Thursday, July 31, 2008

Binge drinking 'out of control'

Binge drinking is "spiraling out of control" in Grey-Bruce, with a third of residents who drink alcohol reporting engaging in it during the past year, a figure 12 per cent higher than both the provincial and national averages.

The percentage of local drinkers over the age of 12 binge drinking nearly doubled to 34 per cent in 2007 from 18 per cent in 2001, according to the Canadian Community Health Survey, which monitors a range of health indicators including alcohol and tobacco use.

"For the most part, most places in Canada have not doubled. These numbers are just really high," said Matthew Myatt, associate epidemiologist for the Grey Bruce Health Unit.

"I wouldn't say we expected to see the jump in the numbers because this is really high, 12 per cent (higher than the average) is huge."

The provincial average for binge drinking by those who drink alcohol was 21.2 per cent in 2007, the national average was 21.8 per cent. Binge drinking is considered to be having five or more drinks on one occasion at least once per month in the past 12 months.

"Alcohol abuse through binge drinking is spiraling out of control in Grey Bruce," the health unit said in a news release. "Alcohol is the most popular drug in Grey Bruce and its abuse is on the rise."

Research has proven that adverse health effects due to drinking begin at the "binge drinking" level of consumption, Myatt added.

According to Dr. Geoffrey Fong, a psychologist at the University of Waterloo, binge drinking is heavily affected by social context and peer pressure.

"If you start drinking at a young age it becomes a problem that quickly becomes a social epidemic because it's highly visible and spreads throughout a social group," said Fong, an expert in global health issues and the effects of alcohol on social behaviour.

"What initially may seem like a small increase in drinking will blossom fairly quickly because of social effects."

The local co-ordinator of the FOCUS Community Program says the goal of program is to prevent problems, including injuries and chronic diseases, associated with drinking and drug use.

"If adults that drink alcohol can begin to assess the amount and their patterns of drinking, we hope there will be a change in the culture of drinking in Grey Bruce and also a reduction in the burden of disease," Marie Barclay, a public health nurse, said in a news release.
source: Owen Sound Sun Times

Wednesday, July 30, 2008

Unanswered cries for help

Instances are growing in which certain prescription drugs do a lot more than kill the pain — they kill the user.

In articles published this month, Las Vegas Sun reporters Marshall Allen and Alex Richards reported that this tragic trend is national and particularly acute in Nevada.

Their research revealed that 258 people in Clark County died last year — as opposed to 57 in 1997 — from conditions related to overdoses of prescription drugs.

They also documented that Nevadans consume about twice the national average of several prescription painkillers — a statistic that is probably more than coincidental to the rising numbers of fatal overdoses.

To add perspective, Allen and Richards did some comparisons of last year’s in-state deaths. There were more from prescription drug overdoses than from auto accidents. And from firearms. And from overdoses of cocaine, heroin and methamphetamine combined.

On Monday Allen reported that the number of Nevadans who are addicted to prescription drugs has reached crisis proportions. The result is that the state’s inpatient and outpatient substance abuse treatment programs, already overwhelmed by tens of thousands of people addicted to alcohol and street drugs, are increasingly not meeting the need.

Thousands of Nevadans who are succumbing to addiction and want help are being told to wait, when waiting can be perilous to their health.

Inpatient treatment programs are considered best for addicts, but in Clark County there is a total of 375 beds for this service.

Addicts who have money or who have good health insurance have little problem getting treated in Nevada, but the numbers of addicts without these attributes are legion.

Rising fatalities are not the only cost. Addiction often leads to domestic violence and other crimes that take a human toll and overcrowd our courts, jails and prisons. It fills emergency rooms and beds at our public hospitals. It leads to traffic accidents, unemployment and homelessness. These consequences add up to a much greater public cost than an expanded treatment system.

The lack of adequate assistance for addicted Nevadans who lack the means to help themselves is a grave problem that should be addressed by the 2009 Legislature.
source: Las Vegas Sun

Tuesday, July 29, 2008

History shows illegal drugs are not a recent problem

Illicit substances have been in demand here for at least 350 years; no legal measures have ever made a difference.

