I-Science: NIDA's Look into the Risks of Designer Drugs

CDC: Women's Painkiller Overdose Deaths Up 400 Percent Over Last Decade

Statistic by the CDC

CBS News Reports - More than five times as many women died of prescription painkiller overdoses in 2010 than in 1999, the Centers for Disease Control and Prevention reported on Tuesday.  About 48,000 women have died from painkiller overdoses between 1999 and 2010, an increase of 400 percent over the period. In 2010, that amounted to about 18 women every day. About half of all women's overdose deaths were due to prescription painkillers.

The startling statistics were revealed in a CDC Vital Signs report on July 2. Prescription painkillers include opioid or narcotic pain relievers, including drugs like Vicodin, OxyContin, Opana and methadone.

"They shouldn't be used lightly, [only] where they are essential, necessary, something like severe cancer pain," CDC director Dr. Tom Frieden told CBS News. "They are important tools. But all too often, the risks are way higher than the benefits."

Since 2007, more women have died from drug overdoses than motor vehicle crashes. Women ages 45 to 54 are at the highest risk of dying from taking too many painkillers. About 10 percent of female suicides are committed with prescription painkillers.

In addition, women between 25 and 54 are more likely than any other age group to have to go to the emergency room due to prescription painkiller misuse or abuse. For every woman who died of a prescription painkiller overdose, 30 more went to the emergency room for misuse or abuse. The rate of ER visits was about one woman every three minutes in 2010.

"It's a big problem among women," Frieden said to the New York Times. "It's underrecognized."

Overall, drug overdose deaths rose for the 11th straight year in 2010, and in 60 percent of the fatalities prescription painkillers were involved. Opioid deaths were involved in three out of four medication-related deaths.

The CDC reported that men are still more likely to die from painkiller overdoses. Male prescription painkiller deaths also increased by 265 percent in the same time frame, but the gap between the two genders is closing.

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Experts say that increased painkiller prescription rates may be behind the rising numbers. Part of the reason that women are so vulnerable is that they are more likely to be in chronic pain, be prescribed painkillers, be given higher doses and use them longer than men. Compared to men, women are also more likely to become addicted to prescription painkillers faster and are more likely to "doctor shop" for more prescriptions.

Dr. David Sack, CEO of Promises Treatment Centers, previously told CBSNews.com that there was a push to treat pain symptoms 40 years ago, which increased the frequency of painkiller prescription. He said people feel comfortable using prescription drugs because they come from pharmacies and doctors, but do not realize they can have devastating effects if used together or if someone takes too many.

"It's kind of the Heath Ledger phenomenon," Sack explained. "Even though any one of them are not enough to cause an overdose, two or three of theme together is enough."

Opioid prescriptions belong in the same family of drugs as heroin. Sack has also noted many cases of people turning to black tar heroin from prescription drugs because it is cheaper.

Women were also more likely to die of overdoses due to medicines for mental health conditions like antidepressants or benzodiazepines (anti-anxiety or sleep drugs) than men.

Overdose isn't the only problem. Prescription drugs taken by pregnant women can put the fetus at risk of neonatal abstinence syndrome (NAS). NAS is a group of symptoms that happen when a newborn has been exposed to addictive illegal or prescription drugs -- including amphetamines, barbiturates, benzodiazepines, cocaine, marijuana and opiates/narcotics -- while in utero. It is similar to fetal alcohol syndrome (FAS), which happens when a mother abuses alcohol while pregnant.

NAS symptoms depend on the type of drug the mother used and how often she used it. They can include mottling (blotchy skin coloring), diarrhea, excessive or high-pitched crying, excessive sucking, fever, hyperactive reflexes, increased muscle tone, irritability, poor feeding habits, rapid breathing, seizures, sleep problems, slow weight gain, sweating, sneezing or stuffy nose, trembling or vomiting. Symptoms appear one to ten days after birth.

The CDC said the U.S. government is tracking prescription drug overdose trends to monitor the epidemic, teaching health care providers and the public about the warning signs of abuse, and creating programs to help treat prescription drug abusers and those who overdose. In addition, the CDC says the Affordable Care Act should provide better access to mental health and substance abuse treatment programs for those who need it.

