About Addiction: food, treatment, babies and teens

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.

Is opiate pain medication safe for addicts? Part I

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!

Citations:

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.

Prescription opiates (pain killers) and NFL careers

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

New drug testing technology? Cocaine and saliva

A recent development (check it out here) might lead the way to a quicker, more easily administered drug test. Instead of the lab analysis of urine, blood, or other fluids, this recent technology might allow first responders, such as EMTs, to assess a person’s exposure to drugs (prescription and otherwise) by simply dipping this device (think pregnancy test) into their saliva.

As of right now, the researchers have been able to demonstrate the success of the technology with cocaine, but it shouldn’t be too long before they can provide similar devices for many different drugs.

Now, it’s true that I usually focus on abused drugs in this blog, but this technology could help medical professionals identify dangerous drug interactions common to many prescribed, properly taken, medications. Given the huge increases in prescription medication abuse in the United States, that could be extremely useful and might save some of the 12,000 lives annually lost to accidental overdoses.

Maybe when these devices get cheap enough they can be used in addiction treatment centers to provide more immediate testing results.

Who knows, one day, the technology might be widespread enough to make home drug-testing a simple reality. Whether that’s a good or bad thing should probably be left to another post…

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”

Opioid prescription overdose and abuse – Staying safe while reducing pain

A new article just published in JAMA (see here) reports a strong relationship between high-dose opiate prescribing and accidental overdose deaths. The authors focused on a sample of Veterans and found that those prescribed more than 50mg of morphine per day, or the equivalent of other opiate drugs, we much more likely to die of such overdose than patients being prescribed lower doses. Fortunately, only about 20% of the patient-months (a measure of how many people were prescribed a specific dose for how long) were prescribed these high doses but the rate of overdose for this group was 3 to 20 times higher! Continue reading “Opioid prescription overdose and abuse – Staying safe while reducing pain”

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.