Teens and drugs: Drug use statistics and treatment that works

Here are some drug use statistics:

  • Over 80% of teens engage in some form of deviant behavior (1).
  • Over 50% of high-school seniors admit to having used drugs (2).
  • Only 10%-15% of the population develop drug addiction problems related to their drug use (1).

The question is:

If the majority of teens experiment with drug use, and so few eventually develop drug addiction problems, should we be focusing on something other than stopping kids from trying drugs? Continue reading “Teens and drugs: Drug use statistics and treatment that works”

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.

More money more problems? Rich teens and drugs

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.

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”

About Addiction: Alcohol, Emergency Rooms, and Prescription Drug Abuse

This are the new links about addiction and drug abuse. Leave us your feedback!

Red Bull and Alcohol

The Huffington Post: Red bull is a much caffeinated energy drink and when mixed with liquor, it can diminish the awareness of drowsiness, feelings of un-coordination and intoxication. Studies show the added caffeine only makes you believe that you are more in control.

New York Times: A new zero tolerance policy begins for drunk drivers in New York State. Anyone convicted of misdemeanor or felony drunk driving will be required to install an ignition interlock breathalyze device that does not allow the car to start if it detects a threshold level of alcohol on the breath of the driver.

Join Together: Teens who binge drink could be increasing their risk of developing osteoporosis later in life. Adolescent rats who consumed large doses of alcohol suffered genetic damage in areas related to bone formation

Hospital and Emergency Room Admissions

The Herald: Hospital admission for heroin and cocaine overdose increased in Glasgow in four years. There is a rise for the most serious drugs including heroin, cocaine, methadone and morphine and codeine.

AOL health: In 2007, around 12 million Americans visited an emergency room for a mental disorder or/and substance abuse problems. One out of every 8 patients seeking help came in because of drugs or a mental health issue.

Prescription Drug Abuse

The Salt Lake Tribune: Prescription drug abuse is America’s fastest growing drug problem. An estimated 6.2 million people report having misused prescription drugs in the past month. Prescription drug abuse increased in Utah.

Prescription drug abuse up 400%:Here are two different links to articles discussing this through ABC and The Huffington Post.

About Addiction: Prescription Medication, Anti Smoking, Alcohol, Ecstasy, and Marijuana

We have the newest links about addiction. This week we feature info on cough medicine, prescription medication, smoking, alcohol, ecstasy, and marijuana. Let us know what you think and leave us your feedback.

Cough and Prescription Medication

CNN Health: The trend for kids to abuse cough medicine is either back, or never left since my days in high-school. Kids get high from a large dose of dextromethorphan, the active ingredient in Robitussin, hence the trend’s nickname “Robo tripping”.

Health Day: Substance abuse treatment admissions of prescription medication (mostly pain relievers) have increased over 400 percent during 10 years. The proportion of admissions for abusers increased from 2.2 percent in 1998 to 9.8 percent in 2008.

Anti Smoking Campaign

New York Times: According to federal officials, the nation has failed to reach its 2010 health goal of reducing high school smoking to 16 percent. They called in report for a resurgence of anti-smoking advertisements.

USA Today: New York became the first American city to require stores to post 4-square-foot warnings showing the physical effects of smoking near tobacco displays or smaller ones at each register. Last month, a few retailers and the nation’s three big tobacco companies sued the city to stop the posters.

Alcohol and Binge-Drinking

Journal Watch: Binge-drinking adolescents are 2.3 to 3.0 times more likely than non-bingers to continue this behavior into their 30s. Striking changes in brain morphology persisted even after alcohol cessation in monkeys exposed to alcohol.

Science Daily: Teens tend to increase their alcohol consumption in summer. Experts suggest parents monitor their children during summer breaks.

Cesar Fax: Of the sexually active high school students 22% reported that they used alcohol or drugs before their last sexual intercourse. Males are significantly more likely than females to report using alcohol or drugs prior to having sex.