EVERY TIME gardaí make a big drug seizure - and there have been plenty of them recently - they must have mixed feelings. On the one hand, there is another victory in the "war on drugs". Good police work seems to be getting results. On the other hand, though, everyone - especially gardaí - knows that however many battles are won, the war was lost a long time ago. The reality is that the amount of seizures is largely a function of the amount of drugs being imported; that when one gang is broken, there will always be another hungrier, more vicious one ready to step into the breach; and that for all the millions spent here and the trillions spent worldwide, illegal drugs are cheaper and more ubiquitous than they have ever been.

The real issue is, of course, demand. If people want mind-altering substances, there will be big money in supplying them. We lose sight of this reality because we have a distorted narrative in our heads. The story we assume to be true is that, while Irish people always drank alcohol and took enthusiastically to tobacco, illegal drugs are essentially a recent phenomenon. They came in during and after the 1960s, along with all the other moral and social laxities of that decade. They are an outside influence, a downside to the modernity that we adopted. They cling, therefore, to the surface of Irish culture and can, with enough persistence, be scraped off.

It is weird that we should think this, because there are few western European societies in which the consumption of illegal, mind-altering substances was so open, and so socially acceptable for so long. I doubt that there are many readers who haven't drunk, or been present when others drank, the primary Irish illegal drug of the 19th and 20th centuries. It is called poteen. How odd that we forget about it, and forget, too, that 400 years of law enforcement failed to stop people making and drinking it.

Poteen became prominent in Irish society after 1661, when excise duty on Irish whiskey was re-introduced. As duty went up and the price of "parliament whiskey" rose, the native Irish responded by making their own alcohol. Originally, this was generally decent malt whiskey. But as time went on, poteen developed in a way that we are familiar with from cocaine or heroin. With a thriving, unregulated trade in which price was the key factor, poteen makers turned to whatever was available - molasses, sugar, treacle, potatoes, rhubarb. The more unscrupulous of them added bite to an adulterated product with meths or paint stripper.

The stuff became dangerous, unreliable and of often poor quality. The authorities came down heavy, sending armed soldiers against the distillers. Illegal distillers were shot, imprisoned, transported. None of it made a blind bit of difference.

Neither did the threats of the IRA in the early 1920s or the creation of a native government. The "war on poteen", as we might call it, continued in the 1930s, during which there were 500 stills detected every year by the Garda. But it was social change - emigration, relative prosperity, urbanisation - and cheaper official whiskey, that eventually killed the poteen trade. It was not law enforcement.

Poteen, it might be objected, is unusual, because it represented a displacement of an existing demand. How, then, could one explain the huge demand for another mind-altering substance: ether?

In his classic historical essay, Ether Drinking in Ulster, KH Connell disclosed the extraordinary story of the widespread and open consumption of this hallucinogenic industrial solvent, especially in the North. In the 1890s, it was estimated that 50,000 people in counties Derry and Tyrone were "etheromaniacs". The burning, unstable liquid, which turns to gas at body temperature, was not pleasant to drink (it made the uninitiated violently ill) but its effects seem to have been rather like those of LSD: "You always heard music and you'd be cocking your ears at it . . . Others would see men climbing up the walls and going through the roof . . ." Again, like today's illegal drugs, ether was widely consumed even though it harmed people's health, led to deaths by accidental overdoses, and encouraged some addicts to steal in order to supply their habit. And again, law enforcement was relatively ineffective. Ether-drinking died out largely because of social change and the availability of alternative intoxicants.

The point of this brief history lesson is simply this: there has been a demand for illegal and unapproved mind-altering substances for at least the last 350 years in Ireland. That demand has been channelled into different substances - poteen, ether, hash, LSD, heroin, cocaine, ecstasy - but there is no great evidence that it is actually higher now, as a proportion of the population, than it was a century ago.

Law enforcement (even when it was much harsher than it is now) and church sanction (even when the churches were far more powerful than they are now) had little success in combating this trade, so long as the demand made it a lucrative one. Why do we imagine that things are any different now?
source: © 2008 The Irish Times

Monday, July 28, 2008

Titan Pharmaceuticals Announces Positive Results from Phase III Clinical Trial of Probuphine for the Treatment of Opioid Addiction

Titan Pharmaceuticals, Inc. (AMEX:TTP) today announced positive, statistically significant results from its randomized, double-blind, placebo controlled, multi-center Phase III clinical trial of Probuphine®. Probuphine is Titan’s novel, subcutaneous implant formulation designed using its ProNeura technology to deliver six months of buprenorphine. Buprenorphine is currently marketed as a sublingual formulation for the treatment of opioid addiction.

