Prescription Drugs

Since the mid-1990s, the percentage of prime-age American men who don’t have a job — and aren’t looking for one — has risen dramatically. Over the same time period, per-capita sales of opioid painkillers in the United States has more than quadrupled. A new study suggests that there may be a relationship between these two facts.

In a paper published by the Brookings Institution on Thursday, Princeton economist Alan Krueger compares county-level data on opioid-prescription rates and labor-force participation, and finds that the more opioids were prescribed in a given region, the more likely that region was to have seen a significant decline in workforce participation.

The correlation was so dramatic, Krueger estimates that rising opioid prescriptions could plausibly account for one-fifth of the decline in the labor-force participation among American men between 1999 and 2015.

In previous research, Kreuger revealed that nearly half of all American men between the ages of 25 and 54 who were not in the labor force took pain medication on a daily basis. For two-thirds of those men, that daily pain medication was the kind that requires a prescription.

Critically, Krueger’s new research suggests that the counties where opioids are most widely prescribed aren’t, necessarily, places where the population is exceptionally ill or disabled. Rather, they are places where doctors seem to be exceptionally comfortable writing opioid prescriptions to treat pain.

Currently, America’s overall labor-force participation rate is 62.9 percent, unchanged from three years ago, and well below the 67 percent level that was typical in the late 1990s. Most of this decline can be attributed to benign factors — the retirement of the baby boomers, and a rising percentage of young Americans delaying work to pursue higher education. But the drop in participation by prime-age men has been sharp — right now, America has the second-lowest such rate among OECD countries — and very much malign: Krueger finds that prime-age men who have dropped out of the labor force are significantly less happy than their employed and unemployed peers.

There is still some ambiguity in Krueger’s findings. It’s possible that, to some extent, labor-force detachment increases demand for prescription opioids, rather than vice versa. Nonetheless, his paper offers compelling evidence that America’s painkiller habit isn’t just producing 100 overdose deaths in our country each day, but also impairing our economy’s capacity to grow.

Notably, the prescription opioid industry has achieved all this without actually reducing the levels of pain that Americans report.

“Despite the massive rise in opioid prescriptions in the 2000s,” Krueger notes in his paper, “there is no evidence that the incidence of pain has declined.”


Co-prescription of opioids and selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) was common in the US from 2013 to 2014, according to a recent study.1 In March 2016 the FDA issued a safety warning about the risk of serotonin syndrome with combined use of opioids and triptans, or SSRIs/SNRIs.2 Whether the FDA warning has resulted in changes in prescribing practices is unknown, though it may be too early to know.

However, what’s clear is that the opioid problem in the US is not going away quickly. Despite recommendations against opioids for acute migraine from the American Academy of Family Physicians (AAFP) and the American Headache Society (AHS) and despite CDC guidelines3 against opioids for chronic non-cancer pain, prescription of opioids in the US tripled between 1999 and 2015.

Serotonin syndrome is a very rare but serious adverse effect of serotonergic antidepressants, caused by excess serotonergic agonism. Symptoms range from mild (diarrhea, shivering) to severe and potentially life-threatening (muscle rigidity, fever, seizures). The opioids most commonly linked to serotonin syndrome include fentanyl, methadone, andoxycodone. Meperidine, methadone and tramadol carry label warnings about the risk of serotonin syndrome.

To provide better epidemiological data about the nationwide prevalence of co-prescription of these medications in the period before the FDA warning, researchers lead by David A. Sclar, PhD, of the Midwestern University College of Pharmacy in Glendale, Arizona, used data from the National Ambulatory Medical Care Survey (NAMCS) database for 2013 to 2014. NAMCS is a cross-sectional nationally representative survey of office-based physician visits run annually by the National Center for Health Statistics (NCHS). The analysis included data from 903.6 million outpatient visits.

Key results

• 2% of visits (17.7 million) involved co-prescription of opioids with a triptan or SSRI/SNRI

-Opioid–SSRI/SNRI: 16,044,721 visits

-Opioid–triptan: 1,622,827 visits

• 20% of opioid co-prescribing involved higher-risk opioids with a label warning about serotonin syndrome

-Tramadol most common: 18.6% of opioid–SSRI/SNRI and 21.8% of opioid–triptan co-prescriptions

• 16.3% of visits for migraine involved opioid prescribing

-3.8% of these involved opioid-SSRIs/SNRIs co-prescriptions

-2.0% of these involved opioid-triptan co-prescriptions

The authors emphasized that the prevalence of opioid prescriptions for migraine has changed little over the past decade. A complicating factor is that patients with migraine commonly suffer from depression, making them at increased risk of co-prescription for serotonergic antidepressants and opioids. While acknowledging the importance of effective pain control in migraine, they warned that these results should not discourage undertreatment of depression.

“[T]reatment with serotonergic antidepressants in patients with migraine and comorbid depression must not be unnecessarily discouraged, given the importance of treatment with appropriate pharmacotherapy and evidence that depression is highly prevalent and may be undertreated in this patient population,” they wrote.

They noted that the study precedes the FDA warning by about 2 years, and most of the study occurred before the 2014 DEA re-classification of tramadol as a schedule-IV controlled substance and hydrocodone as a schedule-II controlled substance. Further study is needed to evaluate how these changes may have affected prescribing practices.

Take home points

• Between 2013 to 2014, 2% of outpatient visits surveyed by NAMCS involved co-prescription of opioids with a triptan or SSRI/SNRI

• 20% of these involved higher-risk opioids with a label warning about serotonin syndrome

• 16.3% of visits for migraine involved opioid prescribing

• Further study is needed to evaluate how a 2016 FDA warning about co-prescription of opioids and SSRIs/SNRIS or triptans may have affected prescribing practices.

Source: June 27th 2018

The opioid crisis is unlike any drug epidemic America has ever known. It’s claiming lives at an almost unimaginable rate.

But to get an idea of why these drugs are taking such a toll, you have to look at the people who are dying.

This is not just the curse of the stereotypical addict.

Many of those admitted to the country’s fast swelling mortuaries were middle class professionals whose first fix was dealt to them by a doctor.

Back in the 90s and early 2000s, pharmaceutical firms began a major lobbying exercise, persuading doctors to prescribe their synthetic forms of heroin for pain relief.

Soon GPs across the country were handing out powerful prescriptions for relatively minor ailments.

The drugs worked, but they proved highly addictive and when patients’ prescriptions ran out, many took to the streets to feed what had fast become a habit.

That’s where the problem really starts. In pill form, this medication could be controlled, but by going to “street chemists” for their fix, people were taking a huge risk.

They’d buy the drugs, illegally imported from China, ready mixed with harmless powders. Just a few grains of opioid in each capsule, which they’d either snort, smoke or inject.

Most of the powders are phenomenally potent. One, Carfentanil, is said to be 10,000 times stronger than heroin.

Originally created as an elephant tranquiliser, a couple of grains could be enough to kill.

Others are less powerful but still deadly, and here’s the real issue – most addicts have no idea which kind of opioid they’re taking.

Yet across America people are seeking out dealers and buying this stuff for as little as two dollars per fix.

Some have reached a truly hopeless stage.

Ian Blackburn, a long-time addict, told me he’s never known anything like it. He’s felt in control of his drug habit in the past. Not any more.

“Three hits, that’s all it takes”, he told me: “You take this stuff three times and it’s forever”.

He explained how he doesn’t get a buzz from the drug any more, he simply takes it to feel normal, to take the pain of withdrawal away. Without it, his legs start to cramp, his stomach wrenches and he loses control of his functions.

“Every couple of hours you need a hit”, he says “no ifs ands or buts, you’re going to find it and you’re going to get money to get it, no matter what”.


September 2017

There will never be fundamental change in west Belfast’s drug problem without addressing the poverty and conflict legacies affecting it, a new report has found.

Launched on Monday, the West Belfast Community Drugs Panel’s report examined all aspects of drugs misuse in the area and provided a series of recommendations.

The panel was set up in October last year in reaction to a spate of drug-related deaths in the west of the city and is made up of representatives from several government departments, including the Belfast Trust and the Public Health Agency.

Families in the area affected by drugs, including bereaved parents, were also invited to give their views through community representatives on the panel, which was chaired by Noel Rooney, former head of the Probation Board for NI.

Funding for the report was provided by the Belfast Policing and Community Safety Partnership, which is made up of councillors and representatives from statutory agencies.

The report found significant issues relating to drugs misuse in west Belfast, many related to chronic under-funding by successive governments and the lack of a coherent, multi-agency strategy to deal with the problem.

It also identified significant contributing factors relating to the area’s social housing provision.

Several of the root causes detailed in the report, however, are generational and systemic.

“The West Belfast drugs issue is directly related to the area being affected by systemic poverty and the legacy of the NI Conflict and, unfortunately, this looks set to worsen over time,” the report reads.

“There will never be a fundamental change for west Belfast without addressing the poverty and conflict legacies.”

Elsewhere, the panel found addiction to prescription medications to be disproportionately high in the area.

“Evidence shows the level of prescribing medication in west Belfast is higher than in most other parts of Belfast, the north of Ireland and Great Britain,” the document states.

The report recommends several measures that public agencies could take to try and tackle the problem, including:

– An anti-poverty plan aligned with appropriate, long-term funding (10-15 year minimum)

– A multi-layered education strategy with a focus on early intervention

– A co-designed pilot social housing model, specifically for the area

– A zero-tolerance drugs policy from the PSNI, with a stronger focus on small level dealing

In addition, the report includes a ‘What We Heard’ section summarising key information providing to the panel by members of the public, community representatives and others.

“Criminal gangs, some claiming to have paramilitary connections, are controlling the supply of cocaine and heroin in some streets to children as young as 12-years-old,” the report reads.

“They decide what to provide and how much it will cost local people.”

Prescription medications being reported as being currently misused in west Belfast include: Tramadol, an opiate-based painkiller, and Fentanyl, a tranquiliser 100 times stronger than heroin.

It is now in the hands of government agencies to decide which, if any, of the report’s recommendations they might adopt.

Source:   11th June 2018


Submitted by Livia Edegger 

US researchers that analysed over a million lab samples found that prescription drug abuse is twice as likely to decrease in states with drug prevention programmes in place. The states of Florida, Georgia, Kentucky, New York and Tennessee have seen a decline of 10% in prescription drug abuse, a rate 2.5 higher than the average rate for the rest of the country. In addition to the nationwide drug monitoring programme, these states have implemented programmes such as awareness raising initiatives, training and guidance for physicians and additional regulations to curb prescription drug abuse. Overall, prescription drug abuse has fallen from 63% in 2011 to 55% in 2013 with the most significant decline in teen rates from 70% to 57%. Despite these improvements, prescription drug abuse continues to be widespread in the US with more than half the patients endangering their health by misusing prescription drugs.



23rd July 2014

Public health officials say the nerve pain medication gabapentin is being found in an increasing number of overdose deaths, according to CBS News.

Gabapentin is a non-narcotic drug used to treat seizures and pain associated with shingles. Doctors have been prescribing it for a growing number of other conditions, as a way to offer pain relief without opioids. A study published last year found that for people who use heroin, the combination of opioids with gabapentin potentially increases the risk of overdose death.

“Unfortunately, we now need to worry about it because people are abusing it,” Dr. James Patrick Murphy, a pain and addiction specialist in Kentucky, told the Louisville Courier-Journal. “Alone, it’s not something that will stop your breathing or your heart,” he said. “But if you take it along with a drug like heroin or fentanyl, together it might be enough to make you stop breathing and put you over the edge.”

Source: April 5th 2018

Click on the images to enlarge the detail.



Deaths from drug overdoses have jumped in nearly every county across the United States, driven largely by an explosion in addiction to prescription painkillers and heroin.

Some of the largest concentrations of overdose deaths were in Appalachia and the Southwest, according to new county-level estimates released by the Centers for Disease Control and Prevention.

The number of these deaths reached a new peak in 2014: 47,055 people, or the equivalent of about 125 Americans every day.

Deaths from overdoses are reaching levels similar to the H.I.V. epidemic at its peak.

The death rate from drug overdoses is climbing at a much faster pace than other causes of death, jumping to an average of 15 per 100,000 in 2014 from nine per 100,000 in 2003.

The trend is now similar to that of the human immunodeficiency virus, or H.I.V., epidemic in the late 1980s and early 1990s, said Robert Anderson, the C.D.C.’s chief of mortality statistics.

H.I.V. deaths rose in a shorter time frame, but their peak in 1995 is similar to the high point of deaths from drug overdoses reached in 2014, Mr. Anderson said. H.I.V., however, was mainly an urban problem. Drug overdoses cut across rural-urban boundaries.

In fact, death rates from overdoses in rural areas now outpace the rate in large metropolitan areas, which historically had higher rates.

Heroin abuse in states like New Hampshire make it a top campaign issue.

Drugs deaths have skyrocketed in New Hampshire. In 2014, 326 people died from an overdose of an opioid, a class of drugs that includes heroin and fentanyl, a painkiller 100 times as powerful as morphine.

Nationally, opioids were involved in more than 61 percent of deaths from overdoses in 2014. Deaths from heroin overdoses have more than tripled since 2010 and are double the rate of deaths from cocaine.

In New Hampshire, which holds this year’s first presidential primary, residents have repeatedly raised the issue of heroin addiction with visiting candidates.

“No group is immune to it — it is happening in our inner cities, rural and affluent communities,” said Timothy R. Rourke, the chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse.

Most of the deaths from overdose in the state are related to a version of fentanyl. “Dealers will lace heroin with it or sell pure fentanyl with the guise of being heroin,” Mr. Rourke said.  But fentanyl can be deadlier than heroin. It takes much more naloxone, a drug that reverses the effects of an opioid overdose, to revive someone who has overdosed on fentanyl.

Mr. Rourke said that high death rates in New Hampshire were symptomatic of a larger problem: The state is second to last, ahead of only Texas, in access to treatment programs. New Hampshire spends $8 per capita on treatment for substance abuse. Connecticut, for example, spends twice that amount.

