with non-medical use of prescription drugs. The issue brief points out that drug overdose rates have risen steadily in the United States since 1999, with most of the increase due to prescription drugs.

Data from the Drug Abuse Warning Network (DAWN), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), estimate that in 2008 people 12-20 years old accounted for an estimated 141,417 (14.5 percent) of the 971,914 emergency department visits for nonmedical use of pharmaceuticals. These numbers do not include suicide attempts.

“Our Nation faces many public health threats that deserve our immediate attention. Among them, there is the pressing reality of drug overdoses. Teens and others have a false assumption that prescription drugs are a safer high,” said Grant Baldwin, PhD, MPH, Director of CDC’s Injury Center Division of Unintentional Injury Prevention. “These data and that from other sources show us that prescription drug misuse is a significant problem in both adolescents and adults.”

The CDC recommendations in the issue brief are based on promising interventions and expert opinion to help health care providers, state and federal agencies, as well as private insurance providers and pharmacy benefit managers, to better understand the impact and cost of unintentional poisoning. CDC continues to respond to this problem through surveillance activities, epidemiologic research, and evaluation of interventions with the greatest promise of creating a public health impact.

Source: CDC, June 3, 2010

New OxyContin Formulation Designed to Discourage Abuse of the Drug

The U.S. Food and Drug Administration today approved a new formulation of the controlled-release drug OxyContin that has been designed to help discourage misuse and abuse of the medication.

OxyContin is made to slowly release the potent opioid oxycodone to treat patients who require a continuous, around-the-clock opioid analgesic for management of their moderate to severe pain for an extended period of time. Because of its controlled-release properties, each OxyContin tablet contains a large quantity of oxycodone, which allows patients to take their drug less often. However, people intent on abusing the previous formulation have been able to release high levels of oxycodone all at once, which can result in a fatal overdose and contributes to high rates of OxyContin abuse.

The reformulated OxyContin is intended to prevent the opioid medication from being cut, broken, chewed, crushed or dissolved to release more medication. The new formulation may be an improvement that may result in less risk of overdose due to tampering, and will likely result in less abuse by snorting or injection; but it still can be abused or misused by simply ingesting larger doses than are recommended.

“Although this new formulation of OxyContin may provide only an incremental advantage over the current version of the drug, it is still a step in the right direction,” said Bob Rappaport, M.D., director of the Division of Anesthesia and Analgesia Products in the FDA’s Center for Drug Evaluation and Research.

“As with all opioids, safety is an important consideration,” he said. “Prescribers and patients need to know that its tamper-resistant properties are limited and need to carefully weigh the benefits and risks of using this medication to treat pain.”

According to the U.S. Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, approximately half a million people used OxyContin non-medically for the first time in 2008.

The manufacturer of OxyContin, Purdue Pharma L.P., will be required to conduct a postmarket study to collect data on the extent to which the new formulation reduces abuse and misuse of this opioid. The FDA is also requiring a REMS (Risk Evaluation and Mitigation Strategy) that will include the issuance of a Medication Guide to patients and a requirement for prescriber education regarding the appropriate use of opioid analgesics in the treatment of pain.

Purdue Pharma is based in Stamford, Conn.

Addiction to Prescription Pain Killers Among Patients and Physicians

Chemical dependency and recovery in patients and physicians are closely examined in a series of articles and editorials in the July 2009 issue of Mayo Clinic Proceedings. The subject is especially timely. As the immense challenges, including potential tragedies, of prescription chemical addiction and abuse are being discussed, these articles offer crucial overview, direction and optimism.

Addiction to and abuse of prescription opioid drugs are prevalent, and they exact an immense toll on patients, physicians and society, according to Steven Passik, Ph.D., Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, in “Issues in Long-Term Opioid Therapy: Unmet Needs, Risks, and Solutions.”

Opioid drugs have been used by humans for thousands of years and are the longest continuously used class of medications, explains William Lanier, M.D., editor-in-chief of Mayo Clinic Proceedings. Dr. Lanier and Evan Kharasch, M.D., Ph.D., Department of Anesthesiology, Washington University in St. Louis, authored the editorial “Contemporary Clinical Opioid Use: Opportunities and Challenges.” It summarizes the recent increased interest in this drug category.

Opioid medications are chemicals that work by binding to specific receptors, particularly in the nervous system and gastrointestinal tract; decrease perception of pain and reaction to pain; and increase pain tolerance. Side effects include sedation, respiratory depression and constipation. When opioid consumption is ongoing, physical dependence can and will develop. This, in turn, can lead to problematic withdrawal upon abrupt discontinuation of medication. Dependence, coupled with the feeling of euphoria these drugs can produce, leads to abuse.