Probuphine showed a clinically and statistically significant difference over placebo in illicit opioid use over 16 weeks as measured by urine testing performed three times per week (p=0.0361) – this was the primary endpoint acceptable to the U.S. Food and Drug Administration (FDA). Additionally, Probuphine achieved statistical significance in the Phase III trial’s key secondary endpoint, the difference in illicit opioid use from weeks 17-24 (p=0.0004). Moreover, Probuphine treatment showed a statistically significant difference in illicit opioid use versus placebo over the full six-month (weeks 1-24) period (p=0.0117).

“We are extremely pleased by these positive results and the potential of Probuphine to be an important advance in the treatment of opioid addiction,” said Marc Rubin, M.D., President and CEO of Titan. “Even as buprenorphine, with estimated sales of half a billion dollars in worldwide sales, is fast becoming the gold standard for opioid addiction treatment, there are growing concerns about compliance with and abuse of the currently available treatment options and a critical need for safe, effective treatment options. These data show that our proprietary subcutaneous implant can safely deliver Probuphine over six months. We look forward to completing this development program and forging strategic alliances to commercialize Probuphine worldwide.”

Additional secondary efficacy analyses, including the mean percentage of urines negative for illicit opioids over treatment weeks 1-16, 17-24, and the complete six-month period also statistically favored Probuphine over placebo. Another important indicator of treatment effectiveness, patient retention, was approximately 66 percent for Probuphine compared to 31 percent for placebo. Probuphine was also well tolerated throughout the six-month trial.

“These data are very promising and I believe that the success of Probuphine should have a very significant impact on our ability to effectively treat opioid addiction,” said Walter Ling, M.D., Professor of Psychiatry and Director of the Integrated Substance Abuse Programs at the David Geffen School of Medicine at UCLA, and a principal investigator in this trial. “As a clinician, I am concerned by the growing problem of opioid addiction, especially prescription opioid abuse, and the challenge of effectively treating our patients with a safe, abuse-resistant and diversion-resistant treatment. These data could translate into a dramatic change in our treatment possibilities.”

Worldwide, it is estimated that there are 6 million opioid addicts. Approximately one-half of this potential patient population is addicted to illicit opioids, such as heroin, and the other half to prescription drugs, such as oxycontin, methadone, and codeine. Until recently, the only approved medication assisted therapies for opioid addiction had been available at only a limited number of authorized facilities in the U.S. As of 2000, U.S. physicians can be certified to prescribe less restricted opioid addiction medications in an office setting, which has greatly expanded patient access to opioid addiction pharmaceutical therapies. Despite these advances, this remains a highly underserved market with only about 750,000 people globally receiving medicinal treatment for opioid addiction.
More details here...
source: Business Wire

Saturday, July 26, 2008

Two Takes: Drugs Are Too Dangerous Not to Regulate—We Should Legalize Them

The nation's drug problems should be controlled through regulation and taxation

Peter Moskos of John Jay College of Criminal Justice wrote Cop in the Hood: My Year Policing Baltimore's Eastern District.

Drugs are bad. So let's legalize them.

It's not as crazy as it sounds. Legalization does not mean giving up. It means regulation and control. By contrast, criminalization means prohibition. But we can't regulate what we prohibit, and drugs are too dangerous to remain unregulated.

Let's not debate which drugs are good and which are bad. While it's heartless to keep marijuana from terminally ill cancer patients, some drugs—crack, heroin, crystal meth—are undoubtedly bad. But prohibition is the issue, and, as with alcohol, it doesn't work. Between 1920 and 1933, we banned drinking. Despite, or more likely because of, the increased risk, drinking became cool. That's what happens when you delegate drug education to moralists. And crime increased, most notoriously with gangland killings. That's what happens when you delegate drug distribution to crooks. Prohibition of alcohol ended in failure, but for other drugs it continues.