Appalachia has been stricken with overdose deaths for more than a decade, in many ways because of prescription drug addiction among its workers.  West Virginia and neighboring states have many blue-collar workers, and “in that group, there’s just a lot of injuries,” said Dr. Carl R. Sullivan III, the director of addiction services at the West Virginia University School of Medicine.

“In the mid-1990s, there was a social movement that said it was unacceptable for patients to have chronic pain, and the pharmaceutical industry pushed the notion that opioids were safe,” he said.

A few years ago, as laws were passed to address the misuse of prescription painkillers, addicts began turning to heroin instead, he said. Because of a lack of workers needed to treat addicts, overdose deaths have continued to afflict states like West Virginia, which has the highest overdose death rate in the nation.

“Chances of getting treatment in West Virginia is ridiculously small,” Dr. Sullivan said. “We’ve had this uptick in overdose deaths despite enormous public interest in this whole issue.”

While New Mexico has avoided the national spotlight in the current wave of opioid addiction, it has had high death rates from heroin overdoses since the early 1990s.

Heroin addiction has been “passed down from generation to generation in small cities around New Mexico,” said Jennifer Weiss-Burke, executive director of Healing Addiction in Our Community, a non-profit group formed to curb heroin addiction. “I’ve heard stories of grandparents who have been heroin users for years, and it is passed down to younger generations; it’s almost like a way of life.”

Dr. Michael Landen, the state epidemiologist, said the state recently began grappling with prescription opioids. Addictions have shifted to younger people and to more affluent communities.

Ms. Weiss-Burke, whose son died from a heroin overdose in 2011, said it was much harder to treat young people. “Some young people are still having fun and they don’t have the desire to get sober, so they end up cycling through treatment or end up in jail,” she said.

Her center recently treated a 20-year-old man who was sober for five months before relapsing, then relapsed several more times after that.  “When you go right back to the same environment, it’s hard to stay clean,” she said. “Heroin craving continues to haunt a person for years.”

Source :


Source:   ZOHYDRO Backlash,  ACCBO newsletter, April-June 2014

University of Michigan’s annual drug abuse survey – Monitoring the Future University of Michigan’s annual drug abuse survey, Monitoring the Future, were released today showing that the percentage of teens using over-the-counter (OTC) cough medicine containing dextromethorphan (DXM) to get high remains at just 3 percent, the lowest level recorded for teen cough medicine abuse since 2015. When first reported in 2006, teen abuse of these OTC cough medicines was nearly 6 percent, but has declined significantly since then.

Since 2006, the rate of teen OTC cough medicine abuse has decreased by 44% (from 5.4% to 3%).

Over the past decade, the Consumer Healthcare Products Association (CHPA) has worked to help reduce teen DXM abuse by employing three strategies: increasing parent engagement in abuse awareness and prevention; heightening teen perceptions of the risks and social disapproval of medicine abuse; and limiting teen access to DXM through age-18 sales restrictions in states. In 2008, CHPA member companies voluntarily placed a “PARENTS: Learn About Teen Medicine Abuse” icon on the packaging of cough medicines containing DXM. The icon serves as a mini public service announcement for parents, making them aware of cough medicine abuse at the point-of-sale and point-of-use and directing them to – a well-established website and abuse prevention campaign aimed at engaging parents and community leaders about teen abuse of OTC cough medicine.

“Public policy and education are both vitally important to combating teen OTC cough medicine abuse,” said CHPA president and CEO Scott Melville. “This is why CHPA has long supported state efforts to limit teen access to DXM and has worked to increase parental awareness through our Stop Medicine Abuse education campaign, while at the same time, ensuring continued access for millions of families who responsibly use medicines containing DXM.” CHPA also collaborates with the Partnership for Drug-Free Kids to target teens who are most likely to abuse DXM based on their online search activity and to provide them with accurate information about the consequences of abusive behavior. Teens are directed to visit to learn more.

“The Partnership for Drug-Free Kids welcomes the data from this year’s Monitoring the Future Survey showing no year-to-year increases in high school students’ misuse of over-the-counter cough and cold remedies,” said Partnership president and CEO Fred Muench. “For nearly a decade now, the Partnership and CHPA have collaborated on a digital media prevention effort targeting this behavior – and we have seen steady and significant declines over this period in teens’ misuse of OTC cough medicine to get high. It’s compelling evidence that smart, strategic prevention initiatives can work, and can deliver real benefits to teens and their families.”

Additionally recognizing that retailers play a critical role in abuse prevention, this year CHPA launched a new Pharmacists & Retailers page on the site, where retailers can download or order free materials.

Please visit for more information about teen DXM abuse, the retailer education materials, and other helpful resources for parents and community leaders.

The Consumer Healthcare Products Association (CHPA) is the 136-year-old national trade association representing the leading manufacturers and marketers of over-the-counter (OTC) medicines and dietary supplements. Every dollar spent by consumers on OTC medicines saves the U.S. healthcare system $6-$7, contributing a total of $102 billion in savings each year. CHPA is committed to empowering consumer self-care by preserving and expanding choice and availability of consumer healthcare products.


Monitoring the Future University of Michigan’s annual drug abuse survey, Monitoring the Future, were released today showing that the percentage of teens using over-the-counter (OTC) cough medicine containing dextromethorphan (DXM) to get high remains at just 3 percent, the lowest level recorded for teen cough medicine abuse since 2015. When first reported in 2006, teen abuse of these OTC cough medicines was nearly 6 percent, but has declined significantly since then.

Since 2006, the rate of teen OTC cough medicine abuse has decreased by 44% (from 5.4% to 3%).

Over the past decade, the Consumer Healthcare Products Association (CHPA) has worked to help reduce teen DXM abuse by employing three strategies: increasing parent engagement in abuse awareness and prevention; heightening teen perceptions of the risks and social disapproval of medicine abuse; and limiting teen access to DXM through age-18 sales restrictions in states. In 2008, CHPA member companies voluntarily placed a “PARENTS: Learn About Teen Medicine Abuse” icon on the packaging of cough medicines containing DXM. The icon serves as a mini public service announcement for parents, making them aware of cough medicine abuse at the point-of-sale and point-of-use and directing them to – a well-established website and abuse prevention campaign aimed at engaging parents and community leaders about teen abuse of OTC cough medicine.

“Public policy and education are both vitally important to combating teen OTC cough medicine abuse,” said CHPA president and CEO Scott Melville. “This is why CHPA has long supported state efforts to limit teen access to DXM and has worked to increase parental awareness through our Stop Medicine Abuse education campaign, while at the same time, ensuring continued access for millions of families who responsibly use medicines containing DXM.” CHPA also collaborates with the Partnership for Drug-Free Kids to target teens who are most likely to abuse DXM based on their online search activity and to provide them with accurate information about the consequences of abusive behavior. Teens are directed to visit to learn more.

“The Partnership for Drug-Free Kids welcomes the data from this year’s Monitoring the Future Survey showing no year-to-year increases in high school students’ misuse of over-the-counter cough and cold remedies,” said Partnership president and CEO Fred Muench. “For nearly a decade now, the Partnership and CHPA have collaborated on a digital media prevention effort targeting this behavior – and we have seen steady and significant declines over this period in teens’ misuse of OTC cough medicine to get high. It’s compelling evidence that smart, strategic prevention initiatives can work, and can deliver real benefits to teens and their families.”

Additionally recognizing that retailers play a critical role in abuse prevention, this year CHPA launched a new Pharmacists & Retailers page on the site, where retailers can download or order free materials. Please visit for more information about teen DXM abuse, the retailer education materials, and other helpful resources for parents and community leaders.

The Consumer Healthcare Products Association (CHPA) is the 136-year-old national trade association representing the leading manufacturers and marketers of over-the-counter (OTC) medicines and dietary supplements. Every dollar spent by consumers on OTC medicines saves the U.S. healthcare system $6-$7, contributing a total of $102 billion in savings each year. CHPA is committed to empowering consumer self-care by preserving and expanding choice and availability of consumer healthcare products.


US life expectancy fell because of the opioid crisis. (Reuters/Adrees Latif)

September 28, 2017 The opioid crisis in the United States is killing nearly one hundred people per day. Some areas are particularly hard hit, leaving officials to deal with constantly multiplying bodies of those claimed by overdose. In Ohio, morgues keep running out of space, forcing authorities to use temporary cold-storage trailers instead. In New Hampshire, medical examiners can’t handle the influx of bodies, making them unable to perform routine autopsies.

Add to that a new, terribly sad number: in West Virginia, officials had to spend nearly $1 million on the transportation of corpses in the fiscal year that ended June 30. Authorities told the Charleston-Gazette Mail that the number of body transports nearly doubled from 2015 to 2017, with a record 880 people dying in the state of overdose last year—the highest rate in the US. One embalmer had to come out of retirement three years ago to help deal with the amount of bodies.

Each death requires at least two trips—to the morgue and to the funeral home. With only two state-run morgues, long trips become costly. West Virginia lawmakers had to approve an additional $500,000 in funding to transport the dead this year. With body transport becoming such a big business—$881,620 paid to private contractors in fiscal year 2017—some improprieties emerged as well. A company that at one point controlled 94% of the state’s business has recently been suspended for a potential and alleged breach of confidentiality, the Charleston Gazette-Mail reported.

The opioid crisis has reached such dire proportions in the US that a recent analysis published in the Journal of the American Medical Association said it cut the life expectancy in the US by 2.5 months. The total estimates of the epidemic’s cost to the economy vary, from $25 billion to even $150 billion a year, when you consider the cost of a lost life (paywall).

The Trump administration promised to take on the issue, with the president himself saying it was a “national emergency,” but no concrete steps have been made yet—including a formal declaration that the epidemic is a national emergency, which would unlock resources that could help.

Source: Reuters . September 28, 2017

Warfarin. A single published case report describes an interaction with a patient taking warfarin who also regularly smoked tobacco and marijuana. The patient had multiple comorbidities and was taking at least 10 other medications. On at least two occasions, the patient’s international normalized ratio (INR) increased to values over 10 with episodes of bleeding. The only change reported for both occasions was an increase in the amount and frequency of marijuana smoking.[24] Patients who take warfarin and use marijuana regularly should receive close INR monitoring for any potential interaction.

Antiepileptic drugs (AEDs). A recent study examined baseline serum AED levels to identify drug-drug interactions between CBD and 19 AEDs during an open-label safety study in 81 patients (39 adults, 42 children) with refractory epilepsy.[25] As doses of CBD were increased, the researchers noted an increase in the serum levels of topiramate (P<.01), rufinamide (P<.01), and desmethylclobazam (P<.01) and a decrease in the levels of clobazam (P<.01) in both adult and pediatric patients. In adult patients, a significant increase in the serum levels of zonisamide (P=.02) and eslicarbazepine (P=.04) was observed with increasing CBD dose. No other drug interactions among the 19 AEDs were noted.   The authors recommended monitoring serum AED levels in patients receiving CBD, as drug-drug interactions may be correlated with adverse events and laboratory abnormalities.

Patients using marijuana should be educated to avoid drugs that affect associated CYP450 enzymes. When these drugs cannot be avoided, and marijuana use is expected to continue, the patient should be monitored closely for potential drug interactions.   Be Aware and Educate Patients

Smoking more than two joints weekly is likely to increase the risk for drug-related interactions.[5,10] No data exist monitoring large-scale marijuana use in the United States. However, in Washington, a state in which marijuana use is legal, the average user is estimated to smoke two to three joints per week.[26]  With growing legalization and use throughout the nation, healthcare professionals must exercise heightened caution in the situation of concomitant use of medications and marijuana.

Source:: Stirring the Pot: Potential Drug Interactions With Marijuana – Medscape – Jun 08, 2017.

A disturbing majority of businesses in the U.S. are being negatively impacted by prescription painkiller abuse and addiction among employees.

A survey recently released by the National Safety Council reveals more than 70 percent of workplaces are feeling the negative effects of opioid abuse. Nearly 40 percent of employers said employees are missing work do to painkiller abuse, with roughly the same percent reporting employees abusing the drugs on the job. Despite the prevalence of addiction in offices across the country, employers are doing little to mitigate risk. Record pill abuse in workplaces is coming at a time when Americans are taking more opioids than ever before, reports The Washington Post.

A recent survey from Truven Health Analytics and NPR reveals more than half of the U.S. population reports receiving a prescription for opioids at least once from their doctor, a 7 percent increase since 2011. Data released by the Centers for Disease Control and Prevention (CDC) Friday reveals that almost half of non-cancer patients prescribed opioids for a month or more are still dependent on the pills a year later.

Experts say that current opioid and heroin abuse is driven in large part by the over-prescribing of pain pills from doctors. Despite the problems opioid abuse is causing in the workplace, many employee drug tests do not look for the substance. Fifty-seven percent of businesses test for drugs, but 41 percent of those businesses do not test for opioids.

“Employers must understand that the most dangerously misused drug today may be sitting in employees’ medicine cabinets,” Deborah Hersman, president and CEO of the National Safety Council, said in a statement. “Even when they are taken as prescribed, prescription drugs and opioids can impair workers and create hazards on the job.”

Among people not currently taking opioids, nearly half view addiction as the biggest threat from using painkillers. Among current patients on opioids, fears over unwanted side effects still dwarf fears about long-term dependence and addiction. Medical professionals say doctors need to start by prescribing the least potent and least addictive pain treatment option, and then cautiously go from there.

Experts also say the patient must take greater responsibility when they visit their doctor and always ask “why” before accepting a prescription.

Addicts may begin with a dependence on opioid pills before transitioning to heroin after building up a tolerance that makes pills too expensive. States hit particularly hard by heroin abuse are beginning to crackdown on doctors liberally doling out painkillers.

“When four out of five new heroin users are getting their start by abusing prescription drugs, you have to attack the problem at ground zero – in irresponsibly run doctors’ offices,” New Jersey Attorney General Porrino said in a statement March 1. “Physicians who grant easy access to the drugs that are turning New Jersey residents into addicts can be every bit as dangerous as street-corner dealers. Purging the medical community of over-prescribers is as important to our cause as busting heroin rings and locking up drug kingpins.”

A record 33,000 Americans died from opioid related overdoses in 2015, according to the CDC. Opioid deaths contributed to the first drop in U.S. life expectancy since 1993 and eclipsed deaths from motor vehicle accidents in 2015. Combined, heroin, fentanyl and other opiate-based painkillers account for roughly 63 percent of drug fatalities, which claimed 52,404 lives in the U.S. in 2015.


