July 5th, 2012
Our weekly About Addiction summaries are back! Make sure to tune in for the latest in research and news coverage of the drug abuse and drug addiction landscape. This time we’re talking about the food and drug addiction connection, drug using baby boomers, accidents, addicted babies, and drug using teens during summer breaks. If you
Food or drugs? A new study suggests a path for choice – A recent study Yale School of Medicine professors has found that neurons associated with overeating are also linked to non-food associated behaviors such as drug addiction. However, their discovery points to a relationship different than the contemporary view; they found an inverse relationship between eating and drug addiction that shows people who lack a desire for food have a higher predisposition towards drug addiction. According to their findings, it seems that the drive for food and the drive for drugs compete with one another!
Obamacare’s effect on addiction treatment – The recent ruling by the Supreme Court to uphold the Affordable Care Act was a huge moment in our country for many reasons. In the world of addiction, it has a great impact as well! By making sure all citizens have health insurance, it gives those seeking treatment a huge advantage: choice. In the past, those seeking addiction treatment could be limited by their insurance situation. Now, those seeking help will be able to get the treatment that is right for them, not just what is available to them. Also, substance abuse treatment will be able to have a more wide-reaching effect as treatment can be provided earlier as well as a preventative measure.
The dangers of driving high – According to a recent study done at Dalhousie University, marijuana use has a severe adverse effect on safe driving. This may not be new information, however this paper was the first to separate driving under the influence of marijuana from the influence of other drugs and alcohol. They looked at nine smaller studies including 49,411 people in order to calculate their results: finding that cannabis use nearly doubles the likelihood of a motor collision as compared to an uninhibited driver. With marijuana being the most widely used illicit substance in the world, with its usage rate still rising, it is important to separate the truths and myths about its effects.
Babies born addicted – This Thursday’s episode of Rock Center With Brian Williams featured a story on babies born with withdrawal symptoms from prescription painkillers. This is an epidemic in America, and the symptoms are heartbreaking to watch: the babies have tremors, digestive problems and cry inconsolably. There’s little doctors and nurses can do to comfort them as they slowly wean them off of the drugs. On this Thursday’s new Rock Center, Kate Snow reports on the shocking increase in the number of babies born addicted.
A Teenagers’ Summer: No school, less supervision, more drugs? – A new study released by SAMHSA (Substance Abuse and Mental Health Services Administration) reports that 671,000 teens aged twelve to seventeen will try alcohol for the first time this June and July alone; 305,000 teens will try cigarettes for the first time during these months, while 274,500 will have their first experience with marijuana. These numbers are an increase from the rest of the year, likely due to an increase in free time and decrease in adult supervision. While a large proportion of these individuals will never end up developing an addiction or substance abuse problems, this study makes it clear that the summertime may be a good time to talk to your kids about the risks and effects of these substances.
Spankings leading to drug abuse? New research reveals it may not be as far-fetched as you may think – The American Academy of Pediatrics (AAP) has released research that reveals strong links between corporal punishment in childhood and mood disorders, personality disorders, and addiction and drug abuse later in life. Specifically, according to the study, spankings raise the risk of alcohol and drug abuse by 59 percent. With a reported 94 percent of three- and four-year-olds receiving a spanking at least once in the last year, this has a widespread effect on the entire population. While one spanking does not lead to abuse, the research points to physical punishment as a regular means of discipline having adverse effects on mental health later in life.
Is grandpa getting high? More and more often the answer is becoming yes! – Drug use and drug abuse are often thought of in connection with young people, however the Baby Boomers are proving it can affect older people just the same. Last year alone an estimated 4.8 million adults aged 50 and above used an illicit drug. The risk is not just with illegal drugs, but also the misuse of prescription drugs. With the average 50-year-old-man using four different prescription drugs per day, the risk of becoming addicted to any one of them is substantial.
