29 minutes reading time (5888 words)

ATOD News REcap for Week Ending July 27

Popular Synthetic Drug Simple to Obtain From China, Experts Say

The popular synthetic drug methylone, a key ingredient in “bath salts,” is simple to order online from China, experts tell The Virginian-Pilot. In one recent case that ended up in federal court, two Virginia men emailed a lab in China, wired several thousand dollars to an English-speaking customer service representative and received 100 pounds of the drug in the mail, according to the newspaper.
“It’s probably easier than buying a case of wine online,” said Richard Yarow, an attorney for a man who pleaded guilty to assisting one of the importers wire money to China. “When you buy wine you at least have to show ID” upon delivery, he added.

Methylone is a white crystalline powder. In addition to being used to make bath salts, it also can be snorted, swallowed or mixed into drinks. The drug costs about $350 per ounce on the street. Importers charge $2,600 to $4,000 per pound. Methylone was legal in most places in the United States until recently, and was sold online and in some gas stations and head shops. Some states began banning synthetic drugs last year, and more have followed suit this year.

Earlier this month, President Obama signed legislation that bans synthetic drugs. The law bans harmful chemicals in synthetic drugs such as those used to make synthetic marijuana and bath salts. Bath salts are marketed under names such as “Ivory Wave,” “Purple Wave,” “Vanilla Sky” or “Bliss.” The drugs mimic the effects of cocaine, LSD, Ecstasy and/or methamphetamine. According to the Drug Enforcement Administration, users have reported impaired perception, reduced motor control, disorientation, extreme paranoia and violent episodes. Bath salts have become increasingly popular among teens and young adults. Packages sent to the United States are subject to inspection, but drug-sniffing dogs usually cannot detect methylone and other synthetic drugs, according to federal agents. A spokesman for U.S. Customs and Border Protection told the newspaper they cannot prevent people from ordering things off the Internet.

Alzheimer’s and Alcohol: The Real Connection

As a doctor who takes care of older adults, I am often asked two types of questions about drinking or alcohol consumption. An 80-year-old male patient, who is “sharp as a bell,” recently told me that for the past many years his singular vice has been having  “a martini with two olives” every night before dinner. He wanted to know if this was medically acceptable, or whether he should quit.

An 84-year-old female patient, who is cognitively intact and a life-time teetotaler, had read that mild-moderate alcohol consumption (1-2 drinks/day) was good for the heart and may even decrease the risk of Alzheimer’s disease. She asks: “Would you recommend that I start having a daily drink?”
Two studies presented at the Alzheimer’s Association International Conference in Vancouver on Wednesday help us to better address these questions. One study followed a group of women 65 or older who started out as non-drinker, mild drinkers, or moderate drinkers (no heavy drinkers, please).  After 20 years, they were evaluated for memory problems and dementia.  The women who went from non-drinking to any level of drinking increased their chances of developing memory or dementia problems by 200 percent.  

Also, the women who were moderate drinkers at the start and stayed that way did not have a lower risk of developing problems than the ones who didn’t drink the whole way through.  So going from teetotaler to any level of drinking was actually harmful.  Being a drinker from the start didn’t necessarily hurt, but it wasn’t protective. A second study looked at binge drinking, or having four or more drinks at one sitting.  Patients were evaluated in 2002 and followed for eight years.  The study found that people who had one binge-drinking episode per month were 62 percent more likely to show memory problems than those who didn’t binge drink.  Those who had two or more binge-drinking episodes were 147 percent more likely to have these problems than the non-bingers.  

So one episode per month was bad, but two episodes was more than two times worse. These studies confirm what we have been recommending for our patients:  If you’re a light or moderate drinker — 1 oz. of alcohol per day if you are a woman, up to 2 oz. for men — you don’t need to change your habits. That martini or glass of wine with dinner is OK.  But if you don’t drink, starting alcohol consumption in your later years isn’t a good idea.  It may increase your risk of mental decline and Alzheimer’s disease. Neither of these studies addressed what to recommend to older patients, relative to alcohol intake, who are already experiencing cognitive decline or have Alzheimer’s. Research has shown that in these individuals, no alcohol intake — or switching to non-alcoholic beers and other beverages — is best, since even small amounts of alcohol can upset their delicate cognitive equilibrium and significantly worsen cognition and even trigger behavioral problems
Dr. George Grossberg is the Samuel A. Fordyce Professor of neurology and psychiatry at the Saint Louis University School of Medicine and past president of the American Association of Geriatric Psychiatry and of the International Psychogeriatric Association (IPA).

