About Addiction: School, prescriptions, heroin and morality

It’s Monday and you get another great summary of news and research about addiction that have been making noise this week. If you care about addiction and about recovery, you know you want to stay abreast of what’s important and A3 wants to give you just that! So read on..

Recovery High: A new kind of high school: Across the country, new kinds of high schools are popping up called “recovery high schools”. At these schools kids and teachers aren’t just focused on grades, they are helping the students recover from their drug addiction and alcohol addiction. For teens entering addiction treatment, 75 percent relapse within the first year, often due to the return to the environment that facilitated the use in the first place. While the long-term effectiveness of these schools is still being evaluated, they are showing promise; and with the recent passage of the Affordable Care Act allowing for increased options for recovery, don’t be surprised to see these kind of high schools becoming more and more common. To see the video check out this link.

Prescription Painkillers leading teens to Heroin: According to national data from the Centers for Disease Control and Prevention, the number of deaths from prescription drug overdose tripled between 2000 and 2008. Experts point to the ease of access teens have to prescription pills, such as Percocet’s and Vicodin, from emergency rooms, dentist offices, and especially unfinished prescriptions in household medicine cabinets as one of the main reasons for the increase. These drugs have been found to at times lead teens to heroin, which provides a more intense version of the same high for a fraction of the price. As a result, in the decade from 1999 through 2009, the yearly deaths of people aged 15 to 24 from heroin overdose shot up from 198 to 510.

Heroin abuse becoming a national epidemic: Heroin use and death is still on the rise, exploding in use over the last couple years, fueled by the Baby Boomers. The Boomers increased use of prescription drugs can quickly lead down a road to heroin; once the prescription runs out or the cost gets too high, the more available, cheaper heroin becomes an attractive option. While its use has been increasing nationwide, the statistics from Oregon this past year give an example of the entire nation’s problem. Last year alone, there were 143 heroin-related deaths in Oregon, a 59 percent increase from the year before and almost the entire nation’s total from a decade ago! Marion County, in particular, has already seen more deaths so far this year than in all of 2011. Heroin is on the rebound, no longer a “dormant drug”, and, with its drastic increases recently, should be addressed sooner rather than later.

Addiction: Disease or moral failing? One of the most common questions regarding addiction is the debate on whether it is a disease or a moral failing.  A recent article by Dr. Marc Lewis addresses the question from both sides. He starts by pointing out the common critiques that “you don’t ‘catch’ addiction”, “you don’t treat addiction with medications or expect a cure”, and “you don’t ‘have’ addiction” like you would “have” a cold or other disease, in order to show why addiction should not be considered a disease. However, he then counters with the comparison to type II diabetes, which fits the mold of the earlier critiques, yet is never questioned as being a disease. In fact, having type II diabetes is not seen as a “moral failing” and it seems addiction is following this path and becoming more frequently seen as a disease rather than a moral failing. Truth is, addiction is likely going to continue being seen as straddling these two domains.

A cautionary tale of Fentanyl addiction: Fentanyl, a new painkiller, is becoming the next in a line of destructive and deadly prescription drugs. According to Dr. Michelle Arnot, Fentanyl is 100 times stronger than morphine and 750 more potent than codeine. The article tells the tale of a man who lost his “perfect wife” to Fentanyl addiction. Prescribed as patches to be sucked on, addicts soon learn to smoke them in order to get a greater effect. Shortly after her abuse began, the “perfect wife” was going through a month’s supply in under a week. This led to pawning her children’s and family’s belongings, turning her into someone no one recognized. One day, her husband came home from work to find her dead. Now, her husband wants her story to serve as a warning to anyone else becoming entangled with Fentanyl.

Helping siblings of addicts: When addiction leads to a fatality, almost everyone who knew the victim is affected. However, they are affected and handle it in different ways. Most people know about the grief parents feel when losing a child, and they are given support and programs to help deal with it. Siblings, on the other hand, have often gone overlooked in the coping process, largely because they do not grieve in the same way as parents. The emotional needs, and even physical needs, of addicts’ siblings can often be neglected in favor of the addict while they’re still alive and in favor of the parents needs after an addict’s passing. Now, programs such as GRASP (Grief Recovery After a Substance Passing) are popping up with the goal of helping these siblings cope.

U.S. Drug overdose deaths are increasing

The second leading cause of accidental death in the US is drug overdose (JAMA 2007). Prescription painkiller overdose deaths (opioid analgesics like OxyContin, Vicodin and methadone) account for nearly half of the 36,450 total fatal overdoses with 15,000 deaths that have claimed a number of celebrity lives including famous actor Heath Ledger (CDC 2011).

With so much concern over illegal drugs, it seems silly not to focus on a problem that is at least as deadly but far more accepted.