Seeing addiction as a disease, not a moral failing – In an interview with MSNBC’s Andrea Mitchell, director of the National Institute of Drug Abuse Nora Volkow explains how addiction and drug use affect the brain and why it should be considered a disease, not a moral failing. Check out this link to see the whole interview.
|Posted in: Links
Tags: abuse, addiction, babies, baby boomers, disease, driving, drug, Drugs, elderly, marijuana, neurons, Obamacare, painkillers, prescription, punishment, spankings, substance abuse, summer, teens
June 20th, 2012
In our previous article on pain medication and addicts we looked at how common opiate prescriptions are among people who are, or ever have been, identified as having substance abuse issues. We saw that although clinicians are often aware of the problem of possible prescription addiction developing, the issue of managing pain often results in the eventual prescription of opiate medications for chronic pain even in this population.
This time we’re going to explore whether these prescriptions end up resulting in benefits to the patients. We are going to look both at opiate and non-opiate pain relief as it applies to addicts or past addicts with chronic pain.
Pain medication benefits among addicts
Stimulant users (cocaine, amphetamines, and methamphetamine) are not expected to experience many physical or chemical (neurophysiological or neuropharmacological) changes in their brain and nervous system that would interfere with opioid medication therapy. Additionally, their use of meth, cocaine, and similar drugs is not expected to increase their experience of pain unless they’ve been injured while using those drugs. That by no way means that their drug abuse prevents them from experiencing pain, but it less of a direct influence on the future likelihood that they’ll suffer with chronic pain.
But those who do, or have, abused alcohol, benzodiazepines, and obviously opiates (heroin, morphine, oxycontin, etc.) are much more likely to be differentially affected by these medications. Physicians know this well, and in preparation for serious medical procedures specifically ask about such drug use to properly manage patients during surgery (don’t want someone waking up in the middle).
One of the most obvious factors has to do with the high tolerance opiate abusers and users build up to these drugs. For this reason, the doses often needed to help long-term opiate abusers with chronic paid using opiate pain medications can be so extreme that they would easily kill an inexperienced opiate user. We’ve talked about tolerance many times on A3, so I’ll just summarize by saying that the body and brain of opiate addicts will have a much reduced response to opiate medications because their bodies have become less sensitive to the substances in response to the extended high dose use they have put it through. This can happen through reduction in available opiate receptors as well as increased responsiveness in other regulatory systems meant to counteract the opiates (the opponent process theory).
In short, since pain perception and experience is so dependent on the body’s natural opiate response, people addicted to opiate drugs (heroin, morphine, oxycontin, vicodin) have essentially neutralized their natural pain machinery and are more likely to feel pain for an extended period after they quit. By super-activating their pain-blocking response using drugs they have weakened the body’s natural pain-response and are more likely to experience pain when they stop.
These factors are also important when considering pain medication for people in addiction treatment. Indeed, research (1) has found that patients in Methadone Maintenance programs, who are maintained on long-term opiate therapy, are more likely to experience severe pain and more likely to get opiate pain medication prescriptions for it when compared with people in drug-free residential treatment. However, the patients in the drug-free environments were more likely to have used alcohol or benzodiazepines to deal with their chronic pain, so it seems like a bit of a case of choosing between the better of two evils.
The specific medications for opiate-experience patients can also be different, and using more long-release or extended release formulations of these drugs can reduce the abuse liability of the medication itself while also offering better outcomes. I have to say though that the results differ when looking at different populations and it’s always important to consult, and be very honest and clear, with your doctor.
Overall, research suggests that opiate pain medications are as effective for patients who have a history of substance abuse as hey are in the general population (but our Part I article suggests that effectiveness is itself limited). One issue, especially for heroin addicts (or people addicted to other opiates) who are in recovery or active use is balancing pain management with potential abuse problems. Unfortunately, it is true that the medications most effective in treating the pain are also the ones most likely to be abused (2). Our next article is going to cover the issues of prescription abuse in this population but I think it’s important to point out that chronic pain can be debilitating in itself and that it is likely not useful to withhold medication from someone because of the possibility that they will abuse it if the medication itself will help them.