The CDC is encouraging health providers to recognize the signs of prescription drug abuse in their patients and follow guidelines when it comes to prescribing medications. Doctors should avoid giving painkillers and benzodiazepines to the same patient, and help pregnant women who are addicted seek help. Prescription drug monitoring programs (PDMPs) can also help track patients who are abusing drugs and the system.

Patients should discuss which medications they are taking, including over-the-counter ones, with their health care provider and only use them as directed. As soon as they are done using treatment, they should discard any leftover medication. Patients should never sell or share their prescription drugs, and be open with their health care provider about their pregnancy plans before they take prescription drugs.

Source:  www.cbsnews.com

Urban Outfitters Causes Parents to be Concerned with Simulated Products that Promote Drug & Alcohol Abuse

KevinMD.com: Why the American Problem with Opioids and Chronic Pain is Here to Stay

Image by:  Shutterstock

By Dr. Jennifer Gunter - America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you.

To combat our opioidification the Food and Drug Administration has recommended prescribing restrictions on hydrocodone (remember, we consume 99% of the global hydrocodone supply). These obstacles do not appear derived from evidence-based guidelines and probably won’t do much to reduce the vast majority of inappropriate prescribing, although they may slightly curtail physicians that run pill mills and may also help with diversion (lying to get opioids to sell them on the street).

But I want you to consider these following pain scenarios, because this is how the majority of opioids are prescribed in the United States. In each scenario there is a patient with chronic low back pain who started taking a Norco (acetaminophen and hydrocodone) every day or two for her pain, but now four years later is taking 8 Norco a day.

• Patient A was never referred to physical therapy, never prescribed an adjuvant medication for chronic pain (adjuvant medications treat the way chronic pain is produced in the nervous system), never given a graduated exercise program, never had her anxiety or depression discussed never mind treated, and never given the option of a long-acting opioid. In short, she was only ever offered one therapy, the wrong one. Over time, her pain worsened (a natural consequence of untreated depression, anxiety, and immobility) and she needed more Norco a day.
• Patient B was offered all the above therapies and they were well-covered by her insurance, but she found reasons to cancel physical therapy at the last minute, was intolerant of every medication except the Norco, and refused to speak with a pain psychologist despite being profoundly depressed (PHQ-9 of 24) and suffering from an anxiety disorder. Over time her pain worsened and she needed more Norco a day.
• Patient C wants to go to physical therapy, but the co-pay is $80 so even twice a month isn’t possible (a month of Norco costs $5). She is dutifully doing her home exercises, but often does too much and pays for it in pain the next day because learning pacing from a pain psychologist isn’t a covered benefit. She is open to addressing her depression and anxiety, but don’t have mental health coverage. She tried nortriptyline (the only truly low-cost adjuvant medication for chronic pain, $4 a month via WalMart), but it was ineffective. Generic gabapentin, the next generic that is offered (because brand name drugs are prohibitively expensive under her health plan) is $1 a pill and that will be about $180 a month. She would love to do Tai-Chi or restorative Yoga to get moving, but can’t afford it. Over time her pain worsened and she now needs 8 Norco a day.
• Patient D had an MRI when she complained of back pain. A bulged disc was identified. After 2 epidurals that didn’t work (no PT or other multidisciplinary approach was offered), she had back surgery. When, after a brief 4 month post surgery respite, the pain worsened she had more epidurals and another surgery with a multi level fusion. And then another one. Over time her pain worsened (she now has failed back syndrome) and she takes 8 Norco a day

Despite the fact that opioid monotherapy is sub-optimal care, it happens all the time. I’m not sure how the FDA restrictions will help a doctor, who has less than 15 minutes and may not fully understand the multidisciplinary approach required to address chronic pain, delve into anxiety, depression, physical therapy, cognitive behavioral therapy, weight loss, pacing, adjuvant medications, nerve blocks, dietary modifications, and the appropriate use of opioids (just to name a few therapies).

Non-compliance is a challenge in all aspects of medicine, and chronic pain is no different. However, the availability of opioids as a potential therapy certainly confuses things. A beta-blocker for high blood pressure has no component of secondary gain. How do we approach non compliance in chronic pain when opioids are on the table? We know that exercise and physical therapy reduces both pain and work disability for many patients with back pain and are the standard of care, but what if a patient is less than compliant with physical therapy or flat-out refuses yet shows up on time for her opioid prescriptions? Non compliance isn’t limited to physical therapy or exercise either. How will the FDA restrictions guide clinicians in these scenarios?