Coordinated Strategy Has Impact on High-Risk College Drinking, Study Suggests

A coordinated strategy aimed at high-risk college drinking can be effective, a new study suggests. The strategy addresses alcohol availability, policy enforcement and perceptions about the rate of high-risk drinking among peers, HealthCanal.com reports. Campuses that implemented the strategy saw a 50 percent decrease in alcohol-related injuries, the researchers report in the journal Alcoholism: Clinical and Experimental Research. The study included five universities in North Carolina, which put together coalitions of campus administrators, faculty and staff, students and community members. Participants on each campus developed a strategic plan for their school. The universities were compared with five similar schools that did not implement an alcohol intervention. “We realized that high-risk drinking is not just a campus problem, and it’s not just a community problem. 

You have to look at the entire ecosystem,” lead researcher Mark Wolfson, Ph.D., of Wake Forest Baptist Medical Center in Winston-Salem said in a news release. Strategies included restricting access to alcohol by underage or intoxicated students, increasing or improving coordination between campus and community police, and establishing consistent disciplinary actions for those who violated policies. Campuses with alcohol-reduction strategies found the percentage of students reporting severe consequences due to their own drinking decreased from 18 percent to 16 percent, while rates were unchanged on campuses without such strategies. 

Those who reported injuring another person while drinking decreased from 4 percent to 2 percent on campuses with alcohol-reduction strategies, compared with a nonsignificant decrease at the other universities. While the results were modest, the researchers said the strategies could help many students. They estimated that on a campus of 11,000 students, these interventions would result in 228 fewer students experiencing at least one severe consequence of drinking over a one-month period, and 107 fewer students would injure others due to alcohol over the course of a year.

One in 10 Employers in U.S. Say They Will Cut Health Coverage

A new study finds about one in 10 U.S. employers say they plan to cut health coverage for workers over the next several years, as the bulk of health care reform regulations are implemented. The results of the study, conducted by the consulting company Deloitte, are less drastic than those of a study conducted last year by the consulting company McKinsey, which found 30 percent of employers would “definitely or probably” stop offering health insurance after 2014. The Wall Street Journal notes the majority of Americans under age 65 who have health insurance receive it through an employer. Currently, most employers who offer health care coverage say they do so because it helps them recruit and keep employees. 

The Deloitte study found about one-third of companies said they might decide to stop offering health coverage under several scenarios: if they find health care reform requires them to provide more generous benefits than they do currently; if a scheduled tax on high-cost plans takes effect; or if they decide the cost of penalties for not offering insurance is less expensive than paying for benefits. Companies with 50 or more employees that do not provide health benefits after 2014 face penalties that start at $2,000 for each worker. The cost for providing health insurance far exceeds that amount for most companies, the article notes. However, companies that provide health insurance get tax breaks, and often can offer lower wages. The survey found fewer than 2 percent of companies with more than 1,000 workers said they would consider dropping coverage, compared with 13 percent of those with 50 to 100 workers.

Study links alcohol/energy drink mixes with casual, risky sex

(Medical Xpress) -- A new study from the University at Buffalo's Research Institute on Addictions (RIA) has found a link between the consumption of caffeinated energy drinks mixed with alcohol and casual -- often risky -- sex among college-age adults.
According to the study's findings, college students who consumed alcohol mixed with energy drinks (AmEDs) were more likely to report having a casual partner and/or being intoxicated during their most recent sexual encounter. The results seem to indicate that AmEDs may play a role in the "hook-up culture" that exists on many college campuses, says study author Kathleen E. Miller, senior research scientist at UB's RIA. The problem is that casual or intoxicated sex can increase the risk of unwanted outcomes, like unintended pregnancies, sexually transmitted diseases, sexual assault and depression, says Miller. And previous research has linked energy drink consumption with other dangerous behaviors: drunken driving, binge drinking and fighting, for example. "Mixing energy drinks with alcohol can lead to unintentional overdrinking, because the caffeine makes it harder to assess your own level of intoxication," says Miller.
"AmEDs have stronger priming effects than alcohol alone," she adds. "In other words, they increase the craving for another drink, so that you end up drinking more overall."
The good news: Miller's study found that consumption of AmEDs was not a significant predictor of unprotected sex. Drinkers were no less likely than nondrinkers to have used a condom during their most recent sexual encounter.