There are certainly approaches to pain-management that do not use medication (exercises, meditation, cognitive behavioral approaches, and more) and an initial recommendation can be that those be tried first, followed by non-opiate pain-relief and then the opiates. However, other options do not manage to deliver results, opiate pain medication can be effective in managing pain symptoms, especially if physicians are aware of methods to spot abuse and control it.
Next up – how to identify prescription abuse in patients, what does it mean, and what should we do about it?
1. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.
2. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.
May 30th, 2012
A recent user question on VYou (see my response here) addressed the issue of prescribing addicts with opioid pain medication. Since prescription medication abuse and addiction is on the rise and getting more and more attention in the media every year, the question of whether addicts in recovery, or people who have dealt with substance abuse and addiction problems in the past, should be prescribed these medications is a very relevant one.
Chronic pain affects a substantial portion of the population worldwide (as many as 30%, see here). Opiate medications are one of the most commonly used approaches to treating such pain, which if untreated can cause serious disruptions to sufferers’ lives. Even when treated, chronic pain can be pretty debilitating. Some research (1) brings up good questions about the true effectiveness of opiate therapy for chronic pain, especially among long-term opiate users (like heroin and prescription pain medication addicts) but also among other drug using populations.
So how common is the practice? What sort of results do drug addicts usually get from these opiate therapies? And finally, how many of the addicts or drug abusers who receive these therapies end up abusing them and can we identify those people early so we can stop prescribing to them? In this three-part series of articles we’re going to cover these questions in-depth.
Prescription pain medication use in addict populations
Clinicians treating chronic back pain choose from a range of options, including opioid medications, exercise therapy, nonsteroidal anti-inflammatory medications, tricyclic antidepressants, acupuncture, and electrical stimulation. One study (1) found wide variability in the percent of chronic pain patients prescribed opioids (from 3%-66%) although the studies varied widely in their size and population served – some even looks at general back pain and not chronic pain alone (they tended to have much lower opioid prescription percentages). Among chronic pain clinic patients, chronic opioid pain medication use was estimated at 19% (2).
Among addicted populations, concerns about tolerance, withdrawal, and abuse tend to cut prescription rates for opioid pain medications. However, past drug abuse can exacerbate pain issues, especially for people who abuse, or have abused, opiates in the past. For this reason, it can sometimes be difficult to properly manage pain in people with a history of addiction. One study (3) found that as many as 67% of patients in a Methadone Maintenance Program and 52% of patients in short term residential treatment programs were being prescribed opiates for pain. It’s important to note that these numbers are higher than those reported in other studies but that populations in treatment do generally show prescription rates higher than the general population. A study in Finland (a country that has great medical record data) found that opiate prescription rates in substance abuse populations were equivalent (not higher or lower) to those in the general population. The College of Problems on Drug Dependence itself had released an official statement noting that a balance must be reached between fear of opioid prescriptions for pain and the usefulness of opioid pain medication for chronic and severe pain (4).
Interestingly, it seems that of all opioid pain medication prescriptions, the largest increases in troubling use has been around oxycodone (Oxycontin), which gets mentioned as often in emergency departments (ED) around the country even though it is prescribed about one-third as often as hydrocodone (Vicodin). This is less surprising when you consider the fact that many addicts report using oxycontin in different ways including smoking, snorting, and injecting the stuff, which is stronger and does not have the same amount of fillers as most hydrocodone preparations. The fact that oxycodone is stronger also means it is more effective for pain relief through higher activation of the opioid system that is relevant for addiction.
In our next piece we are going to explore whether opiate pain medication is helpful in controlling pain among addicts and substance abusers, see you then!
1. Martell, O’Connor, Kerns, Becker, Morales, Kosten, Fiellin. (2007). Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine, 146, 116-127.
2. Chabal, Erjavec, Jacobson, Mariano, Chaney (1997). Prescription Opiate Abuse in Chronic Pain Patients: Clinical Criteria, Incidence, and Predictors. Clinical Journal of Pain, 13, 150-155.
3. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.
4. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.
|Posted in: Education, Opiates, Prescription
Tags: abuse, addicts, chronic, chronic pain, college on problems of drug dependence, CPDD, drug, effectiveness, heroin, medication, morphine, opioid, opioid pain, opioid pain medication, oxycontin, pain, pain medication, prescription, vicodin, VYou
March 19th, 2012
By Dr. Adi Jaffe and Tariq Shaheed
How annoying is it to be running late for work unable to find your keys, wallet, or coveted smart phone? You check under the bed, between the sofa cushions, and in your useful phone valet, before giving up and calling in late to work (if it’s not your phone you’re missing). You ask your wife, who says she hasn’t seen it, and your child, who thinks it’s under the bed (you’ve looked, it’s not). Finally, giving up, you go to your car, where your phone sits smugly right on the passenger seat. As troubling and frequent as this story might be, it’s nothing compared to the difficult experience of over 20 million Americans who annually look for addiction treatment but don’t find it . So what’s keeping so many Americans out of treatment?
Internal and external barriers to addiction treatment entry
In a study done in 2008, researchers surveyed a sample of 518 subjects varying in race and age, to find out about the barriers keeping them out of addiction treatment.  The study was conducted in Montgomery County Ohio, was a part of nationally funded “Drug Barrier Reduction” effort lead by the National Institute on Drug Abuse (NIDA). Most participants were using crack (38.4%), heroin (25.1%), marijuana (14.9%), and alcohol (11.2%). The researchers found a number of internal and external barriers that keep drug abusers from getting the help they need. Internal barriers included stigma, depression, personal beliefs, and attitudes about treatment, while external barriers (systematic or environmental circumstances that are out of a person’s control) include time conflicts, addiction treatment accessibility, entry difficulty, and cost of addiction treatment. 
The researchers concluded that both internal and external barriers can be addressed and improved, but that eliminating the external barriers to addiction treatment is most feasible and could substantially decrease the number of untreated addicts in the United States. Since addressing an internal barrier like “believing one can quit at anytime” (accounts for 29.3% untreated Americans) still requires the ability of the substance user to get treatment, it seems that addressing external triggers will be more immediately effective. Just as motivation to find an item such as keys, phone, or wallet is not the only factor in obtaining that item, a substance user with no internal barriers to treatment is still constrained by all those external barriers, and still not in substance abuse treatment.
The most commonly cited external barriers in the study were:
- Time conflicts – being unable to get off work for treatment, household obligations, busy schedules and simply not having time for substance abuse treatment.
- Treatment accessibility – living too far away for treatment, not knowing where to go for treatment, having difficulty getting to and from treatment, and not understanding the addiction treatment options. Subjects reported that being wait-listed for a facility, and having to go through to many steps contributed to deterring them from seeking treatment.
- Financial barriers included inability to pay for treatment and being uninsured.
Some common internal barriers include:
- Stigma associated with the label of being call an alcoholic or an addict, or stigma regarding addiction treatment. Thus being unwilling to share problems and ask for help.
- Psychological distress such as depression and neuroticism which produces a lack of motivation among substance abuse treatment seekers.
- Personal beliefs
- Religion- God will remove the addiction at the right time
- Denial – User doesn’t believe they are an addict
- Doesn’t need treatment – For example 30% of heroin abuser believed they would recover without treatment.
Although getting substance abusers help is difficult, it starts by understanding the nature of the problem. While one person may not believe they are addicted, another may not understand how sliding scale payment for treatment works. Different individuals may need different helpful resources when it comes to understanding their options.
Thoughts and limitations regarding the research
As we pointed out in a recent article, it’s important to know who is participating in addiction research. In this case, the individuals recruited were reporting for substance abuse treatment assessment at a county intake center. This means the clients are likely from relatively low Socioeconomic Status (SES) groups, but also that they are for some reason motivated to find treatment. Those reasons themselves could be internal (decided to make a change) or external (got arrested), but it’s important to know that these findings do not necessarily apply to more affluent, insurance carrying, or addiction treatment uninterested, individuals. We are currently in the process of conducting a more general study to assess needs in that group.