The Centers for Disease Control and Prevention (CDC) stated that 33,091 people died from opioid overdoses in 2015, which accounts for 63 percent of all drug overdose deaths in the same year. A recent report from the CDC found that drug deaths from fentanyl and other synthetic opioids, other than methadone, rose 72 percent in just one year, from 2014 to 2015. Last year, the death of music icon Prince was linked to fentanyl and the prescription drug has become a source of concern for government agencies and law enforcement officials alike, as death rates from fentanyl-related overdoses and seizures have risen across the country.

What exactly is fentanyl?

According to the National Institute on Drug Abuse, fentanyl is a powerful synthetic opioid analgesic that is similar to morphine – but is 50 to 100 times more potent. It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known by such names as Actiq®, Duragesic® and Sublimaze®. Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions.

When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation. But fentanyl’s effects resemble those of heroin and include drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, unconsciousness, coma and death.

So why is abuse and misuse of fentanyl so dangerous?

When prescribed by a physician, fentanyl is often administered via injection, transdermal patch or in lozenges. However, the fentanyl and fentanyl analogs associated with recent overdoses are produced in clandestine laboratories.

This non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids. Fentanyl sold on the street can be mixed with heroin or cocaine, which markedly amplifies its potency and potential dangers.

Users of this form of fentanyl can swallow, snort or inject it, or they can put blotter paper in their mouths so that the synthetic opioid is absorbed through the mucous membrane. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

Can misuse of fentanyl lead to death?

Opioid receptors are also found in the areas of the brain that control breathing rate. High doses of opioids, especially potent opioids such as fentanyl, can cause breathing to stop completely, which can lead to death. The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains fentanyl.

The United States Drug Enforcement Administration issued a nationwide alert in 2015 about the dangers of fentanyl and fentanyl analogues/compounds. Fentanyl-laced heroin is causing significant problems across the country, particularly as heroin use has increased in recent years.

Source:   Jan 18th 2017

Utah, more than other area of the nation, is suffering from a silent epidemic.  From 2000 to 2014, Utah has experienced a nearly 400% increase in deaths from the misuse and abuse of prescription drugs. Each month there are 24 individuals who die from prescription drug overdoses.

What can we do to help alleviate this growing epidemic? Constant education of the public is essential to prevent drug and alcohol abuse. There is great danger in legal prescription medications and illicit drugs.

What is addiction? As defined by the American Society of Addiction Medicine: “Addiction is a biological, psychological, social and spiritual illness.”   We are learning more and more that opioids now kill more young adults than alcohol. Yet, these deaths are preventable.

Addictionologist, Dr. Sean A. Ponce, M.D., at Salt Lake Behavioral Health Hospital is an advocate of prevention and clinical expert in the treatment of addiction.    Dr. Ponce relates having cancer to that of drug or alcohol addiction. “For cancer, we want to know the prognosis, how far it’s spread… we want to hear the word remission.  Do we talk about that with addiction?”

He goes onto say, “Addiction is a disease that can also spread.  It is a disease that can be mild, moderate or severe.  We want to put it into remission. When cancer reoccurs everyone rallies around that patient to help. When addiction reoccurs what happens?  We send a mixed message.  It is also a disease and we need to be able to help.”

Dr. Ponce also tells us that, “Surviving isn’t really a way to live.  Thriving is.”

Intermountain Health Care recently kicked off a prescription opioid misuse awareness campaign with new artwork in the main lobby of McKay-Dee Hospital including a chandelier built entirely of pill bottles.

This artwork highlights the hospital’s efforts to raise awareness about prescription opioid misuse and represents the 7,000 opioid prescriptions filled each day in Utah. It’s aim: to inform visitors that the risk of opioid addiction “hangs over everyone.”

The campaign’s partners include: Bonneville Communities That Care, Weber Human Services, Use Only as Directed, and Intermountain’s Community Benefit team.

There are also several elevator doors, in McKay Dee Hospital, covered with warnings against opioid use. It definitely sends a strong message to stop and think about the dangers involved.

As previously mentioned, Salt Lake Behavioral Health is a private, freestanding psychiatric hospital specializing in mental health and substance abuse treatment.

You may use this link to learn more about how to help prevent the spread of this deadly epidemic.


More than 900 people died in British Columbia last year from illicit drug overdoses, but the provincial health minister says the toll could have been far higher and he warned the federal government Wednesday the epidemic is spreading across Canada.

The arrival of the powerful opioid fentanyl pushed the provincial death toll to a new peak of 914 overdose deaths in 2016. The BC Coroners Service reported the figure is almost 80 per cent higher than the 510 deaths due to illicit drugs in 2015.

Chief coroner Lisa Lapointe said December was the worst month at 142 deaths, the highest monthly death total ever.

“The introduction of fentanyl to our province is a game-changer,” Lapointe told a news conference. “We’ve now got this contaminant in the illicit drug system that is not manageable.”

Health Minister Terry Lake said B.C.’s death toll would have been much higher if it had not been for overdose prevention measures undertaken by the province and the often heroic efforts by first-responders and others who rushed to provide aid to victims.

“The evidence suggests many, many more lives would have been lost had we not done what we have done,” he said.

Lake said he has records of 96 overdose reversals at community overdose prevention sites where addicts can use drugs under supervision of health officials. There were no overdose deaths at the Insite safe-injection site in Vancouver’s Downtown Eastside, he said.   “We’ve seen the mobile medical unit, over 600 overdoses treated,” he said.

The B.C. government declared a public health emergency last spring in an attempt to reduce the rising numbers of drug overdose deaths.  The B.C. Centre For Disease Control also launched a take-home naloxone program for residents to reverse the effects of opioids.

The government also announced late last year that overdose prevention sites would be established in communities across the province where people could take illicit drugs while being monitored by trained professionals equipped with naloxone.

Lake said the federal government should declare a nationwide public health emergency, saying the problem is spreading across the country.

“It would focus, from a national perspective, action on this epidemic,” he said. “We haven’t had any additional funding from Ottawa to help us with this. Declaring a national public health emergency would focus all Canadians on an issue that is wracking B.C. at the moment.”

Lapointe couldn’t forecast an end, saying it will require long-term vigilance and programs on the part of governments, health providers, first-responders, families and drug users themselves.

She said she recognizes that those who are dependent on illicit drugs aren’t going to be able to abstain, but she urged them to take the drugs in front of someone who has medical expertise or at least with a sober friend.

An average of nine people died every two days from overdoses last month, she said.

“We know that this represents suffering and devastation in communities across our province.”

The coroner’s service said fatalities aren’t just happening among those who use opioid drugs, such as heroin.

“Cocaine and methamphetamines are also being found in a higher percentages of fentanyl-detected deaths in 2016,” Lapointe said.

People aged 30 to 49 accounted for the largest percentage of overdose deaths last year, and males accounted for more than 80 per cent of the overall toll.  Dr. Perry Kendall, the province’s chief medical health officer, said the number of deaths is difficult to confront.

“This was unexpected and disheartening,” he said. “We still have not as yet been able to reverse the trend. This is frankly a North America-wide problem.”

He said he will review European drug treatment programs that prescribe heroin-like medicines to addicts.

Source:  THE CANADIAN PRESS Published on: January 18, 2017 |

Fentanyl is a painkiller that is 50 times stronger than heroin. It has already killed thousands, including Prince. Chris McGreal reveals why so many are playing Russian roulette with this lethal drug Natasha Butler had never heard of fentanyl until a doctor told her that a single pill had pushed her eldest son to the brink of death – and he wasn’t coming back. “The doctor said fentanyl is 100 times more potent than morphine and 50 times more potent than heroin. I know morphine is really, really powerful. I’m trying to understand. All that in one pill? How did Jerome get that pill?” she asked, her voice dropping to a whisper as the tears came. “Jerome was on a respirator and he was pretty much unresponsive. The doctor told me all his organs had shut down. His brain was swelling, putting pressure on to the spine. They said if he makes it he’ll be a vegetable.”

Painkiller addiction claims more lives in the US than guns, cutting across class, race and region

The last picture of Jerome shows him propped immobile in a hospital bed, eyes closed, sustained only by a clutch of tubes and wires. Natasha took the near impossible decision to let him die.  “I had to remove him from life support. That’s the hardest thing to ever do. I had him at 15 so we grew together. He was 28 when he died,” she said. “I had to let him die but after that I needed some answers. What is fentanyl and how did he get it?” That was a question asked across Sacramento after Jerome and 52 other people in and around California’s capital overdosed on the extremely powerful synthetic opioid, usually only used by hospitals to treat patients in the later stages of cancer, over a few days in late March and early April 2016. Twelve died.

Less than a month later, this mysterious drug – largely unheard of by most Americans – killed the musician Prince and burst on to the national consciousness. Fentanyl, it turned out, was the latest and most disturbing twist in the epidemic of opioid addiction that has crept across the United States over the past two decades, claiming close to 200,000 lives. But Prince, like almost all fentanyl’s victims, probably never even knew he was taking the drug.

“The number of people overdosing is staggering,” said Lieutenant Tracy Morris, commander of special investigations who manages the narcotics task force in Orange County, which has seen a flood of the drug across the Mexican border. “It is truly scary. They don’t even know what they’re taking.” The epidemic of addiction to prescription opioid painkillers, a largely American crisis, sprung from the power of big pharmaceutical companies to influence medical policy. Two decades ago, a small family-owned drug manufacturer, Purdue Pharma, unleashed the most powerful prescription painkiller yet sold over the pharmacist’s counter. Even though it was several times stronger than anything else on the market, and bore a close relation to heroin, Purdue claimed that OxyContin was not addictive and was safe to treat even relatively minor pain. That turned out not to be true.

It spawned an epidemic that in the US claims more lives than guns, cutting across class, race and geographic lines as it ravages communities from white rural Appalachia and Mormon Utah to black and Latino neighbourhoods of southern California. The prescription of OxyContin and other painkillers with the same active drug, oxycodone, became so widespread that entire families were hooked. Labourers who wrenched a back at work, teenagers with a sports injury, just about anyone who said they were in pain

was put on oxycodone. The famous names who ended up as addicts show how indiscriminate the drug’s reach was; everyone from politician John McCain’s wife Cindy to Eminem became addicted.

Clinics staffed by unscrupulous doctors, known as “pill mills”, sprung up churning out prescriptions for cash payments. They made millions of dollars a year. By the time the epidemic finally started to get public and political attention, more than two million Americans were addicted to opioid painkillers. Those who finally managed to shake off the drug often did so only at the cost of jobs, relationships and homes.

After the government finally began to curb painkiller prescriptions, making it more difficult for addicts to find the pills and forcing up black market prices, Mexican drug cartels stepped in to flood the US with the real thing – heroin – in quantities not seen since the 1970s. But, as profitable as the resurgence of heroin is to the cartels, it is labour intensive and time-consuming to grow and harvest poppies. Then there are the risks of smuggling bulky quantities of the drug into the US.

The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. The drug was originally concocted in Belgium in 1960, developed as an anaesthetic. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.

At first the cartels laced the fentanyl into heroin to increase the potency of low-quality supplies. But prescription opioid painkillers command a premium because they are trusted and have become increasingly difficult to find on the black market. So cartels moved into pressing counterfeit tablets.  But making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”

The authorities liken buying black market pills to playing Russian roulette. “These pills sold on the street, nobody knows what’s in them and nobody knows how strong they are,” said Barbara Carreno of the DEA.

After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.  Others knowingly take the risk. In his long battle with addiction, Michael Jackson, used a prescription patch releasing fentanyl into his skin among the arsenal of drugs he was fed by compliant doctors. Although it was two non-opioids that killed him, adding fentanyl into the mix was hazardous.

Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.  “I didn’t even know,” she said. “You find stuff out after. It’s killing me because they’re saying, ‘Well, yeah, Jerome was taking them pills all the time.’ And I’m like, ‘He was doing what?’”

Jerome may have had a prescription, but like many addicts he will have needed more and more. The pill that killed him was stamped M367, a marking used on Norco pills made of an opioid, hydrocodone. It was a fake with a high dosage of fentanyl.   This is fentanyl. The first time you take it you’re not coming back. You’re gone

“If Jerome had known it was fentanyl he would never have took that,” said Natasha. “This ain’t like crack or a recreational drug that people been doing for so many years and survived it but at 60 or 70 die from a drug overdose because their heart can’t take it no more. This is fentanyl. The first time you take it you’re not coming back. You’re gone.”

That wasn’t strictly true of the batch that hit Sacramento. It claimed 11 other lives. The youngest victim was 18-year-old George Berry from El Dorado Hills, a mostly white upscale neighbourhood. The eldest was 59. But others survived. Some were saved by quick reactions; doctors were able to hit them with an antidote before lasting damage was done. Others swallowed only enough fentanyl to leave them seriously ill but short of death.

It was a matter of luck. When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal. The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills.

That probably explains the unpredictable mass overdosing popping up in cities across the US. In August, 174 people overdosed on heroin in six days in Cincinnati, which has one of the fastest-growing economies in the Midwest. Investigators suspect fentanyl because the victims needed several doses of an antidote, Naloxone, where one or two will usually suffice with heroin. The same month, 26 people overdosed on fentanyl-laced heroin in a four-hour period in Huntington, a mostly white city in one of the poorest areas of West Virginia. In September seven people died from fentanyl or heroin overdoses in a single day in Cuyahoga County, Ohio.

The US authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death. The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.

The police did not have to look far for the source of the drug that killed Jerome. He and his girlfriend were staying at the house of her aunt, Mildred Dossman, while they waited for their own place to live. Jerome was smoking cannabis and drinking beer with Dossman’s son, William. Shortly before 1am, William went to his mother’s bedroom and came back with the fake Norco pill. Jerome took it and said he was going to bed.  Jerome’s girlfriend was in jail after being arrested for an unpaid traffic fine and so he was alone with their 18 month-old daughter, Success, lying next to him.