Law enforcement can't reduce supply or demand. As a Baltimore police officer, I arrested drug dealers. Others took their place. I locked them up, too. Thanks to the drug war, we imprison more people than any other country. And America still leads the world in illegal drug use. We can't arrest and jail our way to a drug-free America. People want to get high. We could lock up everybody and still have a drug problem. Prisons have drug problems.

Illegal production remains high. Since 1981, the price of cocaine has dropped nearly 80 percent. Despite the ongoing presence of U.S. and other troops, Afghanistan has been exporting record levels of opium, from which heroin is made. Poor farmers may not want to sell to criminals, but they need to feed their families, and there is no legal market for illegal drugs. Al Qaeda in Afghanistan, the FARC in Colombia, and drug gangs in Mexico all rely on drug prohibition. A legal drug trade would do more to undermine these terrorists than military action would. If we taxed drugs, profits would go to governments, which fight terrorists.

Illegal drug dealers sell to anyone. Legal ones are licensed and help keep drugs such as beer, cigarettes, and pharmaceuticals away from minors. Illegal dealers settle disputes with guns. Legal ones solve theirs in court. Illegal dealers fear police. Legal ones fear the IRS.

Less use. Regulation can reduce drug use. In two generations, we've halved the number of cigarette smokers not through prohibition but through education, regulated selling, and taxes. And we don't jail nicotine addicts. Drug addiction won't go away, but tax revenue can help pay for treatment.

The Netherlands provides a helpful example. Drug addiction there is considered a health problem. Dutch policy aims to save lives and reduce use. It succeeds: Three times as many heroin addicts overdose in Baltimore as in all of the Netherlands. Sixteen percent of Ameri-cans try cocaine in their lifetime. In the Netherlands, the figure is less than 2 percent. The Dutch have lower rates of addiction, overdose deaths, homicides, and incarceration. Clearly, they're doing something right. Why not learn from success? The Netherlands decriminalized marijuana in 1976. Any adult can walk into a legally licensed, heavily regulated "coffee shop" and buy or consume top-quality weed without fear of arrest. Under this system, people in the Netherlands are half as likely as Americans to have ever smoked marijuana.

It's unlikely that repealing federal drug laws would result in a massive increase in drug use. People take or don't take drugs for many reasons, but apparently legality isn't high on the list. In America, drug legalization could happen slowly and, unlike federal prohibition, not be forced on any state or city. City and state governments could decide policy based on their needs.

The war on drugs is not about saving lives or stopping crime. It's about yesteryear's ideologues and future profits from prison jobs, asset forfeiture, court overtime pay, and federal largess.

We have a choice: Legalize drugs, or embark on a second century of failed prohibition. Government regulation may not sound as sexy or as macho as a "war on drugs," but it works better.
source: U.S News And World Report

Friday, July 25, 2008

Illegal Painkiller Overdoses Kill More Than 1,000 Americans

More than 1,000 Americans died in 6 cities between 2005 and 2007 from overdosing on nonpharmaceutical fentanyl (NPF), in the biggest ever epidemic of overdoses involving illegally produced versions of the painkiller. Health officials predict there will be further outbreaks of NPF overdose because the illegal narcotic is easier and cheaper to produce than heroin.

The figures are being reported today by the US Centers for Disease Control and Prevention (CDC), in the 25th July issue of the Morbidity and Mortality Weekly Report (MMWR).

Illicitly manufactured nonpharmaceutical fentanyl (NPF) is 30 to 50 times more potent than heroin. It is a synthetic opioid and classed by the US authorities as a narcotic.

The findings of a CDC and Drug Enforcement Agency (DEA) investigation showed that between 4th April 2005 and 28th March 2007, a total of 1,013 deaths occurred in six US jurisdictions; the largest NPF epidemic to date. This is nearly 10 times higher than an epidemic in the 1980s when 110 people died of fatal overdoses of different fentanyl analogs, said the report.

The largest number of deaths were in metropolitan Chicago (349), Philadelphia (269), and Detroit (230). The other areas were St. Louis, Missouri, and the states of Delaware and New Jersey.

Emergency medical staff said some of the victims were found with the needle still stuck in their arms. The drug was so powerful that they died before completing the injection, said Dr Stephen Jones, a co- author of the report who is now retired from the CDC, reported Reuters.