Also, the time and costs constraints identified by participants can often be overcome by increasing flexibility in searches and by better tailoring the treatment referrals (see our Rehab Finder articles). Costs can be reduced while saving time by looking into outpatient, rather than residential, treatment options. Unfortunately, Americans have been exposed only to the residential treatment model (a la the Dr. Drew and Intervention television shows), but outpatient addiction treatment is effective, costs less, and truly a better fit for many clients (especially those still working, attending school, etc.).
Finally, not all of the internal beliefs can be written off as unreasonable barriers – indeed, it is likely that most individuals who do not seek official substance abuse treatment, and certainly most of those who never enter official substance abuse treatment, will still recover from their addiction without it. As we pointed out in previous articles (see here, and here), most people who use drugs do recover and many do it with no treatment per se, especially when looking at our biggest substance abuse problem – alcohol. That means that some people termed “in denial” and “not needing treatment” were actually either correct, lucky, or both. Recovery doesn’t have to look like we expect it to, it just has to result in a person who is no longer suffering with addiction.
A3 Plug (you knew it was coming)
At A3 we believe information is the key; by dispelling myths about addiction, removing stigma and anonymity, reviewing the latest research in treatment, and finding 21st century solutions to barriers, we hope to reduce the number of untreated. Join us in the fight to educate and treat addiction.
1. Jiangmin Xua; Richard C. Rappa; Jichuan Wanga; Robert G. Carlsona. (2008) The Multidimensional Structure of External Barriers to Substance Abuse Treatment and Its Invariance Across Gender, Ethnicity, and Age.
2. An investigation of stigma in individuals receiving treatment for substance abuse
November 6th, 2011
There’s been a lot of talk about athletes using drugs in the last decade. Still, most of the attention has been either to steroids and other performance enhancing drugs or to illegal drug use, the kind that has cost some players their careers (Ricky Williams anyone?). But how many people know that prescription medication abuse is a huge problem among athletes long into their retirement?
A recent study using phone interviews with 644 retired NFL players has revealed that the 7% o them are currently abusing prescription opiates (pain killers like oxycontin). This rate is a full 3 times greater than in the general population!!! When it comes to lifetime abuse, the NFL players were also 3 times more likely to abuse these drugs during their career than the rest of the population is during their lifetime!
Some of this is obvious, NFL players are likely to cause some serious abuse to their bodies (their reporting of moderate to severe pain was also 3 times greater than the general population) and opiate medications are very good at taking away the pain. Indeed, the players who used these drugs during their careers reported more injuries overall as well as more career ending injuries. Still, I was surprised to find that more than half of the players who began using prescription opiates during their NFL career got at least a portion of their pills from illicit sources. I would have imagined that professional athletes would have no problem getting prescription pain killers from doctors but apparently, many of them also used teammates, coaches, and trainers (less shocking) as their sources. Not surprisingly, retired NFL players who drink heavily or who reported misusing prescription drugs during their playing career were 2-3 times more likely to be misusing, or abusing, prescription opiates now. That finding supports past notions about the association between abuse of one drug (like alcohol) and abuse of others and about the good ol’ finding that past behavior is one of the best predictors of future behavior. Still, there were other important factors including undiagnosed concussions, severe playing pain, and mental impairment, which all contributed further to the likelihood that ex-players would be abusing prescription opiates currently.
Since prescription abuse is one of the leading causes of accidental death in the U.S. and high doses of prescription opiates specifically have been reported to increase the risk of overdose greatly even among people who are taking them regularly (like V.A. patients), it seems there should be at least some focus dedicated to prescription drug use and abuse among athletes, including retired athletes, in order to reduce the risk of death in this population. For all my searching I couldn’t find a good estimate of the current rate of overdose death among athletes so maybe we should start there.
