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Recreational Use of Prescription Drugs Among Teens

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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

Arthritis Impact on African-Americans and Hispanics

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Arthritis causes more pain and limitations for African-Americans and Hispanics than for whites, according to a study released today by the Centers for Disease Control and Prevention.

African-Americans were 17 percent less likely to report having arthritis than whites, and Hispanics were 46 percent less likely to report the condition than whites, the study said. However, African-Americans and Hispanics with arthritis were almost twice as likely to report severe joint pain and work limitations attributed to their arthritis when compared to whites, it said.

The study, “Difference in the Prevalence and Impact of Arthritis among Racial/Ethnic Groups,” was published in the journal Preventing Chronic Disease.

Arthritis is the leading cause of disability in the United States, affecting 20% of adults. It interferes with work and other daily activities and can complicate the management of other chronic diseases. Arthritis encompasses more than 100 diseases and conditions that affect joints and other connective tissue.

The reason for the racial and ethnic differences, while unknown, may result from a lack of access to health care, language barriers and cultural differences, the report says.

“We must address these stark differences in arthritis impact by using what we know,” said Jennifer Hootman, an epidemiologist for the CDC National Center for Chronic Disease Prevention and Health Promotion and co-author of the report. “We can educate those with arthritis about increasing physical activity and self-management and reducing obesity, especially those in groups bearing a disproportionate burden from arthritis.”

The data, collected from the CDC National Health Interview Survey, are the first to estimate the national prevalence of arthritis and assess its impact among smaller racial and ethnic groups that are usually grouped together when reporting health statistics.

Source: CDC, April 15, 2010

Generic Versions of Cozaar and Hyzaar Tablets Approved for Hypertension Treatment

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The U.S. Food and Drug Administration approved today the first generic versions of two drugs used for the treatment of hypertension. Losartan potassium tablets and losartan potassium and hydrochlorothiazide tablets (a combination drug) are the generic equivalents of Cozaar and Hyzaar tablets, respectively.

Cozaar and Hyzaar tablets are widely-used antihypertensive drugs. Both generic losartan products will carry the same safety warnings as their brand counterparts. These warnings include a boxed warning against the use of these products during the second and third trimesters of pregnancy.

Losartan potassium tablets are approved in 25 milligram, 50 mg, and 100 mg strengths, and Losartan potassium and hydrochlorothiazide tablets are approved in 50 mg/12.5 mg, 100mg/12.5 mg, and 100 mg/25 mg strengths. Both products are manufactured by TEVA Pharmaceuticals USA in North Wales, Pa.

In related actions, the FDA also approved applications from several other companies for losartan potassium and hydrochlorothiazide tablets for the 100 mg/12.5 mg strength only. These companies include Mylan Pharmaceuticals Inc., Roxane Laboratories Inc., and Torrent Pharmaceuticals Ltd.

Source: FDA, April 7, 2010

New OxyContin Formulation Designed to Discourage Abuse of the Drug

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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.

Kids with Sickle Cell Disease More Likely to Have Physical and Developmental Health Problems

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The first national estimate on the health status of children with sickle cell disease revealed that black children with sickle cell disease are more likely to have intellectual disabilities, hearing deficits, and frequent severe headaches or migraines than black children without sickle cell disease. The study by the Centers for Disease Control and Prevention (CDC), “Health Status and Healthcare Use in a National Sample of Children with Sickle Cell Disease,” was published in the American Journal of Preventive Medicine.

The study found that black children with sickle cell disease are four times more likely to have fair or poor health status, twice as likely to have recently visited a mental health professional and have received special educational or early intervention services more often compared with black children without sickle cell disease.

Sickle cell disease is a group of red blood cell disorders that is inherited, passed from parents to children. In sickle cell disease, the red blood cells become hard and sticky, and take on a sickle shape. When the C-shaped cells travel through small blood vessels, they clog the vessels and can block blood flow. In addition, the sickled cells die earlier than normal blood cells, which creates a constant shortage of red blood cells.