“The doctors explained to me that within a matter of minutes he went into cardiac arrest,” said his mother. “Then as he lay there that’s when time progressed for the organs to be poisoned by fentanyl. He was dying with his daughter next to him.” Natasha said other people in the house heard her son in distress, complaining his heart was hurting. But they did nothing because they were afraid that calling an ambulance would also bring the police.

It was not until 10 hours later that the Dossmans finally sought help from a neighbour who knew Jerome. He tried CPR and then called the medics. The police came, too, and in time Mildred Dossman, 50, was charged with distributing fentanyl and black market opioid painkillers. She was the local dealer.

The DEA is tightlipped about the investigation into the Sacramento deaths as its agents work on persuading Dossman to lead them to her suppliers. But it is likely she was getting the pills from Mexican cartels using ingredients from labs in China where production of fentanyl’s ingredients is legal.  Carreno said some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.

Packages of fentanyl are often moved between multiple freight handlers so their origins are hard to trace. Larger shipments are smuggled in shipping containers. Last year, six Chinese customs officials fell ill, one of them into a coma, after seizing 72kg of various types of fentanyl from a container destined for Mexico. American police officers have faced similar dangers. In June, the DEA put out a video warning law enforcement officers across the US that fentanyl was different to anything they have previously encountered and they should refrain from carting seizures back to the office.   “A very small amount ingested, or absorbed through the skin, can kill you,” it said.   A New Jersey detective appears in the video after accidentally inhaling “just a little bit of fentanyl puffed into the air” during an arrest: “It felt like my body was shutting down… I thought that was it. I thought I was dying.”

Along with the Mexican connection, a home-grown manufacturing industry has sprung up in the US. Weeks after Jerome died, agents arrested a married couple pressing fentanyl tablets in their San Francisco flat.

Candelaria Vazquez and Kia Zolfaghari made the drug to look like oxycodone pills. They sold them across the country via the darknet using Bitcoin for payment – on one occasion Zolfaghari cashed in $230,000. The couple shipped the drugs through the local post office. Customers traced by the DEA thought they were buying real painkiller pills. The couple ran the pill press in their kitchen. According to a DEA warrant, a dealer said Zolfaghari made large numbers of tablets: “He could press 100 out fast as fuck.”

The pair made so much money that agents searching their flat found luxury watches worth $70,000, more than $44,000 in cash and hundreds of “customer order slips” which included names, amounts and tracking numbers. The flat was stuffed with designer goods. The seizure warrant described Vazquez’s shoe collection as “stacked virtually from floor to ceiling”. Some still had the $1,000 price tags on them. Zolfaghari was arrested carrying a 9mm semi-automatic gun and about 500 pills he was preparing to post. The dealers made so much money that their flat was stuffed with luxury goods and cash.

Even as Americans are getting their heads around fentanyl, it is being eclipsed. In September, the DEA issued a warning about the rise of a fentanyl variant that is 100 times more powerful – carfentanil, a drug used to tranquilise elephants.

“Carfentanil is surfacing in more and more communities,” said the DEA’s acting administrator, Chuck Rosenberg. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”

The drug has already been linked to 19 deaths in Michigan. Investigators say that with its use spreading, it is almost certainly claiming other lives. Dealers are also getting it from China, where carfentanil is not a controlled drug and can be sold to anyone.

Natasha Butler is still trying to understand the drug that killed her son. She wants to know why it is that it took Jerome’s death for her to even hear of it. She accuses the authorities of failing to warn people of the danger, and politicians of shirking their responsibilities.   A bill working its way through California’s legislature stiffening sentences for fentanyl dealing died in the face of opposition from the state’s governor, Jerry Brown, because it would put pressure on the already badly crowded prisons.

“I’m so dumbfounded. How does that happen?” says Natasha. Her tears come frequently as she sits at a tiny black table barely big enough to seat three people. She talks about Jerome and the tragedy for his three children, including Success, who she is now raising.

But some of the tears are to mourn the devastating impact on her own life. “Look where I’m at. I was in Louisiana. I had a house. I had a job. I had a car. I had a life. I worked every day. I was a manager for a major company. I came here, I became homeless. I had to move into this apartment to help out my granddaughter,” she said. “You see me. This is what my kitchen table is. My son is dead. He had three kids and those two mothers of those kids are depending on me to be strong. I want answers and help. I say, you got the little fish. Where did they get it from? How did they get it here? You are my government. You are supposed to protect us.”


Teens who take opioid painkillers without a prescription also often use cannabis, according to a new study.

Researchers analyzed information from more than 11,000 children and teens ages 10 to 18, in 10 U.S. cities. Participants were asked whether they had used prescription opioids in the past 30 days, and whether they had ever used cannabis.

Overall, about 29 percent of the teens said they had used cannabis at some point in their lives. But among the 524 participants who said they had used prescription opioids in the past 30 days, nearly 80 percent had used cannabis. The findings show that among young opioid users, the prevalence of cannabis use is high, said Vicki Osborne, a doctoral student in epidemiology at the University of Florida. Osborne presented the study Oct. 31 at the meeting of the American Public Health Association in Denver.

Among teens who said they used opioids without a prescription (meaning they obtained the drugs through a friend, family member or other avenue), about 88 percent had used cannabis, compared with 61 percent of those who did have a prescription for the opioids they used.

The study also found that the teens who reported having used alcohol or tobacco in addition to opioids were much more likely to use cannabis as well. Of the participants who had used opioids, those who also reported recent alcohol use were nearly 10 times more likely to have used cannabis, compared with those who didn’t use alcohol recently. And those who currently smoked tobacco were 24 times more likely to have used cannabis than those who were not tobacco users, the study found.

Efforts to prevent young people who use opioid painkillers from also using cannabis should target those who use alcohol and tobacco, Osborne said. Efforts should also target males, who were more likely to report using cannabis than females were, she said.

Interventions should also target young people who use opioids without a prescription, Osborne said. Even though such use of opioids among youth is not as high as it is among adults, the proportion of youth using opioids without a prescription is still concerning, she said.

The researchers plan to study the data further, and look at when young people start using cannabis versus when they start using opioids, Osborne said. Previous studies have found that legalizing medical marijuana actually appears to lead to a reduction in opioid use among adults. However, Osborne said the new findings among youth may be different from those in adults, because even in states that have legalized the use of marijuana, the drug is still illegal for teens to use.

Source:  7 Nov16

Problems resulting from abuse of opioid drugs continue to grow

JUL 22 (WASHINGTON) – Hundreds of thousands of counterfeit prescription pills, many containing deadly amounts of fentanyl and fentanyl-related compounds, have made their way into the U.S. drug market, according to a DEA intelligence report released today.  Law enforcement nationwide report higher fentanyl availability, seizures, and known overdose deaths than at any other time since the drug’s creation in 1959.

Fentanyl is a synthetically produced opioid that, when produced and administered legitimately, is used to treat severe pain. Overseas labs in China are mass-producing fentanyl and fentanyl-related compounds and marketing them to drug trafficking groups in Mexico, Canada and the United States.

In addition to being deadly to users, fentanyl poses a grave threat to law enforcement officials and first responders, as a lethal dose of fentanyl can be accidentally inhaled or absorbed through the skin. DEA recently released a Police Roll Call video nationwide to warn law enforcement about this danger. The video can be accessed at  Other findings from the report:

* Fentanyl and fentanyl-related compounds are traditionally mixed into or sold as heroin, or on its own, oftentimes without the customer’s knowledge. Since 2014, U.S. law enforcement agencies have been seizing a new form of fentanyl—counterfeit prescription opioid pills containing fentanyl or fentanyl-related compounds. The counterfeit pills often closely resemble the authentic medications they were designed to mimic, and the presence of fentanyl is only detected upon laboratory analysis.

* Fentanyl traffickers have been successful at expanding the fentanyl market and introducing new fentanyl-laced drug products to the U.S. drug market. The DEA National Forensic Laboratory Information System (NFLIS) reported that there were 13,002 fentanyl exhibits tested by forensic laboratories across the country in 2015 (the latest year for which data is available), which is a 65 percent increase from the 7,864 fentanyl exhibits in 2014. There were approximately eight times as many fentanyl exhibits in 2015 as there were during the 2006 fentanyl crisis, clearly demonstrating the unprecedented threat and expansion of the fentanyl market.

* The rise of counterfeit pills that contain fentanyl in the illicit drug market will likely result in more opioid-dependent individuals, overdoses, and deaths. There were over 700 fentanyl-related deaths reported in the United States between late 2013 and 2014. During 2013-2014, the Centers for Disease Control (CDC) reported that deaths from synthetic opioids increased 79 percent, from 3,097 to 5,544. Although the synthetic opioid category does contain other opioids, this sharp increase coincides with a sharp increase in fentanyl availability, and the CDC reports that a substantial portion of the increase appears to be related to illicit fentanyl.

* In March 2016, law enforcement officers in Lorain County, Ohio, seized 500 pills that visually appeared to be oxycodone. The pills were blue and had “A 215” markings, consistent with 30 milligram oxycodone pills. Laboratory analysis indicated that the pills did not contain oxycodone, but were instead the research chemical U-47700.  U-47700 is an unscheduled synthetic opioid

not studied for human use that has caused at least 17 overdoses and several deaths in the United States.

* Many Chinese laboratories illicitly manufacturing synthetic drugs, such as fentanyl and their precursors, also manufacture legitimate chemicals for purchase by U.S. companies. This means that laboratories responsible for supplying fentanyl in counterfeit pills can also run legitimate businesses. Although Chinese clandestine laboratories may be contributing to the fentanyl supply, legitimate laboratories may also be sources of supply.

* Traffickers can typically purchase a kilogram of fentanyl powder for a few thousand dollars from a Chinese supplier, transform it into hundreds of thousands of pills, and sell the counterfeit pills for millions of dollars in profit. If a particular batch has 1.5 milligrams of fentanyl per pill, approximately 666,666 counterfeit pills can be manufactured from 1 kilogram of pure fentanyl. The entire intelligence brief, “Counterfeit Prescription Pills Containing Fentanyls: A Global Threat” can be accessed at


Even in a culture that puts safety above all else, pilots aren’t properly educated about the potential dangers of common drugs such as antihistamines and sleeping pills. That’s the conclusion from a new National Transportation Safety Board report on rising drug use among aviators, which largely mirrors trends of greater use of prescription, over-the-counter, and illicit drugs by Americans in general.

About 40 percent of the 6,667 pilots killed in accidents since 1990 had prescription, over-the-counter, or illicit drugs in their bodies, according to a study of nearly 6,600 accidents from 1990 to 2012. Over-the-counter antihistamines such as Benadryl and Claritin were the most common. Antihistamine use rose to almost 10 percent between 2008 and 2012, up from 5.6 percent in the 1990s.

The vast majority of those killed in the period of the study—96 percent—were general aviation pilots typically flying small, one-engine planes; less than 1 percent of incidents involved major airlines. The study focused on evidence of drug use, not on whether the effects of the drug led to impairment while flying. Alcohol was not included in the study because toxicology screenings often detect ethanol the body creates naturally after death.

Use of illicit drugs such as marijuana and cocaine increased to almost 4 percent in the 2008-12 span, up from 2.3 percent in the 1990s. Most of the illicit drugs in the study resulted from greater use of marijuana among the pilots who died, the agency said.

The NTSB, which recommends safety improvements, called on the Federal Aviation Administration to better educate pilots about the potential dangers of some common drugs and develop a policy on marijuana use by pilots. Colorado and Washington have legalized marijuana for adult use, and almost two dozen other states allow marijuana for medical uses. More states are also likely to vote on legalizing recreational and medical marijuana use.

Dr. Mary Pat McKay, the NTSB’s chief medical officer, said more research is needed to determine how drugs can interact with each other and lead to pilot impairment. Sleep aids and pain medications, for example, can hurt pilot performance and yet there aren’t guidelines on how pilots might safely use those drugs.

Source:  10th Sept. 2014

Hospital maternity units and new-born care nurseries would have to report the number of infants born addicted to drugs under a bill headed to Ohio’s governor. The state Senate unanimously passed the measure Wednesday, and Gov. John Kasich was expected to sign it.

The measure is one of several aimed at reducing the state’s prescription painkiller addiction epidemic. Supporters say tracking the number of drug-addicted babies will help the state monitor Ohio’s progress in fighting drug addiction.

The facilities would be required to report the information to the state Health Department every three months. Patients would not be identified, and the information could not be used for law enforcement purposes. Should a maternity unit, maternity home or new-born care nursery fail to comply with the requirement, the state could impose a fine or revoke or suspend its license.

Overdose drug deaths have been the leading cause of accidental death in Ohio since 2007, surpassing car crashes. Many of those deaths are from painkillers and heroin.

Opiates and narcotics taken by the mother during pregnancy can pass through the placenta through the baby, causing the infant to be born dependent on harmful drugs. The babies experience neonatal abstinence syndrome and face an array of health complications, said state Sen. Shannon Jones, a Springboro Republican.

“These new-borns are thrown into painful withdrawal symptoms, such as rapid breathing, vomiting and seizures immediately following their birth,” she said.  Jones told her colleagues on the Senate floor that she had witnessed children withdrawing. “It is the most horrifying thing that I have personally experienced,” she said.

Caring for the drug-addicted new-borns and mothers, who are often on Medicaid, can be costly to the system.  Jones said officials hope to use the information to help measure opiate and illegal drug abuse across the state and better target resources to help women and babies struggling from addiction.

Source: Wednesday, April 2, 2014

Those using strong strains of illegal drugs such as cannabis skunk, or the illegal use of prescription drugs are risking their mental health and the lives of others. Suicidal thoughts are not unknown and this letter from a doctor discusses the problems of confidentiality versus life saving – of the patient or others.

To the Clinicians of the Co-Pilot of Germanwings Flight 9525

Dear German Medical Colleagues,

Please bear with me through this rather long letter. There is so much that I have been wondering and worrying about—including you.

I may never know who you are, but if you provided medical or psychiatric care for Andreas Lubitz, co-pilot of Germanwings Flight 9525, we are colleagues. Whether you saw Mr Lubitz years ago or more recently, or whether you saw him privately or as an airline-appointed medical examiner, you had some responsibility for his care.