Drug overdose deaths increasing quickly

Drug overdoses are normally considered accidental and they're on the riseWe’ve reported on this phenomenon before, so for the regular A3 readers this report might not seem new. But what’s staggering is just how quickly these numbers are moving up.

In 2004 there were 19,838 total accidental overdose deaths, with about 9,000 caused by prescribed drugs, and 8,000 more caused by illegal drugs like cocaine, heroin, and methamphetamines (Paulozzi, LJ, Budnitz 2006). That signals a near doubling in about 7 years, and when you look at numbers from 1999, we’re talking about triple the accidental drug overdose deaths in just over a decade! Fastest growing cause of death in our country ladies and gentlemen.

SAMHSA Reports that use of prescription pain relievers (opioid analgesics) have increased since 2002 from 360,000 to 754,000 people in 2010. That means that people are twice as likely to use these drugs now, which would be fine if 5% of the users weren’t dying every year.  A study I talked about on ABC’s Good Morning America earlier this year (see here) reported that people taking heavy doses are especially likely to die and that this might be at least partially due to additional opioid use over and above the prescribed regimen.Time to get this under control prescribers!!!

This increase in usage opioid analgesics like Oxycontin, Vicodin, and methadone has made them the some of the most deadly drugs in the USA (Paulozzi, LJ, Budnitz 2006). In 1999 to 2004 prescription overdose related to opioid analgesics increased from 2,900 to at least 7,500, this equates to 160% increase in just 5 years (Paulozzi).

A JAMA study conducted between 1999 to 2004 reported that white women showed a relative increase in unintentional drug related deaths of 136.5% followed by young adults aged 15-24 years (113.3%). But the latest report from the CDC suggest that Men and middle aged individuals are most likely to be affected by this growing epidemic. The bottom line is this problem is either moving around or is universal enough affect essentially every major group of Americans. One of the scariest findings from this most recent CDC study may be the conclusion that states are generally unprepared to deal with this growing epidemic.

What can we do about overdose deaths?

First of all, it is seriously time that we had more consistent state and federal computer systems keeping track of prescriptions for heavily controlled drugs in this country. We can keep track of packages moving across state lines with no problem, why is it so damn hard to watch pills that lead to 35,000 deaths? Most states have them in place but they’re not heavily used and there’s nothing at all that looks at cross federal prescription patterns.

Second, we wrote about some harm-reduction methods to reduce overdose deaths, things like intranasal naloxone, safe injection sites, and more. As far as I’m concerned, we need to get off our national moral horse and start acting responsibly when it comes to saving lives. If we have simple solutions that have been shown to reduce deaths while not increasing abuse, I say let’s implement!!! Anything else is simply wrong.

Citations:

Paulozzi, LJ, Budnitz, DS, Xi, Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology Drug Safety 2006; 15: 618-627. (originally published in 2006 and recently updated)

Saving lives made easy – Treating opiate overdose with intranasal naloxone

oxycodone-addiction-big1Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

  • Contact was made with 278 of the original participants.
  • 222 reported witnessing no overdoses during the 15-month span.
  • 7 had their naloxone stolen, lost, or confiscated.
  • 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)

Amy Winehouse dead at 27 – Drug/alcohol overdose?

Amy Winehouse, the soulful singer with the amazing voice and the troubled drug and alcohol use history is dead at 27, according to London Police. Sadly, Amy Winehouse’s celebrity has for the past few years been tied more to her drug and alcohol use than to her music.

No one has reported on whether her death is directly related to drug or alcohol overdose but given Amy’s history with heroin, alcohol, crack, and other drugs, it would not be surprising. This is especially true given her recent cancellation of a European tour due to what seemed like serious drug and alcohol use issues that just didn’t allow her to perform.

This is a sad, sad, reminder that addiction and drug abuse can lead to tragic endings and hopefully will serve as a wake-up call to other addicts who may be close to a similar end but can find the courage and motivation to change in light of Amy’s death.

Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use

We know that addiction can go beyond drug use, but are we becoming addicted to making our bodies perfect?

I put “addiction” in parentheses here because I think it’s important to distinguish substance-related addictions from behavioral ones. There’s no doubt that people’s behavior can become compulsive in the same way addicts become compulsive about using, but I’ve seen no evidence that behavioral addictions interfere with brain function in the way that cocaine, methamphetamine, and opiates alter actual brain mechanisms.

Still, this recent trend of obsessive plastic surgery is a dual-headed “addiction”, one that is both physical and social.  In many ways, people are now able to change aspects of their being that were once thought unalterable including their own physical appearances. To gain social acceptance, if you have money, you now have new tools!

This may also play a big role for those who are love addicted, at least if they have money… Continue reading “Body image and medicalization: Socially relevant behavioral “addictions” beyond drug use”

Alcoholism , Sniffing Bath Salts, and Prescription Medication Abuse

If you care about addiction you’re going to want to read our weekly update from across the globe. It’ll make you smarter – promise (at least when it comes to alcohol and drug abuse issues)!