In almost every single health plan in the United States it is easier to get an MRI and back surgery than it is to get physical therapy. FDA restrictions will not solve this problem.

In the United States there is a reluctance to accept that the mind-body connection is a huge part of the pain equation. The neurochemical changes of depression and anxiety increase pain, because the same chemicals released by an anxious or depressed nervous system are the very same chemicals that produce pain. Basically, depression and anxiety fuel the fire of pain. How will the FDA regulations fix this mind-body disconnect (among both patients and providers ), solve mental health parity, and break down the stigma of mental health?

What if the patient actually has access to and wants to go to a cognitive behavioral therapy program, but she works two jobs and can’t afford to take the time off to go? After all, most of these programs are offered during the day. How will the FDA restrictions help in this scenario?

There are only a few generics for the medications that can actually treat chronic pain, so most of these drugs are very expensive. Many opioids are as cheap as M & Ms. A few extra hoops for hydrocodone won’t solve this issue.

Some docs have admitted to essentially giving Vicodin goody bags to improve Press Ganey scores. Yes, you read that correctly. Check out that link at the peril of your sanity. There is a push to give the patient what they want, which may not always be the standard of care. And yes, many people want opioids. How will the FDA restrictions put the brakes on this trend?

And finally, we practice medicine in a world where some chronic pain conditions respond suboptimally to evidence-based therapies and appropriate, responsible opioid prescribing may be a necessary component.

I practice in chronic pain Nirvana. Everyone of my patients has access to skilled physical therapy, adjuvant medications, a pain psychologist, and a psychiatrist, although rising co-payments are eroding away at the way people can practically access these services. We have intensive cognitive behavioral therapy programs designed to get the immobile moving (immobility is the nemesis of chronic pain, a self-fulfilling prophecy). We even have Tai Chi and Feldenkrais. And yet, sometimes even when we harness all these treatments we still need opioids (although almost always we are able to lower the dose). And sometimes, patients decline all these therapies and only want opioids.

Proposing restrictions helps us think about opioid misuse and abuse, which is good.New York City’s decision to limit opioids prescriptions from the emergency room to a three-day supply is a more thoughtful approach, although not perfect. Chronic pain shouldn’t be managed in the emergency department, although what happens to the patient without insurance who goes to the emergency room for her pain because she knows she won’t be turned away? Should this patient be treated differently than the patient who is going to the emergency room to get Dilaudid (hydromorphone) hoping that her doctor, with whom she has a pain contract, won’t find out?

Requiring a new written prescription for hydrocodone every 30 days probably won’t change too much. Some doctors, to avoid the hassle, might refer a little sooner to pain programs (which will be good, if such a program is available) or to a surgeon (in general less good for chronic pain, but always available). Some doctors may refuse to start opioids (good for some patients and bad for others), but many doctors will probably just leave written prescriptions with their receptionists for their patients to pick up. In summary, the American problem with opioids and chronic pain will remain unchanged.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

Source:  www.KevinMD.com

Automobile Club: Roadwise Rx Explains Specifics on How Medications Affect Driving

AAA's Senior Driving webpage is a tool to keep yourself and others safe on our roads and highways.  It is useful for anyone who is not sure how a drug may impact driving ability.  Click on this link and learn how to drive safely this holiday season and into the New Year.

Here's some info, directly from AAA's site:

Eight out of ten drivers age 65 and older take medications on a regular basis. And despite high prescription and over-the-counter medication use, almost half of seniors using medications have never talked with their health care providers about how the drugs might affect their safe driving abilities.

Roadwise Rx is a free, confidential tool developed by the AAA Foundation for Traffic Safety that adults can use to explore how medications may affect safety behind the wheel.

How it works

Roadwise Rx offers a way for you to record all of your medications in one central location. It also provides customized feedback on how your prescription and over-the-counter drugs, herbal supplements and foods, as well as their interactions with each other, can affect safety behind the wheel. 

PS: 

For some reason marijuana does not come up in the search criteria, but methamphedamine does.  I have sent an email to AAA asking them to add marijuana's side effects so that people are aware that marijuana does impair motor skills.