Ecstasy and Marijuana

The Partnership: Last year Ecstasy use showed a 67 percent increase, and last year marijuana use showed a 19 percent increase, reversing a declining trend. Could decriminalization and medical marijuana be the reason?, high

Los Angeles Times: An estimated 555,000 Americans older than 12 have used Ecstasy in the last month. Ecstasy is a synthetic amphetamine that is been around for nearly 100 years. If you haven’t read about the death’s at the Los Angeles area rave EDC look here.

Crystal meth withdrawal – It’s not like heroin, but don’t expect it to be easy

Heroin, or opiate, withdrawal symptoms is the gold standard of addiction withdrawal. Imagine the worst flu of your life, multiply it by 1000, and then imagine knowing that taking a hit of this stuff will make it all better. Think sweats, fever, shaking, diarrhea, and vomiting. Think excruciating pain throughout as your pain sensors get turned back on after being blocked for way too long. Now you have an abstract idea of the hell and it’s no wonder why heroin withdrawal has become the one every other withdrawal is judged against.

Crystal meth withdrawal

Withdrawing from crystal meth use is nothing like opiate withdrawal and there’s no reason that the withdrawal symptoms should be. Opiates play a significant role in pain modulation and opioid receptors are present in peripheral systems in the body, which is the reason for the stomach aches, nausea, and diarrhea. Dopamine receptors just don’t play those roles in the body and brain, so withdrawal shouldn’t be expected to have the same effect.

But dopamine is still a very important neurotransmitter and quitting a drug  that has driven up dopamine release for a long time should be expected to leave behind some pain, and it does.

One of the important functions of dopamine is in signaling reward activity. When a dopamine spike happens in a specific area of the brain (called the NAc), it signifies that whatever is happening at that moment is “surprisingly” good. The parentheses are there to remind you that the brain doesn’t really get surprised, but the dopamine spike is like a reward signal detector, when it goes up, good things are happening.

Well guess what? During crystal meth withdrawal, when a crystal-meth user stops using meth, the levels of dopamine in the brain go down. To make matters worse, the long-term meth use has caused a decrease in the number of dopamine receptors available which means there’s not only less dopamine, but fewer receptors to activate. It’s not a surprise than that people who quit meth find themselves in a state of anhedonia, or an inability to feel pleasure. Once again, unlike the heroin withdrawal symptoms, anhedonia doesn’t make you throw up and sweat, but it’s a pretty horrible state to be in. Things that bring a smile to a normal person’s face just don’t work on most crystal-meth addicts who are new to recovery. As if that wasn’t bad enough, it can take as long as two years of staying clean for the dopamine function of an ex meth-addict to look anything like a normal person’s.

This anhedonia state can often lead to relapse in newly recovered addicts who are simply too depressed to go on living without a drug that they know can bring back a sense of normalcy to their life. The use of crystal-meth causes the sought-after spike in dopamine levels that helps relieve that anhedonic state.

When it comes to more physiological sort of withdrawal symptoms, the meth addict doesn’t have it that bad, I guess. After an extended period of sleep deprivation and appetite suppression that are some of the most predictable effect of meth, the average addict will do little more than sleep and eat for the first week, or even two, after quitting the drug. Many addicts experience substantial weight gain during this period as their metabolism slows and their caloric intake increases greatly. Like everything else, this too shall pass. With time, most addicts’ metabolism return to pre-use levels and their appetite catches up and returns to normal as well. Still, there’s no doubt that a little exercise can help many addicts in early recovery steer their bodies back on track.

There’s some research being talked about around the UCLA circles to see if detoxification from meth may help people do better in treatment for meth addiction by reducing the impact of their withdrawal. Detox before addiction treatment is an accepted fact in opiate and benzodiazepine addiction, but because of the supposedly “light” nature of crystal meth withdrawal, it’s been ignored. Hopefully by now, you realize that was a mistake.