According to Dr. Lanier, the recent growing interest in opioids stems from five sources: advances in the design of these drugs; expansion and innovation in methods of drug delivery; increased public awareness of pain management options and the appropriateness of aggressively treating pain as the “fifth vital sign” and pain relief as a fundamental human right; growing recognition of the serious consequences of opioid misuse, misadventure and addiction; and medicolegal aspects of practitioners’ prescribing practices and legal consequences for under- or overprescribing.

In addition to individuals who have chronic pain, both cancer and non-cancer related, anesthesiologists have the greatest risk of opioid dependence and abuse among health care providers. Also in the high-risk group for health care providers are nurse anesthetists and sedation nurses. Challenges specific to these groups are discussed by Michael Oreskovich, M.D., Washington Physicians Health Program in Seattle, and Ryan Caldeiro, M.D., Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, in “Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?”

Severe chronic pain includes that produced by cancer and such non-cancer conditions as back injury and surgery. Opioids are a cornerstone of pain management for individuals in these categories, according to Howard Smith, M.D., Department of Anesthesiology, Albany Medical College, N.Y. In “Opioid Metabolism,” he writes that approximately 10 percent to 20 percent of physicians will develop a substance abuse problem during their career, a rate similar to or exceeding the general population. For anesthesiologists, according to Drs. Oreskovich and Caldeiro, the increased risk is cited as an occupational hazard because of the highly addictive medications they administer to patients daily.

Health care professionals helping patients with chronic pain must balance aggressive treatment with the need to minimize the risks of misuse and abuse, according to Dr. Passik. In “A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain,” Charles Argoff, M.D., and Daniel Silvershein, M.D., both from the Department of Neurology, Albany Medical College, N.Y., write that management of chronic non-cancer pain, for example, requires comprehensive assessment of each patient; the establishment of a structured treatment regimen or program; ongoing reassessment of the pain condition and the response to therapy; and a continual appraisal of the patient’s adherence to the treatment. Their colleague, Dr. Smith, stresses the importance of understanding the metabolism of opioids in individual patients.

Keen awareness by family and friends of potential addiction is crucial for physicians and other health care providers, not to mention the general public, who might be at risk, according to “Chemical Dependency and the Physician” by Keith Berge, M.D., Department of Anesthesiology, Mayo Clinic; Marvin Seppala, M.D., Hazelden Foundation, Center City, Minn.; and Agnes Schipper, J.D., Mayo Clinic Legal Department. Especially important is that family, friends and co-workers of health care providers confront any suspected addiction and abuse because of the potential harm that might befall the individual and his or her patients. Health care facilities should have written policies and procedures in place to assist when these highly emotionally charged situations involving health care providers occur, Dr. Berge and his colleagues write. Long-term recovery and sobriety can be achieved with appropriate treatment, aftercare and monitoring, they add.

New opioid formulas designed to minimize abuse are now in late-stage development and could help, Dr. Passik says. These drugs are chemically designed to diminish euphoric effects, thus possibly reducing problematic use. For now, responsibility coupled with expertise, insight, diligence and compassion are among the components that can meet the challenges of opioid use in pain management, the authors agree.

Source: Mayo Clinic, July 7, 2009

Medicare Patches and Hotline Help Seniors Quit Smoking

Seniors trying to quit smoking can be helped by Medicare-supplied nicotine patches and a Medicare hotline, according to new research conducted to estimate the cost of such a Medicare program. The study revealed that close to 20% of seniors who tried the program quit smoking for a year.

“From a public health perspective, it works,” said study lead author Geoffrey Joyce, a senior economist with RAND, which provides research services to the government. While most antismoking efforts focus on younger people, “Nobody has really paid attention to the elderly,” Joyce said.

Even inveterate smokers among seniors can benefit from quitting: a 1986 study showed that a senior who smokes 20 or more cigarettes a day and quits at age 65 could expect to add two to three years to his or her life.

The question being asked by Medicare meanwhile was—is it cost-effective to help seniors quit smoking? This new study was published in the current online issue of the journal Health Services Research.

7,354 seniors participated in the study, and all had enrolled in smoking cessation programs in 7 states between 2002 and 2003. The researchers divided the seniors into 4 groups—one group was given a brochure on smoking cessation; one group was paid for four counselling sessions with doctors; another group was given counseling and a nicotine patch, or the smoking-cessation drug bupropion. Thje last group used a nicotine patch and a hotline.

The one-year quit rates for the first three groups were 10%, 14% and 16%. For the last group the rate was 19%, and participants did not tuch cigarettes for the ensuing year.

Joyce said the difference between the 10 percent quit rate in the brochure group and the 19 percent quit rate in the hotline and patch group was significant: “You can double quit rates with a telephone quitline and a free patch.” Helen Ann Halpin, director of the Center for Health and Public Policy Studies at the University of California at Berkeley, said the study results suggest that “older smokers are motivated to quit and that quitlines and pharmacotherapy greatly increase the odds of successfully quitting.” She added that all 50 states now have a quitline for smokers of all ages.