“In the United States, sickle cell disease is one of the most common genetic disorders; more than 20 percent of children with SCD had recently visited a health care provider such as an optometrist or an ophthalmologist, and had more than one visit to the emergency department in the past year,” said Sheree Boulet, DrPH, with CDC’s Division of Blood Disorders. “The findings of this study emphasize the importance of screening children with sickle cell disease for thinking ability, hearing, and vision problems.”

Further, despite the increased use of health care services, the data showed that more parents indicated that they could not get an appointment for their child soon enough (10.5 percent, compared to 3.9 percent of parents whose children did not have SCD), reported waiting too long in the doctor’s office (8.7 percent versus 4 percent), and could not get through to their doctor on the telephone (7.5 percent versus 1.8 percent).

“This study gives a better insight into the types of disabilities children with sickle cell disease have and can help health care providers plan comprehensive treatments for children with the disease,” said Dr. Boulet.

The study analyzed data from the 1997–2005 National Health Interview Surveys (NHIS) to describe health status and health services use among black children 0-17 years of age with SCD.  The NHIS has monitored the health of the nation since 1957; it is the principal source of information on the health of the civilian noninstitutionalized population of the United States and is one of the major data collection programs of the National Center for Health Statistics (NCHS) which is part of the Centers for Disease Control and Prevention (CDC). NHIS data on a broad range of health topics are collected through personal household interviews.

Source: Centers for Disease Control (CDC), March 23, 2010

Herpes Prevalent in 16 Percent of Americans Aged 14-49

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About 1 in 6 Americans (16.2 percent) between the ages of 14 and 49 is infected with herpes simplex virus type 2 (HSV-2), according to a national health survey released today by the Centers for Disease Control and Prevention.  HSV-2 is a lifelong and incurable infection that can cause recurrent and painful genital sores.

The findings, presented at the 2010 National STD Prevention Conference, indicate that herpes remains one of the most common sexually transmitted diseases (STDs) in the United States.

The new estimate, for 2005-2008, comes from CDC’s National Health and Nutrition Examination Survey (NHANES), a nationally representative survey of the U.S. household population that assesses a broad range of health issues.

The findings suggest relatively stable HSV-2 prevalence since CDC’s last national estimate (17 percent for 1999-2004), because the slight decline in prevalence between the two time periods is not statistically significant.

The study finds that women and blacks were most likely to be infected.  HSV-2 prevalence was nearly twice as high among women (20.9 percent) than men (11.5 percent), and was more than three times higher among blacks (39.2 percent) than whites (12.3 percent).  The most affected group was black women, with a prevalence rate of 48 percent.

As with other STDs, biological factors may make women more susceptible to HSV-2 infection. Additionally, racial disparities in HSV-2 infection are likely perpetuated because of the higher prevalence of infection within African-American communities, placing African-Americans at greater risk of being exposed to herpes with any given sexual encounter.

“This study serves as a stark reminder that herpes remains a common and serious health threat in the United States.  Everyone should be aware of the symptoms, risk factors, and steps that can be taken to prevent the spread of this lifelong and incurable infection,” said Kevin Fenton, M.D., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  “We are particularly concerned about persistent high rates of herpes among African-Americans, which is likely contributing to disproportionate rates of HIV in the black community.”

Research shows that people with herpes are two to three times more likely to acquire HIV, and that herpes can also make HIV-infected individuals more likely to transmit HIV to others.  CDC estimates that over 80 percent of those with HSV-2 are unaware of their infection.  Symptoms may be absent, mild, or mistaken for another condition.  And people with HSV-2 can transmit the virus even when they have no visible sores or other symptoms.

“Many individuals are transmitting herpes to others without even knowing it,” said John M. Douglas, Jr., M.D., director of CDC’s Division of STD Prevention.  “We can’t afford to be complacent about this disease.  It is important that persons with symptoms suggestive of herpes—especially recurrent sores in the genital area—seek clinical care to determine if these symptoms may be due to herpes and might benefit from treatment.”