The authorities decided to carry out the investigation after receiving a number of reports of overdoses linked to NPF. For instance in April 2006 increases in overdoses among illegal drug users were reported in Camden, New Jersey, which triggered similar reports in other jurisdictions, including Chicago and Detroit, which had been discovered earlier but falsely attributed to heroin overdose until urine samples of some of the dead showed traces of fentanyl.

Thus in May 2006 the CDC started ad-hoc case-finding surveillance in six state and local jurisdictions. This was later taken over by the DEA. This is how the 1,013 NPF related deaths were identified. After this the DEA started regulating access to N-phenethyl-4-piperidone, which is used to make illegal analogs of fentanyl.

The CDC report said the pattern of NPF overdoses points to illegal distribution networks, citing as an example that the NPF found in Chicago and Detroit most likely came from a clandestine production site in Mexico. However, they can't explain why they did not find any NPF-related deaths in other areas of high heroin use, such as in New York City.

As well as the deaths discovered through the CDC/DEA surveillance system, over the same period there were reports of other NPF-related deaths from suburban and rural areas of Illinois, Michigan, and Pennsylvania and in Kentucky, Maine, Maryland, Massachusetts, New Hampshire, Ohio, and Virginia.

The CDC suggested that although the number of NPF-related deaths spotted by the CDC/DEA surveillance system fell substantially in 2007, they predict further epidemics of NPF overdoses are likely because the drug is easier and cheaper to produce than heroin.

Deaths related to heroin and other illicit drugs are well documented in the US. From 1999 to 2005, the figure went up by 87.5 per cent, from 4.0 to 7.5 per 100,000 of the population (age-adjustied deaths from unintentional drug poisoning, mostly linked to pharmaceutical and/or nonpharmaceutical drugs).

The CDC said their report had four limitations: first the figures could be under-reported because for example only participating centers in six jurisdictions were included in the surveillance; second, there is no standard toxicology definition of cause of death for fatal drug overdoses; third, some of the deaths could be misclassified as NPF when they were really pharmaceutical fentanyl-related deaths (ie legal use); and finally, in addition to fentanyl, other substances may have contributed to the overdoses, including alcohol.

Nevertheless, the CDC said the figures are sufficient to warrant improvements in a number of areas relating to drug overdoses. These include improvements in identifying and reporting drug overdose, so law enforcers and public health officials can act more quickly (eg to seize drugs and provide outreach support).

The agency also said there was a need to develop or expand:

* National standards for toxicologic testing and classifying cause of death in drug overdose and poisoning.

* Professional standards for referring overdose surivivors for addiction treatment and education, such as those that exist for suicide survivors.

* Public health programs to help drug users get treatment, be educated about risks of overdose, and learn ways to avoid and deal with overdose.

Jones said in a telephone interview reported by Reuters that the report highlights "an extraordinary episode of fatal drug overdoses".

"But it's got to be recognized as part of the bigger problem of the increasing numbers of drug overdose deaths in the United States," he added.
source: MediLexicon

Thursday, July 24, 2008

Drug report shows shifting trends in use and abuse in Texas

Heroin users are younger, and a growing proportion of crack cocaine users are Anglo or Hispanic, according to a recent report on drug abuse trends in Texas.

The shifting demographics highlight why treatment, prevention and education programs must be flexible to respond to new addiction patterns, the report’s author said.

"The type of person using a drug 10 years ago is often not the same person using it today," said Dr. Jane Maxwell of the University of Texas Addiction Research Institute. "It is always evolving. You have to target new groups."

The report, Substance Abuse Trends in Texas, relied on data from multiple agencies, law enforcement and drug-treatment centers.

Among the more important trends noted is a new generation of younger, Hispanic heroin users.

Of those admitted to treatment centers funded by the Department of State Health Services, the average age of a heroin user has fallen from 37 in 1996 to 34 in 2007. Meanwhile, the proportion that is Hispanics has more than doubled, from 23 percent in 1996 to 55 percent in 2007.

"What we’re seeing is more people starting heroin when they are younger," Maxwell said. "One day they’ll use a needle. We need more effective treatment to target a younger population."