And you too are his victims, of sorts. I hope your reputation does not suffer unduly. I hope PTSD does not develop as a result of his apparent suicide. If you provided ethical care (ie, competent care), I hope you are not scapegoated. “Monday morning quarterbacking”—an American football saying about reviewing a game the day after it is played—is always so much easier than preventing problems in real time.

After all, if reports of Mr Lubitz taking an injectable antipsychotic during training in 2009 are true, that doesn’t for sure mean that he had an ongoing or intermittent psychosis. Maybe, just maybe, it could have been a short-acting injection for acute agitation due to extreme stress and/or drug abuse. Similarly, treatment back then for an “episode” of “severe” depression could have seemed to be a one-time episode.

On the other hand, there are reports that Lubitz saw psychotherapists “over a long period of time.” Those psychotherapists probably knew the patient best, especially if he had a particular personality disorder or significant traits of concern (eg, undue narcissism, paranoia).

We have not yet heard anything about whether Lubitz had PTSD, but people with this disorder can appear normal. Perhaps the co-pilot dissociated as he crashed the airplane, which would have allowed him to ignore for minutes the passengers’ screams and the banging on the door of the cockpit. That could account for the fact that voice recording picked up no triumphal shouts, only his steady breathing.

This analysis is all speculation, of course. Maybe it’s the kind of “wild analysis” that Freud so deplored.

I do not know how prominent so-called “anti-psychiatrists” are in Germany, but if they are anything like they are here in the US, they are likely to blame psychiatric medication for the co-pilot’s bizarre and tragic behavior. Of course, they could well have a point. Some antidepressants, which can cause visual side effects, were prescribed for Mr Lubitz, agents perhaps, that we don’t in the US.

We know he was concerned about his vision, but speculation so far is that this complaint was psychosomatic. In addition, sudden withdrawal from some antidepressants can lead to increased agitation. Moreover, antidepressants can trigger a (hypo)manic episode, although of course a manic episode can occur that leads to grandiosity and agitation. On the other hand, no one seems to have described such changes in Mr Lubitz before the crash.

Therefore, I hope your medical documentation was good—better than mine usually was. I hope you documented your risk assessment adequately. If you were unsure of what to do, I hope you obtained consultation and/or supervision. If you worked in a system of care, I hope they adequately monitored the quality of care you provided.

I understand that your medical privacy laws are much more stringent than our patchwork of state and national privacy laws are here in the US, both in life and in death. I heard that you can be imprisoned for up to 5 years for not following strict standards of patient confidentiality. Perhaps that prevented you from contacting Lufthansa instead of just giving the patient an unfit-for-work note, which he subsequently tore up. That, and other reasons, may be causing you to bite your tongue to offer further explanation.

I wonder if your stringent privacy laws are a reaction to the breaches of physicians when the Nazis ruled, as well as the subsequent invasion of privacy in East Germany. Are they an overreaction that needs some degree of correction? After all, airline safety is good, and this may have been a perfect confluence of various factors. Further, to exacerbate our existential anxiety, we have the unexplained disappearance of the Malaysian airliner from just about 2 years ago. Was there a copycat aspect to the Germanwings crash?

All medical colleagues must weigh risk to others against the need for patient confidentiality. This can include whether to divulge patient information such as highly contagious diseases like AIDS or Ebola; abuse of a minor or domestic violence; driving while impaired; carrying a gun; running a nuclear power plant; and being responsible for all kinds of public transportation and safety.

Maybe you wish you could talk and give condolences to those who lost family and friends on the doomed airliner. That would be the human thing to do, but perhaps you can’t?

As psychiatrists, suicide and homicide are essentially our only life and death challenges. So when a patient commits suicide and kills 149 others at the same time, what could feel professionally worse?

Yet we all know that we are not particularly successful at predicting actual suicide or homicide. Complicating that, someone troubled who decides that his or her solution is suicide and/or homicide often seems surprisingly well right before the act. He or she is relieved, having decided on the solution to his problems. We must appreciate our limitations.

Everyone wants to know the co-pilot’s motivation. So do I. But nothing is convincing yet about why he would make sure to kill everyone on board. Way back when, I was taught that in general, suicide was motivated by a desire to die, to kill, and/or be killed. This is a rare example of all—a triple play.

We may need system and cultural changes to how we approach some aspects of mental illness, such as the Air Force Suicide Prevention Program in the US. This program has significantly reduced suicide attempts as well as violence to others.

We and our psychiatric patients are stigmatized in many countries. If such stigma can cause inadequate attention to mental health in routine annual check-ups, no wonder mental health examinations are inadequate for airline pilots.

Complicating our work is the denial, lack of insight, and/or loss of memory among some of our patients. The people that we (clinicians and the public) need to fear most (ie, sociopaths) can be the best at hiding the risk they pose. Periodic research about faking psychiatric symptoms in the emergency department indicates how easily we, in our quest to be helpful, can be fooled. We don’t have corroborating lab tests to fall back on, unlike in other areas of medicine.

During my career, I evaluated and treated a fair number of pilots. Almost always, we grappled with the implications of getting treatment and taking medication. What might help their mental problems might, at the same time, cost them their job, and thereby worsen their mental health. No wonder so many pilots hide psychiatric treatment from their employers.

Who knows? Maybe some of you who treated him didn’t even know that Andreas Lubitz was a pilot. We often know little about the real day to day lives of our patients. Maybe we need to know more.

About a century ago, Freud concluded that his was “an impossible profession.” This may well still be so. The burnout rate of physicians and psychiatrists in the US is over 50%. Know that.

I appreciate why we may never hear your side of the story. That may be a shame, for you probably have much to teach us and can transform some of our fantasies into reality.

In terms of our ethical responsibilities to each other, we are indeed our brothers’—and sisters’—keepers. In that regard, let me know if there is anything more I should know or do.

Your colleague,
H. Steven Moffic, MD (Steve)

Source: Psychiatric Times 16th April 2015

THE methadone programme has failed drug addicts in Clydebank, a leading addictions worker said this week.

methadone-is-a-monsterDonnie McGilveray is the manager of Alternatives, a West Dunbartonshire charity that helps reform drug addicts, many of them methadone users.

He told the Post the methadone programme used to treat heroin addicts has gone unregulated — and described the green liquid as a “monster” that keeps people hooked for good.

His comments come after shock statistics were released last week showing that Clydebank pharmacies claimed £153,000 for methadone prescriptions in 2014.

Donnie told the Post: “I think methadone is helpful for a small cohort of people, the five to ten per cent of people who are chaotic, suicidal or maybe sex workers being used and abused by people. There is a small group of people who need to be made safe.

But that’s not what is happening. We’ve got this monster, a jolly green giant, that many, many addicts are stuck on. And again, it’s not just them who are stuck in this it’s the doctors and nurses who have an obligation to keep them safe.”

National data obtained by BBC Scotland showed pharmacists were paid £17.8 million for handling nearly half a million prescriptions of methadone in 2014. In Clydebank, £153,000 was paid to eight pharmacies to deliver 3,165 prescriptions of the heroin substitute. In Dalmuir Lloyds, £31,671 was claimed for prescribing and supervising methadone to addicts in 2014. But topping the chart was Lloyds Pharmacy on 375 Kilbowie Road which received £38,207 in payments. Pharmacists are paid around £2.32 for dispensing every dose of methadone and about £1.33 for supervising addicts while they take it. Chemists pay the wholesale cost of buying methadone from the government money they claim.

Around 60 per cent of the cash they are paid is made up of their handling fee for the drug and their charges for dishing it out to addicts. In 2013, pharmacies claimed back more than £17.9 million from the Scottish Government for handling 470,256 prescriptions of methadone — 22,980 prescriptions more than in 2014.

Donnie also told the Post he believes West Dunbartonshire, which has a long history of drug problems, is making progress tackling addiction. He said: “At the end of the day, the statistics don’t tell you how many people are on methadone or any details of the prescription, but what we can tell is the drug companies are making a killing from it.”

Figures released by the NHS in 2012 revealed that methadone-implicated deaths increased dramatically in cases where the individual had been prescribed the drug for more than a year.

The addictions worker told the Post he believes methadone should be reserved for the chaotic drug users and other substitutes such as Buprenorphine, Subutex and Dihydrocodiene should be implemented. He continued: “Methadone is not just a medical or pharmaceutical matter but a human rights issue. “The dilemma is that if you reduce someone’s methadone they become unstable and could relapse. Some of the people we work with at Alternatives have relapsed, it’s a regular situation.

If you start to reduce this person they could relapse and relapse significantly, and they might think they can go back onto heroin and inevitably could end up overdosing.”

He added: “That’s my position and I don’t envy the medical side of it in trying to square this problem.”

Top researcher Dr Neil McKeganey, from the Centre for Drug Misuse Research, said the methadone programme “is literally a black hole into which people are disappearing”.

The statistics of methadone prescriptions can be viewed online at:

Alternatives is an organisation funded by West Dunbartonshire Council that helps bring recovering addicts back into society. The project has been around since January 1995, firstly covering Dumbarton and the Vale of Leven, latterly broadening out to Clydebank.

Source: 7th April 2015

Ingenious pill formulations and the latest manufacturing technologies are helping to stem the tide of painkiller addiction.

Mary Marcuccio’s life was turned upside down by drug misuse and addiction. Her son, now 26, started with alcohol and marijuana. Then came cocaine and hallucinogens. By 14, he was stealing prescription painkillers from friends’ medicine cabinets, crushing and snorting the pills to achieve a quick and euphoric high. Within one year, he had graduated to injecting heroin.

This progression is “so stereotypical”, says Marcuccio, founder of My Bottom Line, a Florida-based consulting business for families dealing with substance misuse. According to US survey data, 77% of heroin users say that, like Marcuccio’s son (who remains addicted to heroin), they misused prescription opioids — derivatives of natural or synthetic forms of opium or morphine — before trying heroin.

“It behooves us to make a greater effort at creating unabusable formularies.”

But substance-misuse specialists think that this chain of addiction might be broken with the aid of the latest manufacturing processes to make powerful opioid pain medication more resistant to various forms of tampering. Such drug preparations could also save lives. The death toll from misusing prescription opioids has skyrocketed around the world in the past 20 years, with opioid-linked overdoses exceeding fatalities from road accidents or deaths from heroin and cocaine in countries including the United Kingdom, the United States and Australia. “It behooves us to make a greater effort at creating unabusable formularies,” Marcuccio says.

Fortunately, the science and manufacturing of misuse-deterrence are advancing rapidly — and so is the political climate. In the United States — a country that consumes more than 80% of the global opioid supply — politicians are beginning to craft bills to incentivize the development of misuse-resistant formulations. “The idea is to transition the market,” says Dan Cohen, chair of the Abuse Deterrent Coalition, a network of advocacy organizations, technology manufacturers and drug companies based in Washington DC. “There are now so many different abuse-deterrent formulations that are either in products or in development that there’s enough variety out there for any product to be able to put abuse-deterrence in it.”

The new guard

Some of the latest tablet formulations are so hard that even a hammer-blow cannot pulverize them. Many pills form a gelatinous goo when dissolved that renders them difficult to inject. Others contain reversal agents that negate the high when the tablets are messed with. The idea is to create pain-relief medicines that are less prone to misuse yet work when taken as directed.

The technologies in place today are not ironclad, though. A quick perusal of online message boards and videos reveals numerous tips on how to circumvent the defences of even the most reinforced tablets. What is more, not all prescription opioids on the market are misuse-resistant. “We’re still in abuse-deterrent formulations 1.0,” says Richard Dart, director of the Rocky Mountain Poison and Drug Center in Denver, Colorado. But, he adds with a touch of hyperbole, “there are a zillion abuse-deterrent formulations coming”.

Manufacturers have been worried about prescription-drug misuse for decades. When the first controlled-release formulation of the opioid oxycodone hit the US market 20 years ago, the drug’s manufacturer, Purdue Pharma of Stamford, Connecticut, touted the twice-a-day medicine as a less-addictive alternative to the faster-acting painkillers that provide a big opioid hit all at once. In reality, however, Purdue’s longer-lasting pill, sold under the trade name OxyContin, had the opposite effect.

Drug users easily defeated OxyContin’s time-release mechanism by crushing or chewing it. Just one OxyContin could contain more oxycodone than a dozen instant-release pills but no extra ingredients such as paracetamol that make people sick if taken at high doses. OxyContin quickly became the number one addiction problem in many parts of the world, particularly in the United States and Australia. The drug was so popular among the rural poor of Appalachia in West Virginia and Kentucky that it earned the street name ‘hillbilly heroin’.

Purdue set to work to guard against some of the worst forms of misuse. In 2010, the company introduced a misuse-averting version of OxyContin that contains a polymer made of long-chain molecules. This makes the new tablet more difficult to crush — although it is not rock hard. “It behaves more like plastic,” explains Richard Mannion, executive director of pharmaceutics and analytical development at Purdue. “So, it will deform if subjected to force, but it doesn’t break into a powder easily.” The revised formulation is thus much harder to snort. Plus, Mannion says, when combined with water, the polymer forms a gummy substance that makes it very difficult to draw into a syringe (although misuse is still possible).

The new version of OxyContin has proved to reduce the incidence of therapeutic misuse. A study1 of more than 140,000 people treated at rehabilitation centres across the United States found that misuse by injection, snorting or smoking declined by two-thirds in the two years after the reformulation. In light of these results, in 2013, Purdue won the right from the US Food and Drug Administration (FDA) to describe the misuse-deterrent benefits of OxyContin on the drug’s label and to make marketing claims accordingly. The FDA said at the time that any future generic versions of OxyContin would have to incorporate equivalent misuse-deterrent protection. (In April 2015, the FDA released a guidance document outlining the types of study needed to establish misuse-deterrence, but the report stopped short of addressing generic opioid products.)

Other painkillers that now have FDA-approved misuse-deterrent labelling include Embeda, an extended-release morphine from New York-based pharmaceutical firm Pfizer, and Targiniq, another long-acting preparation of oxycodone from Purdue. Both contain antagonist agents — offsetting ingredients that remain largely inactive when the drugs are taken as directed, but that will annul the opioid’s effects if the drugs are snorted or injected.