Combination of Prevention Approaches Needed to Reduce National Herpes Rates
Although HSV-2 infection is not curable, there are effective medications available to treat symptoms and prevent outbreaks.  Those with known herpes infection should avoid sex when herpes symptoms or sores are present and understand that HSV-2 can still be transmitted when sores are not present. Effective strategies to reduce the risk of HSV-2 infection include abstaining from sexual contact, using condoms consistently and correctly, and limiting the number of sex partners.

CDC does not recommend HSV-2 screening for the general population.   However, such testing may be useful for individuals who are unsure of their status and at high risk for the disease, including those with multiple sex partners, those who are HIV-positive, and gay and bisexual men.


Source: Centers for Disease Control (CDC), March 9, 2010

Heart Disease Hospitalization Rates in the U.S.

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Heart disease hospitalization rates among Americans aged 65 years and older vary substantially depending on where they live, according to a report released today by the Centers for Disease Control and Prevention.

The “Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries” shows that the highest hospitalization rates occur among blacks compared to other racial and ethnic groups.  Hospitalization rates were also highest in counties located primarily in Appalachia, the Mississippi Delta, Texas and Oklahoma. A significant number of Medicare beneficiaries live in counties without hospitals capable of providing specialized heart disease treatment.

The atlas provides for the first time statistics about heart disease hospitalizations at the county level.  Data came from the Medicare records of more than 28 million people each year between 2000 and 2006 in the 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. The report documented an average of 2.1 million hospitalizations for heart disease each year.

“These data bring into sharp focus the differences in heart disease hospitalization rates that exist across this country,” said Michele Casper, Ph.D., epidemiologist in CDC’s Division for Heart Disease and Stroke Prevention.  “Importantly, with county–level information, health professionals at the local, state and national levels will be able to tailor heart disease prevention programs and polices to the needs of people living in communities with high rates of heart disease.”

Heart disease is the nation’s leading cause of death. In 2010, it is estimated to cost the United States $316.4 billion in health care services, medications and lost productivity.

In states with the highest heart disease hospitalization rate, the burden is generally two times higher than states with the lowest rates.  For instance, in Louisiana there were 95.2 hospitalizations for every 1,000 Medicare beneficiaries, compared with 44.8 in Hawaii over the same six–year period.

The atlas also brings to light significant racial and ethnic disparities. The heart disease hospitalization rate is much higher among blacks (85.3 hospitalizations per 1,000 beneficiaries) than for whites (74.4 per 1,000) or Hispanics (73.6 per 1,000).  While these rates declined slowly between 2000 and 2006 for Hispanic and white Americans aged 65 years and older, they remained steady among older black Americans.

The atlas also points out geographical differences in access to hospitals with the capability to treat heart disease patients. In 2005, 21 percent of all counties in the United States had no hospital, and 31 percent lacked a hospital with an emergency room.  Specialized cardiac services are even more limited, with 63 percent of U.S. counties lacking a cardiologist outside the Veterans Affairs system.

“Heart disease is largely preventable, and reducing the toll of this disease on society is a national priority,” said Darwin Labarthe, M.D., Ph.D., director of CDC’s Division for Heart Disease and Stroke Prevention. “With targeted public health efforts, such as prevention and early identification of risk factors, and increased access to appropriate medical care, the burden of heart disease can be reduced.”

Source: CDC (March 1, 2010)

Undiagnosed Diabetes Patients May Also Have Undiagnosed Kidney Disease

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Millions of Americans may have chronic kidney disease (CKD) and not know it, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).

“Our research indicates that much of the CKD burden in the United States is in persons with prediabetes and undiagnosed diabetes, who are not being screened for CKD,” comments Laura C. Plantinga, ScM (University of California, San Francisco). The researchers believe that broader screening may be needed to detect patients with these two “relatively silent yet harmful diseases.”