As for Medicare’s need for cost-effective care, “what we don’t know is how much money this really saves if saving money is your goal,” Joyce said. Still, it seems clear that “if you just look at it from a strict budget perspective, it’s not going to save Medicare a lot one way or another.”

Source: Health Behavior News Service, August, 2008

Counseling Plus Medication May Help Teens Quit Smoking

A clinical trial of 312 teenagers aged 14 to 17 who smoked six or more cigarettes a day and had tried quitting at least twice, found that counseling and medication may help teens quit smoking, though in some cases (26-week time period), the placebo group had higher quit-rates than those taking the drug tested in the study, bupropion.

The subjects were divided into three groups and administered 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion daily, or a placebo (103 teens).

Students received six weeks of treatment and one week of post-treatment, in addition to 10-20 minutes of individual counseling. Followup interviews were conducted by phone after 12 weeks, and in person after 26 weeks.

Quit rates were higher for the 300 milligram group every week except the fourth week. After six weeks, 5.6 percent of subjects in the placebo group, 10.7 percent taking 150 milligrams of bupropion, and 14.5 percent taking 300 milligrams of bupropion had quit smoking. At 26 weeks, 10.3 percent of placebo subjects, 3.1 percent of those taking 150 milligrams of bupropion, and 13.9 percent who took 300 milligrams were still not smoking.

The results indicate that although 300 milligrams of bupropion plus counseling were effective in helping teens quit smoking in the short term, quit rates at the end of the treatment were lower than for adults taking the same medication.

The high rate of relapse after medication stopped suggests the need for a longer treatment period than the 12 weeks recommended for adults may be needed.

"This study provides hope for helping a generation of smokers to quit before they become adults," the authors conclude. "These results are critically important because few effective treatment options are available for adolescent smokers who want to quit."

This study noted that fully one fourth of U.S. high school student currently smoke cigarettes.

The study was conducted by Myra L. Muramoto, M.D., M.P.H., Scott Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, and supported by a National Cancer Institute grant, The Robert Wood Johnson Foundation (financial support for all aspects of the study) and GlaxoSmithKline (maker of bupropion).

Source: Arch Pediatr Adolesc Med. 2007;161(11):1068-1074

Smoking Hooks Kids Almost Immediately, New Study Shows

According to a study published in the July issue of the Archives of Pediatrics and Adolescent Medicine, 10% of 217 studied children who inhaled cigarettes "lost autonomy over their tobacco" use within two days of their first cigarette. Another quarter became addicted within thirty days, and a full half were addicted after smoking only seven cigarettes per month.

The conclusions contradict "conventional wisdom" which believed that it took multiple cigarettes (at least five to six) per day to become addicted to nicotine.

It isn’t long term use that causes addiction, a study author noted, but it is the addiction that causes the heavy use.

Archives of Pediatric and Adolescent Medicine 

Trading Prescription Medications Among Teens

With an increase in the number of psychotropic prescriptions for adolescents there are increased chances of these prescriptions ending up in the wrong hands.

Results of a survey of school students show that 1% of all prescriptions that caregivers write for teenagers are used for non-medical purposes. 6 out 10 students with legitimate psychotropic prescriptions are contacted to redirect their prescriptions. 1% of them agree to do it and some even sell them. As many as 25% have reported that they divert the prescriptions to family and friends.

Critics hold doctors responsible for giving out too many prescriptions to teenagers. However, researchers say that the real problem might be that doctors do not adequately discuss the matter of diverted prescriptions with patients and their families.

Study Claiming Cannabis – Schizophrenia Link Fuels Debate

A controversy has been sparked by a Swiss study, which claims that a link has been established between smoking canabis and developing schizophrenia.

The study concludes that there was an increase in occurrences of schizophrenia during the 90s, which is considered to be a liberal period, and corresponds to higher canabis usage. The critics, however, have pointed out that the study is inconclusive as it is does not take into consideration the individual patients’ drug usage.

Researchers claim that there is a direct relationship between the development of the disease and the rate of canabis consumption. They add that regular smokers of cannabis are at increased risk of developing schizophrenia by two to three times.

Experts on drug issues have welcomed the report, but they also remain cautious. They believe that the hypothesis may indeed be true, but that the results are not conclusive.

Gambling Problems Among Elderly Women

More and more senior women in the United States are getting addicted to gambling and losing everything they own, gambling counselors claim.

A recent study reveals that in America 70% of senior citizens have participated in some kind of gambling activity in the past year.

While traditionally it is thought that it is men who are most commonly addicted to gambling, now women are also being drawn toward gambling more than ever before and some are even losing their life savings.