“These new technologies are showing some positive results,” notes Robert Jamison, a pain psychologist at the Brigham and Women’s Hospital Pain Management Center in Chestnut Hill, Massachusetts. In Australia, for example, OxyContin users accounted for more than 60% of the visits to the Medically Supervised Injecting Centre in Sydney. After the tamper-resistant version of OxyContin hit the Australian market in April 2014, a team led by Louisa Degenhardt, a drug-addiction researcher at the University of New South Wales in Sydney, found2 that the number dropped to 5%. In the United States, levels of opioid misuse have decreased from their peak in 2010, when the new formulation of OxyContin arrived on the market. Rates of opioid dispensing and overdoses have dropped appreciably, too.

These public-health benefits come with an economic bonus. According to calculations from Noam Kirson and his colleagues at Analysis Group, a consulting firm in Boston, Massachusetts, the reformulated OxyContin has reduced misuse-related medical expenses and indirect societal costs by more than US$1 billion per year in the United States3. “These are substantial savings,” Kirson says.


Old habits die hard

Despite the gains, the misuse-deterrence field still has a long way to go. Drug users who have been thwarted by one technology can switch to another prescription medicine that lacks anti-tampering defences. That is what happened in rural Appalachia following the introduction of reformulated OxyContin. Opioid misusers simply started snorting and injecting the less potent immediate-release preparations of oxycodone, most of which lack misuse-deterrence characteristics. “It’s kind of a whack-a-mole situation,” says Jennifer Havens, an epidemiologist at the University of Kentucky Center for Drug and Alcohol Research in Lexington.

Plus, even with the latest physical defences it is still possible to get high by swallowing lots of OxyContin or Embeda pills at once. Preventing oral misuse requires a different approach — which a company called Signature Therapeutics, based in Palo Alto, California, is pursuing.

Signature Therapeutics’ technology uses prodrugs, which are inactive until they undergo the appropriate chemical conversion in the body. When these pills are taken by mouth as directed, a digestive enzyme in the gut called trypsin releases part of the prodrug, initiating the process of opioid drug release. But because trypsin is not found elsewhere in the body, the prodrug remains inert when injected, snorted or smoked. Signature Therapeutics has already tested its painkilling hydromorphone prodrug in a phase I trial of healthy volunteers; the company plans to begin evaluating its oxycodone prodrug in human studies later this year.

Prodrugs alone do not prevent excessive pill-popping, but scientists at Signature Therapeutics have another trick up their sleeves. If the prodrugs look promising in the clinic, the company will add a second compound that blocks trypsin activity. This might seem counterintuitive, but it is all about threshold levels. The amount of trypsin inhibitor found in one or two pills will not interfere with the prodrug modification, but a handful of pills collectively contain enough inhibitor to shut down the conversion process. With this approach, Signature Therapeutics can create either extended-release or immediate-release opioids. Bill Schmidt, chief medical officer at the company, says that the potential of these drugs is “maximum therapeutic benefit with very low abuse liability”.

New formulations such as these could ultimately prove to be almost addiction-proof, but they are not cheap. And their benefits might not be fully realized unless authorities require drug companies to include them. “The problem with abuse-deterrence right now is the lack of incentives,” Cohen says.

Lawmakers in the US House of Representatives previously proposed legislation that would have barred the approval of any new pharmaceuticals that did not use formulas resistant to tampering. That bill died in committee, but, according to Cohen, revised legislation should be introduced again “soon”. Individual US states have also begun to pass laws that compel pharmacists exclusively to dispense, and insurers to cover, misuse-deterrent versions of opioids unless instructed otherwise by a physician.

Ultimately, the success of long-term efforts to rein in opioid addiction could depend on the regulations surrounding generic painkillers. In December 2014, Australia allowed the sale of a generic long-acting oxycodone without misuse-deterrence characteristics. Degenhardt, who is monitoring the drug-misuse data, worries that many of the gains of OxyContin’s reformulation will now be lost. By contrast, US authorities have already said that they will not approve such a product.

All of these efforts should help to bring down the number of overdose deaths and also prevent experimentation with prescription pills. In her study population in rural Appalachia, Havens has met so many young people like Marcuccio’s son — for whom easily misused opioids were the gateway to addiction — that she has reached a simple, but absolute, conclusion: “The only way that abuse-deterrent formulations are going to work is if they’re all abuse-deterring,” she says. “It can’t just be piecemeal. It’s got to be all or nothing.”

Source:   Nature  522, S60–S61 doi:10.1038/522S60a  (25 June 2015)

International Narcotics Control Board report says US and Uruguay are breaking drug treaties and warns of huge rise in abuse of ADHD treatment Ritalin

The United Nations has renewed its warnings to Uruguay and the US states of Colorado and Washington that their cannabis legalisation policies fail to comply with international drug treaties.

The annual report from the UN’s International Narcotics Control Board, which is responsible for policing the drug treaties, said it would send a high-level mission to Uruguay, which became the first country to legalise the production, distribution, sale and consumption of cannabis for recreational purposes.

The UN drug experts said they would also continue their dialogue with the US government over the commercial sale and distribution of cannabis in Colorado and Washington state.

The possession and cultivation of cannabis became legal on 26 February inWashington DC. Voters in Oregon and Alaska have also approved initiatives to legalise the commercial trade in cannabis for non-medicinal purposes.

The INCB said it “continues to engage in a constructive dialogue” with the US government on cannabis developments and it is clear the UN is putting strong pressure on the US government to ensure that the drug remains illegal at a federal level.

The US government has issued new guidance to banks on their provision of services to marijuana-related businesses and all state attorneys have been reminded of the need to investigate and prosecute cannabis cases in all states.

The INCB said it was aware that the US government intended to monitor the impact on public health of legalising cannabis and has again reminded the Obama administration that the position in Colorado and Washington meant the states were failing to comply with the treaties.

Lochan Naidoo, the INCB president, said the limitation of use of narcotic drugs and psychotropic substances to medical and scientific purposes was one of the fundamental principles underpinning the international drug control framework. “This legal obligation is absolute and leaves no room for interpretation,” he said.

The UN body also renewed its call for the abolition of the death penalty for drug-related offences and voiced concern that Oman was proposing to make use of the death penalty for drug-trafficking offences.

The INCB’s annual report records a further rise in the number of new “legal highs” or psychoactive substances that have been identified. The number has risen from 348 to 388 in the past year – an increase of more than 11%. More than 100 countries are taking action against “legal highs” and the INCB has welcomed moves by China, considered by many to be one of the main sources, to start banning these synthetic substances that imitate the effects of traditional drugs such as cannabis and ecstasy.

The UN drug board also warns of a 66% increase in the global consumption of a stimulant, methylphenidate, which is primarily used in the treatment of ADHD or attention deficit hyperactivity disorder and is better known by one of its trade names, Ritalin. The rise has been seen in its use by teenagers and young adults in the US, Iceland, Norway, Sweden and Australia.

It also highlights the lack of access for 5.5 billion people to medicines containing drugs such as codeine and morphine, which means that 75% of the world’s population do not have access to proper pain-relief treatment.

Source: 3rd March 2015

A new study found that campaigns to prevent prescription drugs misuse can be more effective by focusing on peers and not peer pressure.

The study was conducted by researchers from Purdue University. The researchers evaluated survey interviews with 404 adults ages 18 to 29 who misused prescription drugs in the past 90 days. This included 214 in-person interviews. These individuals were recruited from popular nightlife locations such as bars, clubs, and lounges in New York City. Average misuse of prescription drugs, such as painkillers, sedatives and stimulants, was 38 times in the past 90 days.

“With the 18-29 age group we may be spending unnecessary effort working a peer pressure angle in prevention and intervention efforts. That does not appear to be an issue for this age group,” said study co-author Brian Kelly, a professor of sociology and anthropology who studies drug use and youth cultures, in a press statement. “Rather, we found more subtle components of the peer context as influential. These include peer drug associations, peers as points of drug access, and the motivation to misuse prescription drugs to have pleasant times with friends.”

“People normally think about peer pressure in that peers directly and actively pressure an individual to do what they are doing,” said Kelly, who also is director of Purdue’s Center for Research on Young People’s Health. “This study looks at that form of direct social pressure as well as more indirect forms of social pressure. We find that friends are not actively pressuring them, but it’s a desire to have a good time alongside friends that matters.”

For the study, researchers evaluated the role of peer factors on three prescription drug misuse outcomes: the frequency of misuse; administering drugs in ways other than swallowing, such as sniffing, smoking, and injecting the drugs; and symptoms of dependency on prescription drugs.

“We found that peer drug associations are positively associated with all three outcomes,” Kelly said. “If there are high perceived social benefits or low perceived social consequences within the peer network, they are more likely to lead to a greater frequency of misuse, as well as a greater use of non-oral methods of administration and a greater likelihood of displaying symptoms of dependence. The motivation to misuse prescription drugs to have a good time with friends is also associated with all three outcomes. The number of sources of drugs in their peer group also matters, which is notable since sharing prescription drugs is common among these young adults.”

The Centers for Disease Control and Prevention (CDC) has officially declared that prescription drug abuse  in the United States is an epidemic.

As of 2012, overdose deaths involving prescription opioid analgesics, which are medications used to treat pain, have increased to almost 17,000 deaths a year in the United States. In 2013, only 16 percent of Americans believed that the United States is making progress in its efforts to reduce prescription drug abuse. Significantly more Americans, 37 percent, say the country is losing ground on the problem of prescription drug abuse. That figure is among the most pessimistic measures for any of the seven public health issues included in the survey.

The study was funded by the National Institute on Drug Abuse (NIDA). Findings will be presented at the 109th Annual Meeting of the American Sociological Association by study co-author Alexandra Marin, a Purdue sociology doctoral student.

Source:   16th August 

Women throughout the nation are dying at an unprecedented rate from prescription drug overdoses.  So many are dying that it’s been called a public health epidemic.

In fact, since 2007, more women have died annually from drug overdoses than from auto accidents, according to the Atlanta-based Centers for Disease Control and Prevention.

Although more men die from drug overdoses than women, the percentage increase in deaths since 1999 is greater among women, according to the CDC.

In 2010, the deaths of at least 15,323 women were attributed to a drug overdose, a rate of 9.8 per 100,000 population. Deaths from opioid pain relievers increased fivefold between 1999 and 2010 for women. For men, the rate increased by 3.6 times.

In 2010, some 943,365 women nationally visited an emergency room for drug misuse or abuse. The highest number of visits were for cocaine or heroin, benzodiazepines, and opioid pain relievers.

Women are more likely than men to be prescribed painkillers, use them chronically, and acquire them in higher doses. In part, that is because women are more susceptible to chronic pain and more often use the health care system, suggested Dr. James Bentler, medical director for St. Vincent Healthcare’s Emergency Department. They will seek pain relievers for migraines, chronic pelvic pain, endometriosis, cysts, and fibromyalgia, a condition of widespread pain throughout the body.  Women are also more likely to be prescribed drugs to treat depression and anxiety, which can interfere with other medications, sometimes leading to death.

“Women are the primary health care decision-makers,” said Lenette Kosovich, CEO of Rimrock Foundation. “Always have been, always will be, whether for themselves, their husband or their family. Because women are so familiar with navigating the health care system, they find it easier to manipulate and abuse the system.

Women typically have smaller body masses than men, which makes them more susceptible to overdose. They are also more likely to “doctor shop” to acquire pain pills from multiple physicians, CDC officials say.

While many of the initial complaints from women about pain are legitimate and the prescription appropriate, many pain relievers are habit-forming and can lead to addictionMany of the women who become addicted would never dream of turning to illegal drugs or alcohol, but there is no taboo associated with a prescription drug, Bentler

said. “It’s easier to hide, easier to legitimize,” said Coralee Goni, director of residential services at Rimrock Foundation. “You can put it in your Tylenol case.”

There is no single profile of women who abuse prescription drugs. They run from affluent doctors to teachers to street people.  To help curb “doctor shopping,” the 2011 Legislature passed a bill creating a State wide prescription drug registry. The registry is used to monitor certain addictive prescription drugs such as opiates and narcotics, and requires pharmacies to report weekly on the prescriptions they fill for controlled substances, according to Donna Peterson, program manager for the Montana Prescription Drug Registry.  With just a few clicks, a pharmacist can check whether a patient is filling prescriptions elsewhere in the region, Peterson said.

As of this week, the registry contains more than 4.1 million prescriptions for controlled substances, based on reporting from pharmacies that represent more than 567,000 patients, according to Peterson.

The online search feature for the registry was launched in November 2012 and has been operational for more than a year. Eventually it will maintain a full three years of a patient’s prescription history. More than 90,000 searches have been conducted since the registry launched last year, Peterson said. Between Nov. 26 and Dec. 23 of this year, health care providers conducted almost 8,000 patient history searches.

Peterson said many prescribers and pharmacists have told her that the information revealed in the registry is “invaluable. Some providers thought they knew a particular patient very well, but they were surprised at the quantity of controlled substances the (registry) showed the patient was receiving from other providers,” Peterson said.

She said she also has spoken with several prescribers who identified potential prescription forgeries by using the “Prescribing History” feature of the registry, which shows all prescriptions dispensed under the prescriber’s own Drug Enforcement Administration number.

Montana has the 21st-highest drug overdose mortality rate in the United States, with 12.9 per 100,000 people fatally overdosing, according to a recent Trust for America’s Health report.

The number of drug overdose deaths, a majority of which are from prescription drugs, has more than doubled since 1999 when the rate was 4.6 per 100,000.  West Virginia has the highest number of drug overdose deaths; the study also listed New Mexico, Kentucky, Nevada and Oklahoma in the top five in terms of drug fatalities. The study found that the Dakotas have the lowest incidence of drug overdose fatalities.

The Montana Board of Pharmacy requires pharmacies doing business in the state to report to the registry. Some 763 pharmacies, including mail-order pharmacies serving

Montana customers, participate by reporting all painkiller prescriptions to the confidential database.  As of October, authorized pharmacists, physicians and other prescribers had conducted 74,000 patient history searches.