Dealers marketing the drug more to youths plays a major role in the increase, experts say.

In Dallas, for example, the "cheese heroin" epidemic involved dealers cutting heroin with Tylenol PM and selling it for as little as $3 a dose. Of 174 cases in which heroin users were age 19 and under in Dallas in 2007, 52 percent were male, 92 percent were Hispanic, and 96 percent inhaled their heroin, according to the report.

Tarrant County treatment centers saw a much smaller increase in young heroin users.

"We have seen more cases but still not anything like they saw in Dallas," said Stevie Hansen, chief of addiction services for Mental Health Mental Retardation of Tarrant County. "We’re ready for this epidemic to spread this way, but it just really hasn’t happened here. That’s a good thing."

Changing demographics

Statewide, the face of crack cocaine is also changing. It was originally a drug thought to primarily affect African-American communities, but the proportion of African-American addicts in treatment centers has dropped from 75 percent in 1993 to 46 percent in 2007.

The proportion of Anglos in treatment for crack cocaine increased from 20 percent in 1993 to 35 percent in 2007, while the numbers for Hispanics increased from 5 percent to 18 percent.

In Tarrant County, the majority of males treated for crack addiction are still African-American, but white women have surpassed African-American women, according to Fort Worth’s Recovery Resource Council, which screens potential patients.

"That’s how drugs evolve," said Suzanne Lofton, clinical director for the council. "They start in one community, one ethnicity or one age group. Word spreads, and the drug spreads into others."

Other trends noticed in Tarrant County treatment centers are more adults hooked on pain medications and fewer on methamphetamine. More patients seem to have longtime addictions, said Daryl Dulany, a licensed clinical social worker for Volunteers of America.

"I don’t know if it’s because they’re waiting longer to get treatment," Dulany said. "But I do know that the line to get in is longer."

Texas trends

Trends in drug and alcohol use among Texans, according to Substance Abuse Trends in Texas: June 2008, conducted by the Gulf Coast Addiction Technology Transfer Center and University of Texas Addiction Research Institute:

Cocaine/crack In 2007, 13 percent of high-school students reported having used cocaine/crack, compared with 12 percent in 2005. Between 1987 and 2007, the proportion of people using powder cocaine admitted for treatment increased from 23 percent to 48 percent for Hispanics, while it dropped for Anglos (from 48 percent to 33 percent) and African-Americans (from 28 percent to 18 percent).

The number of deaths statewide in which cocaine was mentioned increased from 223 in 1992 to 795 in 2006.

Heroin was the drug of choice for 10 percent of users admitted to state treatment centers. The majority of addicts inject the drug, but the proportion inhaling it has increased from 4 percent in 1996 to 20 percent in 2007.

Those in treatment were younger and more likely to be Hispanic. "This increase in inhalers and decrease in age at admission is evidence of the emergence of younger heroin users," the report found.

Cheese heroin — a mixture of heroin and Tylenol PM — continues to be a problem in Dallas County, the report stated. However, an analysis of overdose deaths there found only one death that involved cheese heroin alone.

The other deaths also involved drugs like cocaine, Xanax or hydrocodone, "which shows that this is not a population of novice users but a growing problem among very young, experienced heroin users."

Prescription drugs Abuse of alprazolam — the anti-anxiety drug in Xanax — and muscle relaxers appears to be growing.

The number of calls to poison-control centers involving alprazolam has grown, and the drug was mentioned on 216 death certificates in 2006, the report found.

Misuse and abuse of the muscle relaxer carisoprodol have also grown. Poison centers reported 83 calls in 1998 and 510 in 2007.

In 2006, carisoprodol was mentioned on 146 death certificates, up from 51 in 2003.

There are some signs that the rate of methamphetamine abuse is slowing. Deaths involving amphetamines or methamphetamines dropped from 2005 to 2006 (the most recent year available), and authorities busted fewer meth labs in 2007 than in 2006.

The Drug Enforcement Agency in Dallas reported that the availability of meth is stable but the price is rising because of tighter border security and increasing difficulty in obtaining the needed chemicals in Mexico.

However, less of the Mexican product could lead to more local labs, Maxwell said.