Regardless of their AmED use, participants in the study were more likely to use a condom during sex with a casual partner than during sex with a steady partner, consistent with previous research. A steady or committed partner is a less risky prospect than a casual partner whose sexual history is unknown, Miller notes, so using a condom may not feel as necessary. To be published in the print edition of Journal of Caffeine Research and available online to subscribers of the journal, the study is part of a larger three-year research project by Miller, funded by the National Institute on Drug Abuse (NIDA).
The research included 648 participants (47.5 percent female) enrolled in introductory-level courses at a large public university. They ranged in age from 18 to 40 but mostly clustered at the lower end of the age spectrum. More than 60 percent were younger than 21.

According to the study's findings, nearly one in three sexually active students (29.3 percent) reported using AmEDs during the month prior to the survey. At their most recent sexual encounter, 45.1 percent of the participants reported having a casual partner, 24.8 percent reported being intoxicated and 43.6 percent reported that they did not use a condom.

According to Miller, drinking Red Bull/vodkas or Jagerbombs doesn't necessarily lead people to get drunk and become intimate with strangers, but it does increase the odds of doing so. But she points out that these drinks are becoming increasingly popular with college-age adults and should be considered a possible risk factor for potentially health-compromising sexual behaviors. The findings may provide a basis for educational campaigns or consumer safety legislation, such as warning labels that advise against mixing energy drinks with alcohol, Miller says.

More information:A copy of the study is available here: www.buffalo.edu/ne… UB-Study.pdf

When campuses and their surrounding communities can join forces to stop alcohol abuse

Not only is alcohol use pervasive among U.S. college students, who typically drink more than their same-aged, non-college peers, but college students also seem to lag behind their peers in 'maturing out' of harmful drinking patterns. There has been little examination of interventions that link community-level and campus-level environments. A unique study that assessed this two-pronged approach to reducing high-risk drinking in and around college campuses has found that it is highly effective in decreasing severe and interpersonal consequences of drinking.
Results will be published in the October 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Alcohol use by U.S. college students is a major public health problem," said Mark Wolfson, a professor with the Wake Forest Baptist Medical Center as well as lead author for the study. "Most college students drink, whether of legal age or not, and many drink at levels that reflect heightened risk. We also know that college students typically drink more than their same-aged peers, and that these elevated levels of high-risk drinking translate into negative health and social consequences, both for the student him or herself, as well as others in terms of unintentional injury deaths as well as blackouts, being the victim of a sexual assault, engaging in unprotected sex, and driving under the influence of alcohol."

Wolfson said it is important to note that colleges typically do not exist in isolation from the surrounding community, and that students very likely live, shop, drink, etc., in the area immediately surrounding the campus. Thus, a community-level intervention, he said, just makes sense. "One example of this would be for college officials to partner with community residents and city leaders and change enforcement practices and policies related to loud and unruly student parties, which can pose significant risks for the partygoers as well as those living in residential areas containing rented houses and apartments adjacent to campus," said Wolfson. "Our study is unique in that it included a focus on colleges and the surrounding community, it used a community organizing approach, it involved implementation of environmental strategies, and that in taking this approach, we were able to demonstrate an impact."
"There have been a number of community-reach initiatives in the past, but very few have addressed the college population," added Ralph Hingson, director of the Division of Epidemiology and Prevention Research at NIAAA. "It is important to protect all students on and off campuses, as college life should be a safe environment for all students."

Wolfson and his colleagues assigned 10 universities in North Carolina to either an Invention or Comparison condition. Those universities designated as an Intervention school were assigned a campus/community organizer, who formed a campus/community coalition that developed and implemented a three-year strategic plan designed to reduce high-risk drinking and alcohol-related consequence among college students. Numerous outcome measures were garnered from a web-based survey of students at each university. "We found that a community organizing approach to planning and implementing environmental strategies on the college campus and in the surrounding community can reduce rates of negative consequences that stem from high risk drinking by college students," said Wolfson. "More specifically, this approach was associated with significant decreases in severe consequences due to the students' own drinking and alcohol-related injuries caused to others."
"It is a key finding that this this approach can reduce alcohol-related harms," said Hingson. "This is a pivotal study because it shows a reduction in alcohol-related harms that some college students can cause other college students, including reductions in physical harms caused by other drinking students. If we can chip away at this, it is a major accomplishment."