“It’s scary business, so we need to be vigilant about giving them out,” Bentler said. “There’s plenty of blame to go around as to how we got to where we are. It’s only fair that since we’re the ones prescribing them that we accept some of that responsibility and try to become better at it. We just can’t blame it on the patients, though they have culpability, too.”

The prescription drug registry is not a cure-all. Of people ages 12 or older who in 2011-2012 used pain relievers for nonmedical reasons, 54 percent said they got them free from a friend or relative, according to the Substance Abuse and Mental Health Services Administration. About 15 percent bought or stole them from a friend. Other than physicians, the balance got pain relievers from drug dealers, strangers, the Internet and other sources.

Between Jan. 1 and Dec. 16, Billings police investigated 31 incidents of people fraudulently obtaining dangerous drugs, according to Lt. Kevin Iffland. Police say the suspects doctor shopped, forged prescriptions, falsified prescriptions and more.

The increase could be due in part of the Billings Police Department teaming with the Drug Enforcement Administration and having an officer assigned to work strictly with prescription drug cases, Iffland said. It is also due to the Prescription Drug Registry.

During the same period, Billings police received 170 cases of stolen prescription medications compared with 205 cases last year. Stopping the epidemic in both women and men is everyone’s responsibility, Bentler said. Doctors need to be careful in how they prescribe medications and patients need to be judicious in how they take them.

“You need to do the right things for people and help them, but there’s a slippery slope you can go down by using these powerful medicines,” Bentler said. “It’s fascinating trying to figure out the right approach. How do you do no harm?”

Source: Dec.2013

Neonatal withdrawal cases on rise, causing infant suffering, high costs

The consequences of drug addiction can carry a heavy toll for the tiniest people: newborn babies who suffer from withdrawal. In the neonatal intensive care unit, health professionals see firsthand a product of alarming increases in prescription opioid abuse — community health advocates cite a 666 percent increase in the dispensing of oxycodone from 2009 to 2011 in Hall County. “We’ve definitely felt that in the neonatal world,” said Janessa Canals-Alonso, nurse manager at Northeast Georgia Medical Center’s NICU. “Where before we were impacted more by premature deliveries, or just a very sick infant, all of sudden we’re constantly having babies that are in withdrawal in our units.” In the Northeast Georgia NICU, about two babies per month are treated for neonatal abstinence syndrome, the medical terminology for addiction withdrawal. Those incidences have doubled in only five years, Canals-Alonso said. Studies show the syndrome is most commonly associated with opiate use — from prescription painkillers like Oxycodone to illegal drugs such as heroin — prior to and during pregnancy. Other types of drugs, like barbiturates, cocaine and smoking, also can cause withdrawal symptoms in newborns.   The effects of NAS are in addition to the impact of the drug on the infant’s development. The severity and duration of withdrawal depends on the drug involved. Symptoms include seizures, tremors, excessive high-pitched crying, hyperactivity and vomiting. The infant is not considered “addicted” to the drug, which speaks to a physical and behavioral state of mind, but experiences withdrawal when the dependency-inducing supply of the drug is cut off outside the womb. A baby suffering from the syndrome for opiate use has to be administered medications such as methadone, an opiate used to treat heroin addiction, and then slowly weaned off of the drug. Such treatment is not cheap. “This hits health care costs dramatically,” Canals-Alonso said. “Just one NICU day itself, without anything, could be $1,200. When you start adding medications, any other treatment that goes on — it could be thousands and thousands of dollars.” The average stay in the NICU is about 15 days for an infant with withdrawal, she said. “This has been a very difficult topic for many NICUs throughout the nation,” Canals-Alonso added.   Indeed, research has shown that like the proliferation of opioid pain prescriptions, the increase locally in infant withdrawals mirrors national trends. A 2012 study published in the Journal of the American Medical Association looked at information on millions of discharges from thousands of hospitals in 44 states to measure trends and costs associated with NAS over the past decade, revealing almost a fivefold increase from 2000 to 2009 in the number of mothers using opiates — from 1.19 to 5.63 per 1,000 hospital births per year. The rate of newborns diagnosed with the syndrome increased from 1.20 to 3.39 per 1,000 hospital births per year. Factoring inflation, total hospital charges for NAS were estimated to have increased

from $190 to $720 million over the same period of the study, with the majority of costs shouldered by Medicaid, researchers said. In October, the Food and Drug Administration recommended tighter controls on hydrocodone, signaling an increasing sense of urgency to combat prescription, illegal sales and improper diversion — such as teens raiding the bathroom cupboard — of prescription opioids.    Men are more affected, but women are catching up in the prescription drug problem, which the Center for Disease Control has labeled an epidemic. The number of women dying due to prescription drug abuse rose 400 percent between 1999 and 2010, the CDC reported, compared to 250 percent for men. One of the biggest problems for pregnant women dependent on a prescription drug is that it may be too late to take the cessation measures necessary to prevent infant withdrawal.   “That can affect the infant. They can have seizures in utero if you went cold turkey,” Canals-Alonso said. “So a lot of the time, to play it safe, the physician will keep that mom on medication or wean her off very slowly. But they can’t take her off completely; that mom can’t take herself off completely.” The seeming paradox of such a situation, and a severe consequence, was prominent in an Oct. 9 wreck in South Hall County, where a pregnant woman was arrested for DUI of drugs, serious injury by vehicle, endangering a child while driving under the influence, driving while license suspended and failure to maintain lane. Sugar Hill resident Amber Nicole Taylor, 22, said she was on drugs prescribed to her when she crossed the center lane and hit two vehicles before overturning her own, seriously injuring her father, according to the Georgia State Patrol. Taylor pleaded guilty and will participate in Hall County’s drug court program. Canals-Alonso said doctors should have frank, informed discussions with patients on the consequences of delivering a baby in withdrawal.   “I think there needs to be more education on the back end as to what are the symptoms the baby can have once delivered,” she said. “Unfortunately when we get these moms, they’re very upset because they weren’t informed that their baby was going to go through up to a six-week withdrawal.” The onset of symptoms of neonatal withdrawal can begin as early as 24 hours of birth or can be delayed until five to seven days of age, dependent on type of drug or substance used. A baby with NAS symptoms sometimes never sees a NICU. “That’s an entire other concern,” Canals-Alonso said. “These babies are very difficult to manage. They cry uncontrollably; you can’t console them. They’re very jittery and they are difficult feeders. A mom is already having to deal with so many new life changes in addition to a baby who is inconsolable. That just adds so much stress.”  She paused, a nurse’s concern coloring her voice.   “You know, you worry about those babies, and those moms as well,” she said.


Infant addiction By the numbers

5.63: Number of new mothers using opiates per 1,000 hospital births in 2009, up from 1.19 in 200

3.39: Number of newborns suffering neonatal abstinence syndrome per 1,000 hospital births in 2009, up from 1.20 in 2000

$720 million: Total hospital charges related to NAS in 2009, up from $190 million in 2000

Source: Journal of the American Medical Association, based on study of hospitals in 44 states

Source:  2nd November 2013

Filed under: Parents,Prescription Drugs :

Prevention is often the best medicine, and that is not only true when it comes to physical health, but also public health. Case in point – young adults reduce their overall prescription drug misuse up to 65 percent if they are part of a community-based prevention effort while still in middle school, according to researchers at Iowa State University.

The reduced substance use is significant considering the dramatic increase in prescription drug abuse, said Richard Spoth, director of the Partnerships in Prevention Science Institute at Iowa State. The research published in the American Journal of Public Health focused on programs designed to reduce the risk for substance misuse. In a related study, featured in the March-April 2013 issue of Preventive Medicine, researchers found significant reduction rates for methamphetamine, marijuana, alcohol, cigarette and inhalant use.

Additionally, teens and young adults had better relationships with parents, improved life skills and few problem behaviors in general. The research is part of a partnership between Iowa State and Penn State known as PROSPER, which stands for Promoting School-Community-University Partnerships to Enhance Resilience. PROSPER administers scientifically proven prevention programs in a community-based setting with the help of the Extension system in land grant universities. The results are based on follow-up surveys Spoth and his colleagues conducted with families and teens for six years after completing PROSPER. Researchers developed the prevention programs in the 1980s and 1990s to target specific age groups.

Spoth said understanding when and why adolescents experiment with drugs is a key to PROSPER’s success. “We think the programs work well because they reduce behaviors that place youth at higher risk for substance misuse and conduct problems,” Spoth said. “We time the implementation of these interventions so they’re developmentally appropriate. That’s not too early, not too late; about the time when they’re beginning to try out these new risky behaviors that ultimately can get them in trouble.”

PROSPER administers a combination of family-focused and school-based programs. The study involved 28 communities, evenly split between Iowa and Pennsylvania. The programs start with students in the sixth grade. The goal is to teach parents and children the skills they need to build better relationships and limit exposure to substance use. “One of the skills students are taught through the school-based program is assertiveness, so that they feel comfortable refusing to do something that might lead to them getting in trouble,” Spoth said. “We try to help parents be more attuned to what their children are doing, who they’re with, where they’re going, effectively monitoring, supervising and communicating with their children.”

Parents say the program works. Michelle Woodruff will admit that being a parent is hard work. “Absolutely, underline and capital letters – it is hard,” said Woodruff, a mother of four sons who range in age from 13-21 years old. But the lessons learned through the PROSPER program, she believes, made her and her husband better parents and also brought out the best in their children. “It was a lot of little things that made us re-evaluate how we parented,” Woodruff said. “I think it makes children more responsible not only to themselves, but their parents and the community. They want to represent their families well, their schools well, their churches; I think it just makes them want to be a better person.” Woodruff is now a member of the PROSPER team in Fort Dodge, where she encourages and supports other parents who participate in the program. Facilitators of the family-focused program use games and role-playing to help parents and children improve communication and set expectations for behavior. Woodruff would like to see more families take advantage of the opportunity. “Do it, not only for the one-on-one time with your child, but also to meet other like-minded parents,” Woodruff said.

“We’re just trying to come together as a community to raise the best kids that we can possibly raise so that they’re successful members of society as adults.”

Community benefits . The ongoing community partnerships are evidence of the PROSPER program’s sustainability, Spoth said. The results extend beyond a reduction in prescription drug or marijuana use. Researchers know that substance abuse often leads to other problem behaviors, so prevention can have a ripple effect and cut down on problems in school and violent behaviors in general. The benefits are measured in economic terms as well as the overall health and outlook of the community. “There are things that can only happen over time if you have sustained programming, because more and more parents are exposed to programs that help them address all of the challenges in parenting,” Spoth said. “As a result, people feel like they’re making connections, their community is a better place to live, and they are positive about the leadership in their community.”

Read more at:

Source: American Journal of Public Health Preventive Medicine April 25, 2013 in Addiction (Medical Xpress)

Sizzurp, purple drank, lean — that cough-syrup-laced concoction of many names — has been gaining popularity in hip hop culture and notoriety as more celebrities fall prey to its effects. Rapper Lil Wayne was hospitalized at Cedars-Sinai last week, reportedly linked to use of the prescription-strength medication.

The codeine in the medicine serves as a pain reliever and also suppresses coughing, said Dr. George Fallieras, an emergency room physician and hospitalist at Good Samaritan Hospital. A second drug in the cough syrup, known as promethazine, is used as an antihistamine and commonly used to treat motion sickness and nausea. It’s also a bit of a sedative — employed partly to keep people from drinking too much of the stuff. “This is a very common cough syrup that, when taken in appropriately prescribed quantities, is quite safe,” Fallieras said.

But promethazine is a depressant of the central nervous system, Fallieras said. More importantly, codeine is a respiratory depressant, he added — and when taken in very large amounts, it can cause people to stop breathing. “A lot of times these guys are not just drinking the purple drink, they’re also drinking alcohol,” Fallieras said. “And potentially in combination with alcohol and other drugs — all of these together can be a lethal cocktail.” Lil Wayne reportedly suffered seizures as well, but Fallieras said that high doses of the drink would probably precipitate seizures only in patients who were already prone to them.

The so-called purple drank gains its name from the dyes in the cough syrup, which is mixed with a soft drink and perhaps a sugary candy for sweetness. It has become very popular, spreading through rap lyrics, and across state lines through Texas and Louisiana (where Lil Wayne hails from).

But codeine is an opiate – the same family of drugs as heroin and morphine — and can be very addictive in high doses, Fallieras said. And promethazine has at least anecdotally been noted to intensify the euphoric effects of codeine in the brain. “There’s a misconception that codeine is a weaker formula of the same class of medicine [as heroin],” Fallieras said. “But the amount of codeine these guys ingest with the syrup is massive … it’s just the same as someone being addicted to heroin, except they’re not using needles.”

Source: Los Angeles Times 19th March 2013

A new study found that middle school students in small towns and rural areas who received brief interventions had lower rates of prescription drug abuse into late adolescence and young adulthood.

Prescription drug abuse is taking a medication without a prescription, or in ways or for reasons not prescribed. Abuse of prescription drugs can have serious and harmful consequences, including addiction, poisoning and even death from overdose. Surveys have found that prescription and over-the-counter medications are among the top substances abused by young people. Developing successful community-based interventions to prevent this abuse is an important public health goal.

A team led by Dr. Richard L. Spoth at Iowa State University conducted 3 studies to assess the effectiveness of brief community-based interventions among rural or small-town students in grades 6 or 7. The studies didn’t target prescription drug abuse specifically. Rather, all 3 studies used universal preventive interventions, which address general risk and protective factors for substance abuse. The work was funded by NIH’s National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA) and National Institute of Mental Health (NIMH).

Study 1 (conducted from 1993 to 2008) tested an intervention focused on families of 6th graders. Study 2(1998-2011) tested a combined family-focused intervention and a school-based life skills training program in 7th graders from 24 schools. Study 3(2002-2009) tested a family-focused intervention and school-based interventions in 6th graders from 28 school districts. Students were randomly assigned to an intervention or control group.

Students completed written questionnaires or phone interviews through ages 17 to 25. They were asked about lifetime use of drugs such as barbiturates, tranquilizers, amphetamines, narcotics, opioids and pain relievers not prescribed by a doctor for their use. The results appeared online on February 14, 2013, in the American Journal of Public Health.