For more visit:  www.seniordriving.aaa.com

It is Time We Publicly Acknowledge the Connection Between Drugs and Violence

The Olsen Twins $55,000 Prescription Pill Junkie Bag

Today, there are more people dying from prescriptions drugoverdoses than from traffic accidents.  But none of that seems to matter to Mary Kate and Ashley Olsen, also known as the Olsen twins.  They probably think they’re hilarious with their new line of junkie pill freak bags.  Fact is however that this is just not funny. 

 To top it all off, this pill riddled tote of nightmarish stupidity can be yours for $55,000 smackeroos!  Hey, these days not even Lindsay Lohan can afford that!  

The fist thing that comes to mind when examining the “creative factors” of this disgusting bag, is that it looks like it was inspired by Michael Jackson and Whitney Houston’s toxicology report!  (May they rest in peace.)  Hey, maybe someone could make a pill that would make stupid celebrities leave the spotlight.  Really Mary Kate and Ashley, is this the best you can do?  What’s next?  Crack pipe earrings and heroin junkie rubber bands with needle charms for bracelets? 

Don’t you guys understand that our nation has a major drug problem with prescription drugs?  If this was supposed to be a publicity stunt, I can’t think of anything worse coming from Mary Kate and Ashley.  Target stores should never carry anymore Olsen twins products.

Photo Source:  TooFab

Senator Feinstein Chairs Senate Drug Caucus Hearing on Prescription Drug Abuse

Morphine: Treatment for Addiction at Birth?

Babies born addicted receive morphine for drug withdrawals.  Morphine, a drug that has withdrawals symptoms which are some of the worst of all opioids.

Parents Lock Your Medicine Cabinet

When I was a kid, my parents probably never suspected that I would reach for the medicine cabinet to eat the Children’s Coricidin, candy flavored chewable cold medication, because it tasted good to me. I really had no idea that I was getting high or that I was reaching for drugs. But eating Coricidin cold meds became a regular habit for me when I was a child and no one ever questioned it.

Corecidin children’s cough and cold medication is widely abused by kids today and when I think back at how people assessed me when I was a kid, during the time I was unknowingly abusing Coricidin, the pieces of the puzzle on how I later became a hard core addict begin to show.

Back then, my parents and teachers often wondered what was wrong with me, because it seemed like I was totally absent minded at times and appeared to be oblivious to my surroundings, like I was living in a dream. Yet no one ever factored in drug abuse and in my mind, what I was doing should have had no affect on any part of my life. It didn't occur to me that there was a connection that needed to be made. I thought I was just eating candy and that all the criticism I got was mean.

The reality however is, that I knew that I could find the Children’s Coricidin in my parents medicine cabinet. I also remember wondering if any of the other drugs in the cabinet tasted like candy and I also remember tasting aspirin, which I didn’t like. Had my parents locked their medicine cabinet, or had they known to do so, perhaps things would have been better for everyone.

Training Doctors about Addiction, the Missing Link?

The two stories in this video tell the tale of how two young men who had normal lives, suddenly had accidents that required medical attention. They both went to the hospital with injuries severe enough, so that they were prescribed pain medication. Eventually, both these men got heavily addicted to their medications and went from the pain pills to hard drugs, becoming homeless street junkies.

The missing link in this story however, is what happened when the doctors realized they should no longer prescribe painkillers. Did the doctors know their patients were getting addicted to the medications prescribed? The answer is a quite probable “yes” because for the types of injuries these men had, they were likely prescribed narcotics, which are known to be addicting and hard to let go of once someone is addicted to them.

Narcotics are also gateway drugs like many other habit-forming drugs on the regulated and black market. The fact is that doctors are not trained to respond to addiction and they are not trained on how to handle a patient, once he or she becomes addicted. Doctors are also not trained on how to handle people in sobriety who have serious medical necessity for medication, that may or may not be habit forming.

For those of us who are sober, when we are faced with a procedure or surgery, we should work with our doctor and a trusted friend to help us manage our prescribed medication. In sobriety this can be a scary place to be, but with plenty of communication and leaving others in charge of managing our medication, we stand a very good chance of overcoming these obstacles and staying in control of our recovery.