"Another important contribution is to the field of alcohol research," said Wolfson. "We have identified the usefulness of measuring the 'dose' of the intervention, at the site level, which is important and something of a methodological innovation, I think." The next step, added Wolfson, is an "implementation manual" he and his colleagues are developing for college officials to use if they want to try implementing the intervention approach used in the study on their own campus.

Provided by National Institute on Alcohol Abuse and Alcoholism

Low Income Means More Medications
Forbes, David Maris, Contributor

According to our national survey released today:
  • 34% of American adults take at least one prescription drug
  • 11.5% of American adults take three or more prescription drugs.
  • 6.5% of American adults take 4 or more prescription drugs.
  • Those at the lowest income level are more likely (two to three times more likely) to be at the highest levels of prescription drug use.
The Lower Income Levels Dominate High Prescription Use Category
Respondents at the lowest income levels indicated that they are much more likely to be taking high levels of prescription drugs (4 or more).
  • In our survey, 10.5% of those earning $0 – $24,999 said they were taking 4 or more prescription drugs.   This compares to zero/no respondents in the highest upper income group ($100,000 – $149,000 income category) indicating they were taking 4 or more prescription drugs Lower Income, and only 3 – 5% those in the $50,000 – $100,000 ranges.
In other words, the lower income respondents are much more likely to be taking four or more prescription drugs than the middle- and upper-income respondents.

However, how does this differ from those taking 1, 2 or 3 drugs?  
When we look at those taking one, two, or three prescription drugs – we don’t see a similar trend of the poor being bigger users of drugs than the higher income levels. Among the many possible explanations, perhaps lower income respondents wait a long time to get medical care and when the patient eventually seeks care, he or she is in worse shape, requiring greater drug intervention.  While we know lack of access to care leads to poorer care and more drastic measures needed when care is eventually used, I am not sure that is what we are really seeing in the data (mostly because there is no linear relationship of income and prescription use for the smaller number of prescriptions).

The second possibility is that what we are seeing is the byproduct of poorly coordinated Federal care  - a system that allows and in face encourages poor patients to be on as many drugs as possible to ensure repeat visits for doctors.  Interestingly, the middle income respondents showed a fairly even use, while the higher income dominated the 1- 2- and 3- medications categories. My own research to better understand Federal healthcare brought me to Appalachia where the combination of low income and aged population make Federal healthcare programs (Medicare and Medicaid) prevalent.

The problems of drug abuse and polypharmacy in Appalachia are staggering.  I visited with one elderly woman who looked older than her years, her legs swollen with edema making walking nearly impossible.  I noticed her shoes did not fit on her feet.  When I asked how many drugs she was currently taking she held up a freezer bag full of medicines.  She told me she takes more than a dozen medications.  I explored it further – she indicated that she was on an antidepressant prescribed by her doctor because he indicated “many people get depressed after surgery” so he prescribed an antidepressant ahead of her knee surgery.  Yes, she was given an antidepressant not to treat, but to prevent, depression – and she was still on it more than a year later.

I do not know exactly how and why this occurred, and it is possible this one instance, it was appropriate for her situation, although I highly doubt it based on her responses to my questions.  I do believe that part of this is due to uncoordinated care and poor incentives.  Doctors get paid to see Medicare and Medicaid patients, and the more regular follow-up appointments, the better it is for them.  True, many doctors are increasingly starting to not see Medicare patients – trying to weed out a lower profit patient population.  However some of those who do sometimes try to make up for the low payments with volume.  Her case, like so many others, points to the problem of polypharmacy – or people on multiple drugs.
Adverse drug reactions among multiple drugs and even Over-the-Counter (OTC) drugs are a serious problem.  It has been estimated that perhaps approximately 16% of hospital admissions were related to adverse reactions to medicines and approximately 100,000 deaths occur yearly due to adverse drug reactions – making it the 4th leading cause of death and ahead of pulmonary disease, diabetes, AIDS and automobile deaths, according to Polypharmacy

I came away from this trip concerned that the aging of the babyboomers and the implementation of government healthcare for a broader group will make the problems of overspending and uncoordinated care – including deaths related to drug interactions - worse, not better. Those that fear that government sponsored healthcare will lead to fewer prescription drugs are simply wrong. It will lead to the opposite – an explosion of people seeking drug treatments and already squeezed doctors to feel even greater pressure. This conclusion seems to be supported by the data from our survey, although it is admittingly not conclusive.