In a study funded by the Centers for Disease Control and Prevention, Plantinga and colleagues analyzed a nationally representative sample of about 8,200 Americans from the National Health and Nutrition Examination Survey. Standard laboratory tests were used to assess the rate of CKD, focusing on people with undiagnosed diabetes or prediabetes (sometimes called “borderline” diabetes).

Based on lab tests, 42 percent of subjects with undiagnosed diabetes had CKD—similar to the 40 percent rate in those with diagnosed diabetes. “Only a small percentage of participants were aware of the diagnosis of CKD,” says Plantinga.

In addition, CKD was present in nearly 18 percent of subjects with prediabetes. Among participants without diabetes or prediabetes, the rate of CKD was about 11 percent.

“Based on these results, there may be a substantial number of individuals in the United States—up to 13 million—who have undiagnosed diabetes or prediabetes and who already have signs of kidney damage and/or reduced kidney function,” says Plantinga. Such patients would be at high risk for worsening kidney disease and diabetes, and for the poor outcomes associated with both conditions—including cardiovascular disease and death.

Diabetes is the most important risk factor for kidney disease, but the new results suggest that harmful effects on the kidneys may be occurring even before diabetes is diagnosed. “Persons at risk for diabetes and their health care providers should be aware that earlier screening for both diabetes and kidney disease may be warranted,” says Plantinga. “Earlier screening would allow for appropriate, timely medical care to prevent further progression and poor outcomes.”

In an accompanying editorial, Gary C. Curhan, MD, ScD (Brigham and Women’s Hospital, Boston, MA) calls for CKD screening to be extended to patients with prediabetes. Curhan also suggests that it may be time to consider the concept of “pre-CKD”—identifying patients at a very early stage of CKD when the disease may still be preventable or reversible.

Although the study shows an association, it cannot determine whether the development of CKD followed the development of diabetes, or whether CKD was actually caused by diabetes. There is also likely some misclassification of both diseases, although the association remained significant when tested under a range of different assumptions.

Study co-authors include Deidra C. Crews, Josef Coresh, Edgar R. Miller III (Johns Hopkins University, Baltimore, MD), Rajiv Saran, Elizabeth Hedgeman (University of Michigan, Ann Arbor), Jerry Yee (Henry Ford Hospital, Detroit, MI), Meda Pavkov, Mark S. Eberhardt, Desmond E. Williams (Centers for Disease Control and Prevention, Atlanta, GA), and Neil R. Powe (University of California, San Francisco) on behalf of the Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team.

Disclosures: The authors reported no financial disclosures.

Source: Clinical Journal of the American Society Nephrology (CJASN), “Prevalence of Chronic Kidney Disease in US Adults with Undiagnosed Diabetes or Prediabetes,” (doi 10.2215/CJN.07891109) and the accompanying editorial,” Pre-Diabetes, Pre-Hypertension…is it time for Pre-CKD?” (doi 10.2215/CJN.01650210)

Depression Among Low Income Latinos

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A new, small study of low-income, depressed Latinos finds that those who stigmatize mental illness are less likely than others are to take medication, keep scheduled appointments and control their condition.

The findings could help physicians develop a series of question to identity patients who might especially be resistant to care and then help them understand how treatment works, said lead study author William Vega.

“Unfortunately, mental-health stigma turns out to be one of the most serious barriers for people receiving care or staying in care,” said Vega, professor of medicine and social work at the University of Southern California.

Many cultures have stereotypes about depression and mental illness, he said, with some viewing it as something that will brand a family for generations. Latinos, in particular, value resilience and think, “it’s a cultural value to be able to handle your own affairs,” he said. “If you can’t, it implies that you’re weak.”

While it might not be surprising that Latinos stigmatize mental illness, “like many things, it’s all anecdotes and innuendo until you do something more solid, like a research study, and start finding out what the issues are,” said Vega, who worked on the study with fellow researchers while at the University of California at Los Angeles.

