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Posts Tagged ‘opiates’

Addiction research – Who are we studying?

March 4th, 2012

I teach a class on the psychology of addiction (Psych 477 at California State University in Long Beach) and as I have been preparing the lectures something has become very clear to me – textbooks patently gloss over important details about the addiction research they cite. One of the most obvious gaps I’ve noticed this semester concerns the population of research subjects most addiction research is conducted on. An example will clarify:

A student group in my class had to read a study assessing the residual effects of methamphetamine on mood and sleep. They were amazed that no changes in mood were observed and that participants slept a full 6-8 hours the night after being administered meth! Would you have been surprised with these results given that we all have been told that crystal meth improves mood and causes insomnia?

Would it matter at all if I told you that the participants in the study were current meth abusers who use an average of 4 times every week?

For anyone not aware of the tainted history of health research in the U.S. (I’m including psychological research in this group), go ahead and read about the Tuskegee Syphilis Experiment and Stanford Prison Experiment (video here). There are other examples including Stanley Milgram‘s obedience studies, and more but as exciting as the discussion of these studies is, it’s time to get back to my main point.

It is mostly due to the ethically-questionable, psychologically damaging, research above that research institutions are now required to vet proposed research studies using Institutional Review Boards (IRBs) to assure that human participants in studies are consenting to participate of their own free will, are not coerced, and are not suffering undue damage. This is also true of addiction research. Rarely does the public consider this fact however when they are being reported on research relevant to addiction. I know this because the kids in my class never gave it a second thought.

When reading about addiction research, think about the subjects participating in itNearly all addiction research, especially studies utilizing “hard” drugs like cocaine, meth, opiates, etc., are required to make use of a very limited part of society – drug using individuals with a history of use of the specific drug of interest who are specifically not interested in treatment. Individuals who have never tried the drug or who want to be treated for drug abuse or dependence (addiction) are excluded due to ethical concerns. In most studies, participants can not qualify if they are addicted to drugs other than those being studies (except smoking, for which exceptions are usually made since we’d be able left with no participants otherwise) or have any associated mental health disorders, which are very common among addicted individuals. I would further assert that for at least a substantial portion of these research participants, the term “addicts” may not be appropriate since many addicts would not willingly give up using their favorite substance for a week or two to be replaces with a hospital bed and an experimenter controlled dose of drug or placebo. Taken together, our research subjects are pretty obviously not representative of all drug users, or all addicts, or all anything else. They make up a very specific group – less than perfect, but what we have to work with.

In some studies that attempt to make a direct comparison between controls (or drug naive participants) and drug users, this is likely less of an issue. This can happen when researchers try to examine brain structure differences, or performance on a specific psychological or physical test. In such cases researchers can at least statistically identify contributions of length of use, method of use, and other relevant data on differences between people who use and those that don’t. There are probably still some serious differences between “true” addicts, recreational users, and semi-chronic users that would be important to understand here, but we can’t so we don’t. But when it comes to assessing mood effects, or indeed any of a number of subjective effects of drugs, drug cravings, and withdrawal, this limitation in the population to be studied is something that often needs to be made explicitly clear to most public consumers of research. Since we can’t assess changes in mood, absorption rate, anxiety, or any other such measure (some exceptions for very low doses in very specific circumstances) among people who are new to the drug, we end up assessing them among people with a lot of experience, but not enough of a problem to want addiction treatment. Again, this should be considered a pretty specific type of drug user in my opinion.

There are other types of studies – those conducted with abstinent ex-users or addiction treatment intervention studies utilizing addicts who want, or who reported to, treatment on their own or in response to advertisements. While these studies make use of populations that can be considered at least closer to the individuals they are specifically aimed at – assessing the return of  cognitive function after short or long term abstinence or testing a new intervention on those who want treatment – they still bring on limitations that need to be specifically considered.

An important point – most researchers recognize these issues and make them explicitly part of their research publications, in a specific section called “Limitations” but what seems troubling is that the public doesn’t have any awareness of these issues. So when someone tells you that “they just found out meth doesn’t actually make people lose sleep,” take a second to ask “for who?”


Posted in:  Education
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Prescription opiates (pain killers) and NFL careers

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!

With these sorts of collisions, is it ay wonder football players are in severe pain when they retire?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…

Citation:

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.

inda B. Cottler, Arbi Ben Abdallah, Simone M. Cummings, John Barr, Rayna Banks, Ronnie Forchheimer


Posted in:  Education
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Alcoholism , Sniffing Bath Salts, and Prescription Medication Abuse

January 17th, 2011

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.


Posted in:  Education
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About Addiction: Smoking, Drugs, Drinking and Cancer

May 17th, 2010

New links for interesting articles about addiction. Check them out!

Tobacco, nicotine, and Smoking

Medical News Today: According to a recent study in China there is a new effective strategy for treating tobacco addiction.  Researchers have developed a novel tea filter that seems to help with cigarette addiction. (Note: this link doesn’t give direct access to the article so we’re basing the summary on the article itself)

SAMHSA: According to a new nationwide study, adolescent smoking may be influenced by mothers’ smoking or depression. The study states that adolescents living with mothers who smoke are 25.6% more likely to smoke. It’s frightening to think that 1.4 million 11-17 year old kids started smoking in the past 12 months!

Science Daily: Exposure to prenatal smoking may lead to psychiatric problems. According to new research, exposure to prenatal smoking can increase the need for psychotropic medications in childhood and young adulthood.