My takeaway’s:
  • Federal healthcare will initially lead to a large increase in Federal spending on drugs.
  • Adverse events, including deaths, from polypharmacy is a serious problem already and will get worse as babyboomers age and government healthcare programs expand.
  • It appears the poor are much more likely to be on a high level of prescription drugs – more should be done to understand why this is.
This article is available online at:  http://www.forbes.com/sites/davidmaris/2012/07/24/low-income-means-more-medications/

Cognitive changes may be only sign of fetal alcohol exposure
Distinct facial features not seen in many cases, NIH study finds
Most children exposed to high levels of alcohol in the womb do not develop the distinct facial features seen in fetal alcohol syndrome, but instead show signs of abnormal intellectual or behavioral development, according to a study by researchers at the National Institutes of Health and researchers in Chile. These abnormalities of the nervous system involved language delays, hyperactivity, attention deficits or intellectual delays. The researchers used the term s functional neurologic impairment to describe these abnormalities. The study authors documented an abnormality in one of these areas in about 44 percent of children whose mothers drank four or more drinks per day during pregnancy. In contrast, abnormal facial features were present in about 17 percent of alcohol exposed children.

Fetal alcohol syndrome refers to a pattern of birth defects found in children of mothers who consumed alcohol during pregnancy. These involve a characteristic pattern of facial abnormalities, growth retardation, and brain damage. Neurological and physical differences seen in children exposed to alcohol prenatally — but who do not have the full pattern of birth defects seen in fetal alcohol syndrome — are classified as fetal alcohol spectrum disorders.

“Our concern is that in the absence of the distinctive facial features, health care providers evaluating children with any of these functional neurological impairments might miss their history of fetal alcohol exposure,” said Devon Kuehn, M.D., of the Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute involved in the study. “As a result, children might not be referred for appropriate treatment and services.”

The Centers for Disease Control and Prevention provides information on the treatments for FASD.
Dr. Kuehn conducted the study with NICHD colleagues Tonia C. Carter, Ph.D., Mary R. Conley and Jim Mills, M.D, as well as researchers at the National Heart, Lung and Blood Institute, the National Capital Consortium, in Bethesda, Md., and the University of Chile in Santiago.  Their findings appear online in Alcoholism: Clinical and Experimental Research.

The research was conducted as part of a long-term study of heavy drinking in pregnancy known as the NICHD-University of Chile Alcohol in Pregnancy Study. To conduct the study, the researchers asked over 9000 women at a community health clinic in Santiago, Chile about their alcohol use during pregnancy. They found 101 pregnant women, who had four or more drinks per day during their pregnancies and matched them with 101 women having similar characteristics but who consumed no alcohol when they were pregnant. After these women gave birth, the researchers evaluated the infants’ health and conducted regular assessments of their physical, intellectual and emotional development through age 8. The researchers documented differences in the rate of children affected in the following areas:

Alcohol exposed
Abnormal facial features
17 percent
1 percent
Delayed growth
27 percent
13 percent
Cognitive delays (including intellectual)
35 percent
6 percent
Language delays
42 percent
24 percent
27 percent
2 percent
Some of the women with heavy drinking habits also engaged in binge drinking (5 or more drinks at a time). Even though these women already had high levels of alcohol consumption, the researchers found that this habit increased the likelihood of poor outcomes for their children.

Meet The Drug Dealer Who Helps Addicts Quit
A prescription drug called Suboxone helps wean people off of heroin and pain pills, but addicts have a hard time getting prescriptions. So they're turning to the black market. Unlike pain pills and heroin, Suboxone (generic name: buprenorphine) is very hard to overdose on. Addicts can take it to avoid withdrawal symptoms and manage their cravings for these drugs. "People who are treated with Suboxone are able to go back to school, they're able to go back to work, they're able to start paying taxes and taking care of their children," says Dr. Miriam Komaromy, who directs a state-funded addiction treatment hospital in New Mexico. "It's making them able to return to being a functioning member of society." New Mexico has the highest fatal drug overdose rate the US. For years, it's battled against one of the worst heroin epidemics in the country. And while heroin use has pretty much held steady, a recent report from the New Mexico Department of Health shows the sales of opioid pain relievers that are popular recreational drugs increased by 131% between 2001 and 2010.
Click here to read the rest of the story.