In the new study, published in the March/April issue of the journal General Hospital Psychiatry, researchers surveyed 200 poor, Spanish-speaking Latinos in Los Angeles. They all had visited local primary care centers; 83 percent were women. All had shown signs of depression in an initial screening.

Another screening found that all but 54 of the 200 individuals were mildly to severely depressed. Researchers deemed 51 percent as those who stigmatize mental illness, based on responses to questions about things like the trustworthiness of a depressed person.

The researchers found that those who stigmatized mental illness were 22 percent less apt to be taking depression medication, 21 percent less likely to be able to control their depression and about 44 percent more likely to have missed scheduled mental-health appointments.

The findings “shows evidence that stigma does exist, and it’s related to things that are important to provide as part of proper treatment,” Vega said.

Jamie Walkup, a Rutgers University associate professor of psychology who studies mental health and stigma, said the key is to find ways to “push back against these negative ideas, hoping that a person with depression will no longer let an aversion to being a person with depression stop them from doing what they may need to do to get help.”

It might be worth asking, he said, “whether it may sometimes make more sense to switch gears with a patient who, for whatever reason, finds it intolerable to think of themselves as having depression.”

In such cases, doctors could find other ways to work with these patients without insisting that they acknowledge their diagnosis.

Source: Vega W, Rodriguez MA, Ang A. Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry 32(2), 2010.


Community-Acquired MRSA’s Increasing Prevalence in Pediatric Patients

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Once considered a hospital anomaly, community-acquired infections with drug-resistant strains of the bacterium Staphylococcus aureus now turn up regularly among children hospitalized in the intensive-care unit, according to research from the Johns Hopkins Children’s Center.

The Johns Hopkins Children’s team’s findings, to be published in the April issue of the journal Emerging Infectious Diseases, underscore the benefit of screening all patients upon hospital admission and weekly screening thereafter regardless of symptoms because MRSA can be spread easily to other patients on the unit.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a virulent subset of the bacterium and impervious to the most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in ill people or in those with weakened immune systems, it can lead to invasive, sometimes fatal, infections.

In 2007, The Johns Hopkins Hospital began screening all patients upon admission and weekly thereafter until discharge. Some states have made patient screening mandatory but the protocols vary widely from hospital to hospital and from state to state.

“MRSA has become so widespread in the community, that it’s become nearly impossible to predict which patients harbor MRSA on their body,” says lead investigator Aaron Milstone, M.D., M.H.S., a pediatric infectious disease specialist at Hopkins Children’s.

“Point-of-admission screening in combination with other preventive steps, like isolating the patient and using contact precaution, can help curb the spread of dangerous bacterial infections to other vulnerable patients.”

The new Johns Hopkins study found that 6 percent of the 1,674 children admitted to the pediatric intensive-care unit (PICU) at Hopkins Children’s between 2007 and 2008 were colonized with MRSA, meaning they carried MRSA but did not have an active infection. Of the 72 children who tested positive for MRSA, 60 percent harbored the community-acquired strain and 75 percent of all MRSA carriers had no previous history or MRSA. MRSA was more common in younger children, 3 years old on average, and among African-American children. The reasons behind the age and racial disparities in MRSA colonization remain unclear, the investigators say. Patients with MRSA had longer hospital stays (eight days) than MRSA-free patients (five days) and longer PICU stays (three days) than non-colonized patients (two days).

Eight patients who were MRSA-free upon admission became colonized with MRSA while in the PICU. Of the eight, four developed clinical signs of infection, meaning that the other four would have never been identified as MRSA carriers if the hospital was not performing weekly screenings of all patients.

The research was funded in part by the National Institutes of Health, the Thomas Wilson Sanitarium for Children in Baltimore and by the Centers for Disease Control and Prevention.

Source: John Hopkins Medicine (March 26, 2010)