Hard drugs

Science Daily:  A newly developed and tested modified enzyme has been shown to break down cocaine into inactive products nearly 1000 times faster than the human body. The article states further that cocaine toxicity due to drug overdose results in more than half a million emergency room visits annually. This new enzyme could help prevent OD deaths by breaking down the drug.

Fox News: The number of soldiers seeking opiate abuse treatment has been increasing, going up from 89 in 2004 to 529 last year.

Addiction Inbox: A study that uses the Stroop test (have to name the colors of words and not the words themselves) seems to be a good predictor for addiction treatment effectiveness and drop out rates. Pretty cool stuff!

Alcohol

Join Together: This is a short article summarizing research which shows that rare childhood leukemia is tied to drinking during pregnancy. According to this research, children whose mothers are drinking during pregnancy are 56 percent more likely to develop a rear form of leukemia called AML.

Addiction Tomorrow: Britain is considering raising the prices of their very low-end alcohols most likely in an attempt to damper the young adults that binge drink and of alcoholics since they are most often the ones that drink the low-end alcohol.


Posted in:  Links
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Brittany Murphy dead at 32 – Anemia, pneumonia, and yes, drugs…

February 4th, 2010

Toxicology update

Well, it seems the toxicology reports are in and Brittany’s death was, at least partially, caused by her taking of multiple prescription drugs. Still, it seems that she was trying to medicate a host of conditions brought on by her underlying anemia and pneumonia. It’s sad to think that this death could have likely been prevented had she simply taken better care of herself and gone to seek emergency care rather than loading her body with those pills. Unfortunately, this seems to be another in a string of medically preventable deaths… Sad.

Original post:

Brittany Murphy, the actress from “Clueless,” and “8 Mile” died last night at Cedars-Sinai in Beverly Hills at the age of 32. Brittany has been rumored to be suffering from severe eating disorders, and recent pictures seem to support that notion. Given that she apparently died from cardiac arrest, I’m wondering if drugs (even prescription drugs) played a role in the death as well… I’ll keep updating the story as more becomes available.

My heart goes out to her family and friends. Certainly a loss suffered far too early.

UPDATE: According to the police report, a number of prescription drugs were discovered in Brittany’s bedroom including (read past the list for my take on this):

  1. Topamax –  While TMZ reported this drug to be used as anti-seizure medication, it is also used to reduce weight-gain associated with the use of many other prescription drugs on this list. Lastly, it is considered to be a mood stabilizer.
  2. Methylprednisolone – An anti-inflammatory that may be used to treat bronchial infections
  3. Prozac – A commonly prescribed SSRI anti-depression med.
  4. Klonopin – A benzodiazepine anti-anxiety prescription medication that is also used to help with insomnia. Like most benzos, the probability of overdose is low if used properly, but overdose would lead to cardiac arrest.
  5. Carbamazepine – Another anti-convulsant mood stabilizer often used to treat bipolar disorder. This prescription drug can be very dangerous when combined with other medications due to its actions on GABA and extensive alteration of Sodium channel activity. It is also a bipolar med.
  6. Ativan – Once again a benzodiazepine that is often used to treat anxiety and insomnia.
  7. Vicoprofen – A pain reliever that includes an opioid (it sounds like vicodin for a reason).
  8. Propranolol – Prescription med used to treat hypertension and as an alternative, less habit-forming anti-anxiety drug.
  9. Biaxin – An antibiotic.
  10. Hydrocodone – Same as Vicoprofen, an analgesic (pain reducing) prescription drug.

What do I think killed Brittany?

With 2 benzodiazepine medications, 2 opiates, and antidepressant, and a drug that is made to lower one’s heart pressure, it’s no wonder that Brittany was found not breathing. I’m going to wait until the final toxicology report to draw a definite conclusion, but from this list, it seems highly likely that a dangerous combination of these prescription drugs was taken, which resulted in Brittany’s heart stopping. Even when taken at their prescribed strengths, these medication, when combined, can form a lethal cocktail.

You should ALWAYS check with your doctor regarding interactions between different prescriptions you’re taking, especially when those medications haven’t all been prescribed by the same physician!


Posted in:  Addiction Stories
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Steven Tyler deals with pain killer addiction by checking into rehab

December 23rd, 2009

After the recent death of Michael Jackson, and possibly Brittany Murphy, due to prescription drug overdoses, Steven Tyler, the lead singer of the mega-band Aerosmith, has checked himself into rehab for pain-killer addiction.

Many pain killers commonly used are opiates (which are very similar to heroin), and many chronic-pain sufferers resolve to taking such drugs in high quantities and for many years. Such use can easily lead to dependence and serious withdrawal symptoms.

We wish Tyler all the best in his rehabilitation efforts. Stay strong Steven!


Posted in:  Education
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Doctor prescription drug use: Addiction fears no one

September 30th, 2009

The story published today by the Baltimore Sun (see here) is another sad reminder that no one is safe from addiction.

Two doctors of pharmacology at the University of Maryland School of Medicine were apparently developing quite a drug habit buying prescription drugs online and then cooking them and shooting them up. Now one of them is dead and the other is in jail looking at some serious time.

I’m not going to repeat the whole story here, but you should go read it.  Prescription drug use is a growing problem in the U.S., apparently, like other addictions, it doesn’t discriminate.


Posted in:  Addiction Stories, Drugs, Drugs, Education, Prescription
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