More Colleges Adopt Smoking Bans

A growing number of U.S. colleges are adopting smoking bans. The Christian Science Monitor reports that many schools have adopted total bans, both indoors and out. On Monday, the Ohio Board of Regents recommended a total ban on tobacco products at the state’s public colleges. In June, the University of Maryland announced all 12 of its institutions will become smoke free by July 2013. At schools in the City University of New York system, the use and advertising of tobacco will not be allowed beginning in September. The American Nonsmokers’ Rights Foundation reports that as of July 1, 2012, there are at least 774 campuses that are 100 percent smoke free. According to the National Center for Tobacco Policy, between one-third and one-half of colleges in the United States have likely implemented a smoke-free policy, or are considering one. The American College Health Association conducted a survey in the spring of 2011 that found 85 percent of college students described themselves as non-smokers, and 96 percent said they never used smokeless tobacco. On most college campuses with smoking bans, the consequences for smoking are often nonexistent or minimal, the article notes. Sometimes repeat offenders will face university disciplinary measures, which vary from school to school. The policies generally are enforced by other students, who do not want to be around cigarette smoke.

Physicians Ask FDA to Revise Prescription Label for Opioids

A group of doctors and public health experts has asked the Food and Drug Administration (FDA) to change prescription guidelines for opioids, to prevent prescription drug abuse, according to Reuters. In a petition to the FDA, 37 doctors, public health officials and researchers asked the agency to prohibit use of opioids for moderate pain. They also called on the FDA to add a maximum daily dose, and only permit patients to take opioids for up to 90 days, unless they are being treated for cancer-related pain. While a change in the label would not limit how doctors prescribe opioids, it would prevent drug companies from promoting the drugs for non-approved uses, the article notes. Some of the petitioners said the government needs to do more to address drug companies’ marketing that encourages physicians to prescribe opioids for chronic pain. Dr. Andrew Kolodny, Chair of the Psychiatry Department at Maimonides Medical Center in New York, told the newspaper many of his patients start taking opioids for valid medical reasons, but become addicted when they take them for too long. “We don’t think drug companies should be allowed to advertise these drugs as safe and effective for long-term pain, if we know very well that they’re not,” said Kolodny, who is also President of Physicians for Responsible Opioid Prescribing. Purdue Pharma, maker of OxyContin, said in a statement, “The FDA, its advisory committees, and numerous medical experts maintain that the current indications for long-acting opioids are appropriate. We agree with the FDA that prescribing information for any medication should be subject to ongoing review and modification to the extent that compelling medical evidence emerges.”

First-Ever Safe Drug Disposal Ordinance Adopted in Northern California
The Alameda County (Calif.) Board of Supervisors this week adopted an ordinance that requires the pharmaceutical industry to pay for a safe medication disposal program for county residents. The Safe Drug Disposal Ordinance is the first of its kind in the nation.  Advocates for the disposal programs such as CADCA coalition member CommPre, a program of Horizon Services, Inc., in Hayward, said the law will save lives by preventing accidental drug overdose and keeping flushed pills from contaminating water.  The ordinance is based on a Canadian “producer responsibility” model and does the following:
·         The ordinance requires pharmaceutical companies that sell drugs under brand and generic names in Alameda County to establish a producer-financed and managed take-back program, as is done in other countries including Canada, Australia, and France;
·         Producers cannot charge visible fees, forcing internalization of costs, to implement the stewardship program so take-back is just a cost of doing business;
·          The program must have an outreach and promotion campaign including prominently displayed signage; • Producers must pay an oversight fee to the county
·         Controlled substances are excluded from the ordinance for now, awaiting Drug Enforcement Administration findings on the issue;
·         Failure to comply allows a maximum penalty of up to $1,000 per day fine