I’m pretty sure that if we look, we’ll find similar patterns among athletes from sports other than football and that there is something more we can do to reduce the abuse of these drugs. I have absolutely no problem with people using opiate pain kills for pain, I just think we need to do whatever we can to cut the overdose risk so that we don’t lose more than 20,000 people to this stuff every year…
Linda B. Cottler, Arbi Ben Abdallah, Simone M. Cummings, John Barr, Rayna Banks, Ronnie Forchheimer (2011). Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug and Alcohol Dependence, 116, 188-194.
|Posted in: Education
Tags: abuse, abusing prescription, abusing prescription opiates, athletes, Drugs, nfl, nfl players, opiates, pain, players, prescription, prescription oopiates
November 4th, 2011
I had the opportunity to sit on a panel today during a drug policy alliance session on the role of the recovery movement in drug policy discussions. While it was obvious that everyone on the panel could generally agree that the current U.S. policy when it comes to drug use, abuse, and addiction is not working and unsustainable, it wasn’t clear that we had a common roadmap of how to get to a better place.
Some of the panel speakers were in recovery and others weren’t and while most were from the U.S. we had a representative of the Scandinavian approach for a nice little “reality check” and a bit more balance than one normally gets on these things. From student representatives of the Columbia University Students for Sensible Drug Policy to the distinguished William Moyers from Hazeldon, our panel certainly didn’t lack in a breadth of experiences. Still, even our eight member-panel couldn’t appease everyone when it came to diversity (we missed the mark on racial representativeness). The discussion was civil, but definitely showed that there are serious differences that need to be bridged if the decriminalization discussion is to ever get serious.
I’m all for collaboration and I definitely think that we need to end up in a place where drug use is no longer criminalized as it currently is. Quadrupling our prison population in a few decades with approximately 20% of inmates incarcerated for drug offenses is stupid, expensive, and does little to stop the problem we’re trying to deal with as evidenced by the relatively stable rate of use, abuse, and addiction in this country.
But how do we move forward? Do we make these drugs legal for everyone to use or place an age limit on it? Do we pretend that there’s no risk that use of legal substances will go up to meet the rates of alcohol and tobacco abuse or do we prepare for the possibility that it might? Do we completely remove legal sanctions from the discussion or do we keep them for a specific subset of hard to reach individuals?
As far as I’m concerned, until these questions are considered and dealt with, there’s not going to be any change. Unfortunately, from my reading of the panel and crowd today, even at a Drug Policy Alliance conference, the responses to each of those questions is likely to bring up a lot of debate. I guess that means our work is not yet done…
September 7th, 2011
Teens raised in affluent homes display the highest rates of depression, anxiety, and drug abuse according to a recent article in Monitor on Psychology, the APA‘s monthly magazine.
One of our recent posts dealt with some of the issues unique to teens and drugs. In addition to the issues we’d already mentioned, the article named a number of reasons for the high prevalence of mental-health issues among affluent teens. Among them were an increasingly narcissistic society, overbearing parents, and an common attitude of perfectionism.
Each of these reasons are likely contributors to the prevalence of mental health and drug abuse issues among upper-middle-class (and above) teens. Still, as far as I’m concerned, the main take home message of the article is this:
Money truly doesn’t buy happiness – Rich teens and drug use.
While drug abuse research often focuses on the lower socioeconomic strata these recent findings indicate that being financially stable offers little in the way of protection from some of the most common psychological difficulties.
Thankfully, the researchers cited in the article gave some simple advice to parents:
- Give children clear responsibilities to help around the house.
- Take part in community service (to unite the family and reduce narcissism).
- Reduce TV watching (especially of reality TV shows that glorify celebrity and excess).
- Monitor internet use.
- Stop obsessing about perfect grades and focus instead on the joy of learning for its own sake.
I couldn’t agree more with these recommendations. Having taught a number of classes myself, I have witnessed the ridiculous inflation in students’ expectations of top grades. I think it’s time we turned attention back to the family and reintroduce some of the basic skills that many addicts find themselves learning much too late… Often in recovery.
|Posted in: Alcohol, Cocaine, Drugs, Education, For others, Marijuana, Meth, Opiates, Opinions, Prescription, Tips
Tags: abuse, affluent, anxiety, celebrity, challenge, class, depression, grades, internet, middle, money, monitor, narcissis, perfectionism, responsibilities, rich, skill, substance, teens and drugs, television, tv, upper