Drug Abuse – Vaccines to treat addictions, and Sniffing Bath Salts

Medical News Today-A biochemical breakthrough by researchers at Cornell  produces a unique vaccine that combines bits of the common cold virus with a particle that mimics cocaine. Researchers believe the vaccine could be tailored to treat other addictions, such as to nicotine, heroin, and methamphetamine. While similar to other vaccine discussions we’ve had here, the method and generalizability here are of specific interest.

BBC News-Publicity of scholastic journals back fired on Dr. David E. Nichols as drug makers profit off his research findings. Dr. Nichols says while some drugs can be manufactured in the kitchen the scale to which these “legal high” drugs are produced indicates some small companies are involved.

Fox News.com– A new “drug abuse” trend of sniffing bath salts to try to get high is emerging in Louisiana and is creating a issue for the Louisiana Poison Center. It appears that more kids are attempting this “trend” resulting in of paranoia, hallucinations, delusions, as well as hypertension and chest pain. The problem’s gotten so bad in the state that the Governor had to make the active ingredient in the bath salts illegal. The bath salts contain a chemical called “Mephadrone and Methylenedioxypyrovalerone or MDPV, which is known to be a stimulant that may also cause paranoia and hostility.

Alcoholism – Studies and Personal Stories about alcohol

Science Daily- A new study has been conducted which shows that midlife alcohol consumption may be related to dementia which is often assessed about 20 years later. The study found that both abstainers and heavy drinkers had a greater risk for dementia and cognitive impairment than light drinkers. Again, it seems that drinking no-alcohol is associated with risk factors and outcomes that are not as ideal as moderate consumption and somewhat similar to heavy drinking.

Counselor Magazine Blog- Everyone loves watching a good and inspirational movie from time to time. The new movie “Country Strong” deals with many issues that everyday individuals face such as alcoholism, mental illness, co-dependency, ageism, and grief. These are elements that a person goes through when they are dealing with alcoholism. The movie depicts that alcoholism is a family disease and does not affect just the alcoholic. Another great point that the movie shows is that if there are underlying issues that are often not resolved that relapse is very common.

Prescription Drug abuse and death

Reuters- A new study has found that an increasing amount of individuals are dying from abusing and misusing prescription drugs as well as illegal drugs. In recent times deaths from “accidental poisonings” or overdose are more than ten times higher than they were in the late 1960s. This increase in drug deaths is higher across almost all age groups than it was in previous decades, especially amongst white Americans.

Chicago Sun Times- Prescription drug abuse is a growing problem in our country, and deaths from unintentional drug overdoses in the US have increased five-fold over the last two decades. The drugs that are commonly causing these deaths are particularly painkillers such as OxyContin (oxycodone), Vicodin (hydrocodone) and fentanyl. What many individuals do not realize is prescription drugs can be much more deadly than illegal drugs. In 2007 alone, abuse of prescription painkillers was responsible for more overdose deaths than heroin and cocaine combined. Prescription painkillers, most of which are opioids, are synthetic versions of opium used to relieve moderate to severe chronic pain, however in large and excessive quantities, they can suppress a person’s ability to breathe and are very dangerous when they are mixed with alcohol or other drugs.

Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death

Christopher Russell and Adi Jaffe

The tobacco epidemic already kills 5.4 million people a year from lung cancer, heart disease and other illnesses. By 2030, the death toll will exceed eight million a year. Unless urgent action is taken tobacco could kill one billion people during this century. (The World Health Organization Report on the Global Tobacco Epidemic, 2008)

These are some scary numbers, right? Cigarette smoking, according to the WHO, is the single most preventable cause of death in the world today, and in conveying these deadly statistics to the general public, cigarettes have come to be alternatively referred to by smokers and non-smokers as “cancer sticks”, “nicotine bullets”, and “coffin nails”.

But does smoking really ‘kill’ anybody in the literal sense with which we use this word?  To an epidemiologist, tobacco smoking (nor many other drugs of abuse for that matter) does not “kill” a person or “cause” illness or death in the way the words “kill” and “cause” are typically understood by the media and general public. For example, if I shoot someone in the head, stab another in the heart, and strangle a third till he stops breathing, it is reasonable to say that my actions were the direct, sole, and sufficient causes of death – I would have killed them. Smoking, however, is often neither a sole nor sufficient ‘cause’ of lung cancer, coronary heart disease, or myocardial infarction because non-smokers die from these diseases, and for example, because only 1 in 10 heavy smokers die from lung cancer when one looks at the overall numbers. Continue reading “Tobacco smoking alone isn’t enough: More than smoking important in lung cancer death”