The county operates drop-off boxes in several cities, even operating a “mobile med disposal” system for transportation-challenged seniors, Pratt said, but the ordinance will help pharmaceutical companies to take responsibility for the entire “life span” of their products. Making drug disposal easier will encourage senior citizens to get rid of expired medications and unneeded drugs, helping to eliminate medication mix-ups, and it will help reduce youth access to prescription drugs and over-the-counter medications. Alameda County saw the rate of hospitalizations from unintentional poisonings among adults 60 and older jump by 43 percent between 1998 and 2006. Nationally, prescriptions for controlled substances increased by 154 percent between 1993 and 2003. Municipal wastewater treatment plants can't keep up. They were designed to treat biological agents in drinking water, not antibiotics, steroids, anti-depressants and pain medications that people throw away or flush. A 2008 Associated Press investigation found pharmaceuticals in the drinking water supplies of at least 41 million Americans in 24 major metropolitan areas. With persistence from the coalition, including County Supervisor and coalition member, Nate Miley, Pratt said the coalition’s prevention plan included the “three Ps: partnering, promotion, and policy” about two years ago.  The coalition has been partnering with the local waste and water agencies, and had some success focusing on the dangers to the environment, but then utilized the other environmental angle when their county council amended the ordinance to include health and safety findings.

Estimated Number of Emergency Department Visits for  Misuse or Abuse of Pharmaceuticals More Than Doubles from 2004 to 2010
The estimated number of drug-related emergency department (ED) visits involving the misuse or abuse of pharmaceuticals increased significantly from 2004 to 2010, according to data from the Drug Abuse Warning Network (DAWN). More than 626,000 ED visits in 2004 were related to the misuse or abuse of pharmaceuticals, compared to more than 1.3 million in 2010. In 2010, approximately one-half (49%) of these pharmaceutical misuse or abuse visits involved pain relievers (both opioid and non-opioid) and more than one-third (35%) involved drugs to treat insomnia and anxiety. In contrast, the number of ED visits involving illicit drug use was relatively stable from 2004 to 2009, and then increased by 20% from 2009 to 2010 (see figure below). There were more than 1.1 million ED visits related to the misuse or abuse or illicit drugs in 2010, primarily for cocaine (42%) and marijuana (39%). The authors suggest that educational efforts “emphasize the difference between appropriate therapeutic use and drug misuse or abuse” and that “raising awareness among first responders, such as emergency medical technicians and emergency department staff, about the possible effects of pharmaceuticals and appropriate treatments can also help reduce the negative effects of these drugs on patients’ health and well-being”

Some Doctors Say Change in Opioid Prescribing Rules Could Hinder Pain Treatment

Some doctors are concerned that making it more difficult to prescribe opioids could hinder treatment of patients in pain, ABC News reports. Earlier this week, 37 health care workers signed and submitted a petition to the Food and Drug Administration (FDA), urging officials to change labels on prescription opioids, in an effort to curb prescription drug abuse.

“I believe this is not an appropriate way to address the disease of addiction,” said Pam Kedziera, Clinical Director of Fox Chase Cancer Center’s pain program. “Pain is a significant problem in the United States, and those who suffer deserve treatment.”

The petition asks the FDA to prohibit use of opioids for moderate pain. It also calls on the agency to add a maximum daily dose, and only permit patients to take opioids for up to 90 days, unless they are being treated for cancer-related pain. While a change in the label would not limit how doctors prescribe opioids, it would prevent drug companies from promoting the drugs for non-approved uses.

“We’ve seen the pendulum go from it being extremely difficult for physicians to prescribe opioids to patients who didn’t have cancer… to where it was clearly being overprescribed,” Dr. Joshua Prager, Director of the Center for Rehabilitation of Pain Syndromes at the University of California at Los Angeles, told ABC News. “What I would argue for is that there really has to be balance that doesn’t have the pendulum swing back too fast and too far beyond what is reasonable.”

Both Kedziera and Prager object to a 90-day limit on opioids. Kedziera says she is concerned about taking chronic pain patients off medication just so that they will not exceed the limit.
Dr. Gregory Collins, who heads the Cleveland Clinic’s Alcohol and Drug Recovery Center, said he believes the measures outlined in the petition “unduly restricts doctors’ access to opiate medication in the treatment of numerous noncancer but painful conditions.”
Bath Salts: Devastation from Addictive "Thinking"
ATOD News Recap for Week Ending July 20

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