In study 1, the intervention reduced the rate of prescription drug abuse by 65%. Of the youth who participated in the intervention, 5% reported lifetime prescription drug abuse at age 25, compared with 16% of those in the control group. In study 2, rates for prescription drug abuse were reduced 33-62% at different ages. In study 3, 23% of youth who participated in the intervention reported lifetime prescription drug abuse in the 12th grade, compared with 29% of those in the control group.

These findings show that brief interventions among 6th and 7th graders in small towns and rural areas can bring long-term reductions in prescription drug abuse.

“The intervention effects were comparable or even stronger for participants who had started misusing substances prior to the middle school interventions, suggesting that these programs also can be successful in higher risk groups,” Spoth says.

This study adds to growing evidence that brief intervention programs can have lasting effects on risky behaviors like drug abuse. Further research will be needed to better understand how best to design programs that target different high-risk populations.

Source: March 4th 2013

Filed under: Health,Prescription Drugs,USA :

U.S. residents continue to be more likely to report the nonmedical use of prescription drugs† than the use of almost all types of illicit drugs, according to recently released data from the 2010 National Survey on Drug Use and Health (NSDUH). Approximately 5% of persons ages 12 or older reported using prescription pain relievers nonmedically in the past year and 2% reported the nonmedical use of prescription tranquilizers—more than any type of illicit drug with the exception of marijuana. The nonmedical use of prescription stimulants was slightly less prevalent at 1.1%. All other substances, including ecstasy and prescription sedatives used nonmedically, were used by 1% or less of U.S. residents. These rankings have remained relatively unchanged over the past five years (see CESAR FAX, Volume 15, Issue 36).

Percentage of U.S. Residents (Age 12 or Older) Reporting Past Year Substance Use, 2010

Percentage of U.S. Residents (Age 12 or Older) Reporting Past Year Substance Use, 2010

†Nonmedical use of prescription drugs refers to using a prescription pain reliever, tranquilizer, stimulant, or sedative without a personal prescription or only for the experience or feeling it causes. It also include drugs within these groupings that originally were prescription medications but currently may be manufactured and distributed illegally, such as methamphetamine, which is included under stimulants.

NOTE: NSDUH is representative of the civilian, noninstitutionalized population aged 12 and older living in the U.S., which represents approximately 98% of the population. The survey excludes homeless persons who do not use shelters, military personnel on active duty, and residents of institutional group quarters, such as jails, hospitals, and residential drug treatment centers.

SOURCE: Adapted by CESAR from Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2010 National Household Survey on Drug Use and Health: Detailed Tables, 2011. Available online at

Fewer American kids are smoking pot and taking LSD and Ecstasy, according to a government report based on 2003 numbers. However, the National Survey on Drug Use and Health also shows more are abusing prescription drugs. The data show a 5 percent decline in the number of 12- to 17-year-olds who say they have smoked marijuana. A little more than 6 percent of teens, 14.6 million people, use marijuana. 

That rate, along with the rates for cocaine, hallucinogens and heroin, were similar to 2002 rates. The survey shows greater drops among those in the same age group using Ecstasy and LSD, down 41 percent and 54 percent, respectively. 

Teens reported drops in use of specific drugs during the last year from the 2002 study: 

• LSD use went from 1.3 percent to 0.6 percent 
• Ecstasy use went from 2.2 percent to 1.3 percent 
• Methamphetamine use dropped from 0.9 percent to 0.7 percent. 

However, the survey found more people had tried prescription drugs when they didn’t need them for medical reasons. An estimated 6.3 million — 2.7 percent of the population over 12 — took unprescribed drugs. An estimated 4.7 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants and 300,000 used sedatives. About 10.9 million teenagers reported drinking alcohol in the month prior to the survey interview in 2003 — 29 percent of the group. These 2003 rates were essentially the same as those obtained from the 2002 survey. 

An estimated 13.6 percent of people 12 or older drove under the influence of alcohol at least once in the 12 months prior to the interview in 2003 (a decrease from 14.2 percent in 2002). These percentages represent 32.3 million people in 2003 and 33.5 million people in 2002. Tobacco Use Overall, the study indicates 20 million people age 12 and older — including adults — were using illegal drugs within a month of the survey. That’s 8.2 percent of the population. 

The overall rate of drug use did not change from 2002 to 2003. Varying ethnic groups showed different levels of illicit drug use: 

• American Indians/Alaska natives — 12.1 percent 
• Reporting two or more races — 12 percent 
• Pacific Islanders — 11.1 percent 
• Blacks — 8.7 percent 
• Whites — 8.3 percent 
• Hispanics — 8 percent 
• Asians — 3.8 percent 

Unemployed adults had an 18.2 percent rate of current drug use, while those working full time came in at 7.9 percent. 

Source: The September 2004 

Between 1995 and 2002, there was a 163 percent increase in the number of emergency room visitis tied to the abuse of prescription drugs according to the Substance Abuse and Mental Health Services Agency. SAMSHA estimates 9 million people now abuse prescription drugs, meaning they use them for nonmedical,and often recreational,purposes.Three million abusers are kids between the ages of 12 and 17 years old. And the abuse can be deadly:Prescription drugs now play a factor in a quarter of all overdose deaths reported in the US.
US drug officials say this represents a dramatic surge – one that took them by surprise. It has presented a whole new set of challenges, such as a lack of law- enforcement resources to track down shadowy Internet sites and unethical doctors and pharmacists. Another key issue: finding a way to balance any law- enforcement measures with the needs of legitimate online pharmacies that have helped the elderly and others save money and time.Federal officials have decided one way to combat the problem is with education. SAMHSA and the Food and Drug Administration have launched a national campaign to warn people that the misuse of prescription drugs is dangerous, as well as illegal.
A complex array of factors has led to the spike in abuse of prescription drugs. There’s the overall increase in the legitimate use of prescription drugs as a society. For instance, since 1995, the number of Ritalin prescriptions written by doctors has quadrupled. During that same time, the stimulant became a favorite recreational drug among teens.
The number of OxyContin prescriptions written between 1996 and 2000 increased 20-fold. One theory contends that the increase in HIV and hepatitis C has prompted some illegal substance abusers to switch to prescription drugs like OxyContin, which can have an effect similar to heroin.
The rise of the Internet has been another factor. Since 1999, online pharmacies – legitimate and otherwise – have mushroomed, giving youth and addicts alike what appears to be easy access to the drug of their choice.

Source: By Alexandra Marks,staff writer of christian science Monitor oct 1st 2003
Filed under: Prescription Drugs,USA,Youth :

The family medicine cabinet, now being “pharmed” by kids looking for drugs over the counter, prescription, whatever they can get their hands on. What happens next is frightening.

According to Pat Connors, substance abuse expert, “They’ll combine them all together in a bag or a hat or whatever, pass it around, take a handful, and then sit back to see what happens to them.”The consequences, for better or worse, are soon obvious. But for doctors, the results of
‘Pharming” are a mystery.
“When a teenager takes unknown pills and is unable to describe the pills, we’re left with a conundrum,” says Dr. Russell Harris, chief of emergency medicine at Our Lady of Lourdes Medical Center. “It could be any host of medications so it’s the fear of the unknown and missing something
that’s potentially dangerous.”And when a prescription mix isn’t available, there’s an even easier option. High doses of over-the-counter drugs, like cough medicine.
“Everyone assumes that the FDA has approved everything and it’s very safe,” says Dr. Harris.While the abuse of over-the-counter drugs is nothing new, studies now show it’s most common among 12 to 17 year olds. In fact, adolescents are 18 times more likely to die from an over-the-counter overdose than from an illicit drug overdose.”What’s new is the nonchalance with which these teenagers seem to be approaching it,” says Dr.
Harris. “When you’re taking things in a larger amount, the medications in the long term may affect the liver, which we may not see till days or weeks later.”And the concern, as always, is what may come next.
“With abuse, the addiction potential can happen very rapidly,” says Connors.

Source:Reported by Monica Novotny.  MSNBC Correspondent Sept. 19th 2003
Filed under: Prescription Drugs,Youth :

By Jonathan Gneiser
Central Wisconsin Sunday
, Sun, Jan 4, 2004

Central Wisconsin is not exempt from a nationwide trend: youths overdosing on nonprescription cough and cold medicines. Dozens of overdoses in the past two years, including at least five deaths in the United States in which the abuse of over-the-counter medicines was a factor, show how medicines such as Coricidin and Robitussin are becoming recreational drugs for kids as young as 12, according to police and doctors.

Jennie Echola, 20, of Marshfield said an acquaintance introduced her to Coricidin HBP Cough & Cold tablets to get a buzz that provided a couple hours of euphoria and hallucinations.

The dangers of DXM Dextromethorphan, also called DXM, is found in more than 120 non-prescription cough and cold medicines, including Robitussin, Coricidin HBP, Vicks NyQuil and Vicks Formula 44. Other facts:
Youths’ nicknames for DXM: Robo, Skittles, Triple C’s, Rojo, Dex, Tussin, Vitamin D. DXM abuse is called “Robotripping” or “Tussing.” Users might be called “syrup heads” or “robotards.”
Symptoms of abuse: They include sweating; high body temperature; dry mouth; dry, itchy or flaky skin; blurred vision; hallucinations; delusions; nausea; stomach pain; vomiting; irregular heartbeat; high blood pressure; numbness in toes and fingers; red face; headache; and loss of consciousness.

How much is too much: A normal dose of DXM is 15 to 30 milligrams. Mind-altering effects can occur at doses as low as 100 milligrams, but many abusers consume enough pills or syrup (say, half a 12-ounce bottle) to result in a dose of 240-360 milligrams.

Its status: The Drug Enforcement Administration classifies DXM as a “drug of concern” because of its potential for misuse, but there are no legal restrictions on buying the drug.

Sources: National Institutes of Health, Drug Enforcement Administration

Although she’s stayed away from illegal drugs, Echola said she thought the cold pills were harmless, because they can be bought legally off the shelf. “I was a walking ‘anti-drug,'” she said. Echola got high on the cold medicine five or six times while she was 19 years old, each time becoming more concerned that she was becoming addicted, she said.

“It’s kind of scary when that’s all you think about,” she said. “It’s like smoking – when you’re under stress you want to smoke more. It basically became an antidepressant for me. “
After becoming upset and having too much to drink at a friend’s birthday party, Echola said she accidentally took Sudafed with Tylenol instead of Coricidin and landed in the hospital for several months. “My liver quit working,” she said.

That incident was an awakening for Echola, who said any sign or smell of the cold pills now makes her gag. “Just thinking about it makes me nauseous,” Echola said. But she’s concerned others, including her 14-year-old brother, could be overdosing on cold medicine. “It seems to be a thing to do with kids his age,” she said. The directions on Coricidin say adults and children 12 years or older can take one tablet every six hours, not to exceed four tablets in 24 hours. The product is not for children under 12.

Recommended doses for over-the-counter drugs should not be ignored, said Joseph Gerwood, a psychologist and certified alcohol and drug counselor for Ministry Behavioral Health of St. Michael’s Hospital in Stevens Point. “The reason is to prevent death and other side effects,” he said. “When you go overboard, you’re going to pay the consequences. You can blow out your liver, heart or have a stroke.” Overdosing with certain cold medicines can stimulate the central nervous system to create hallucinations, anxiety, restlessness and agitation, or depress the system and cause someone to slip into a coma, said Sheila Weix, manager of Alcohol and Drug Recovery Service at Saint Joseph’s Hospital in Marshfield.

“Anytime that you’re using toxic doses of anything in your body, it’s going to have negative effects,” she said. Gerwood said he’s also met with clients who’ve added alcohol or marijuana to the mix. “The problem is when you start mixing this with other drugs, you’re not only playing with fire – you’re in fire,” he said. Riverview Hospital’s medical staff held an inservice on the trend of overdosing on cold medicines about six months ago, said Dave Mueller, director of community relations for Riverview Hospital in Wisconsin Rapids. “We’ve had isolated cases of it over the last year,” he said.

Cases tend to come in streaks whenever there’s a greater awareness of a particular product that can be used to get high, Weix said. Adults also sometimes resort to over-the-counter medications when they can’t get preferred drugs.“There’s always kind of a fringe group that tries these things,” she said. Although Marshfield Police Chief Joe Stroik has only seen a couple of cases reported within the past year, he said it’s an emerging problem. Stroik said he’s especially concerned that teenagers are treating the cold pills like candy.

“With the younger kids, it’s almost like candy Skittles,” Stroik said. “That’s dangerous.”
Residents should clean out their medicine cabinet often to keep tabs on what should be there, Stroik said. Although some retailers won’t sell the medicine to children under 18, Echola said she knows kids have shoplifted boxes of it.

“It shouldn’t be so accessible,” said Echola, who’d like to see the medicine require a prescription, or at least moved behind the counter. After two teenage girls and two 20-year-old men in Merrill overdosed on medicines containing dextromethorphan, or DXM, this year, some drugstores in the city began to stow such remedies behind their counters. At the Aurora Pharmacy, customers aren’t allowed to buy several boxes of Coricidin tablets at once and must request them. Pharmacist Jim Becker said he wants the drug “where we can keep an eye on it.” Although drug manufacturers say they sympathize with concerns about drug abuse, they’re resisting efforts to restrict consumers’ access to Coricidin, Robitussin and other remedies containing dextromethorphan.

“The vast majority of people take them responsibly,” said Fran Sullivan, spokesman for Wyeth Consumer Healthcare in Madison, N.J., which makes Robitussin products. “As a medicine, it works hands-down, so we want people to be able to use it if they need it. “Wyeth increased the size of the packaging for its anti-cough gel-tabs so that it is difficult to stash in a backpack or pocket, Sullivan said. “We’ve noticed that the abuse comes and goes in waves,” he said. “It gets really popular in a small area for a short period of time and then it dies out. Teens end up in the emergency room, it makes the local newspaper, and the area goes on alert.”

Schering-Plough, which makes Coricidin, is working with the Partnership for a Drug-Free America to create an educational Web site on dextromethorphan, company spokeswoman Mary-Fran Faraji said. Company representatives also are meeting with pharmacists, parents, schools and retailers to discuss ways to prevent drug abuse.Gannett News Service contributed to this story.

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