Alcohol continues to be the drug of choice for Texans. In 2007, 78 percent of high-school students reported having drunk alcohol.

Almost 50 percent had drunk in the past month, and 29 had drunk five or more drinks in a row in the last month.

Binge drinking has increased among girls and decreased among boys. In 2005, 26 percent of girls and 33 percent of boys reported binge drinking. In 2007, 28 percent of girls and 30 percent of boys reported doing it.

A 2005 Texas college survey found that 84 percent of students had drunk alcohol in their lifetime and almost 30 percent reported binge drinking.

Reported marijuana use among Texas high school students was down. Thirty-eight percent of students admitted to having smoked it in 2007, a decrease of 4 percent since 2005.

Marijuana was the primary problem for 23 percent of those admitted to treatment programs in 2007, with the average age being 23. Of those admitted, 42 percent were Hispanic, 30 percent were Anglo, and 27 percent were African-American.
source: Star-Telegram,

Wednesday, July 23, 2008

One-in-four adults drinks excessively as doctors warn of 'tsunami of alcohol-related harm'

A quarter of UK adults are damaging their health through excessive drinking, it was revealed yesterday.

Some ten million regularly flout advice on how much to drink, egged on by a licensing industry ignoring its own voluntary code on social responsibility.

There is also clear evidence that cheaper booze is to blame for a massive rise in alcohol consumption, as drink prices have halved in 30 years, relative to earnings.

A blizzard of new figures included:

* The harm caused by excess drinking is costing the UK £25billion a year in healthcare, crime and lost productivity.
* Aound 800,000 hospital admissions a year are due to alcohol-related conditions, 70 per cent more than in 2002-2003.
* Heavy drinking is killing 15,000 people a year - including a quarter of all deaths among young men aged 16 to 24.

Ministers were accused of 'dithering' as they hinted they may bring in laws to replace the failed voluntary code and outlaw aggressive discounting, but said they
would wait for more evidence before making any decision.

Professor Ian Gilmore of the Royal College of Physicians warned: 'The Government are understandably anxious about being seen as a nanny state, but unless they take action their own figures suggest we are moving towards a tsunami of health-related harm.'

Alcohol industry leaders hit back, questioning the findings and accusing the Government of failing to enforce existing laws.

The Home Office commissioned consultants KPMG to assess the voluntary code, which was agreed three years ago and is supposed to stop drinks companies, pubs and bars cashing in on binge drinking.

In particular it is meant to stop the trade glamorising heavy drinking, marketing products to youngsters or encouraging rapid boozing through cutprice promotions in bars.

Another code is meant to ensure drinks containers are clearly labelled with the units of alcohol they contain.

The codes were at the heart of the Government's strategy as it brought in 24-hour drinking.

But researchers uncovered a catalogue of blatant abuses, describing scantily-clad women selling shots of spirits to drunken men in clubs by flirting with them, club DJs urging punters to drink more so they can 'get laid' and bar staff selling alcopops to young customers too drunk to count their change.

In 726 visits they saw only three cases where staff refused to serve a drunken customer. The worst excesses were in 'vertical drinking' venues - the large town centre pubs with no seats where young customers are crammed in.

Researchers also voiced concern over cheap supermarket alcohol.

KPMG concludes that the voluntary code has failed totally. It blames 'overriding commercial interests' to sell more alcohol, and the lack of enforcement. A separate study at Sheffield University highlighted close links between alcohol prices and consumption levels, while Department of Health figures detailed the level of harm.

The British Beer and Pub Association called for 'a renewed focus on individual responsibility and accountability, not just pointing the finger at business'.

A spokesman said: 'The Government should address the underlying culture. Legislation is a sledgehammer that will not crack the nut.'

The lost labelling

The drinks industry first agreed to include alcohol unit information on all bottles and cans ten years ago.

Labels should display the number of units inside and remind drinkers of the Government's 'safe' guidelines.

These are three to four units a day for men and two to three for women.

But a decade later, independent monitoring say they found that only just over half of all packaging - 57 per cent - contains such labelling.

Just 3 per cent carried all the information ministers want, including a warning to pregnant women to avoid alcohol.

The Department of Health admitted: 'There is now real doubt as to whether the agreement can be implemented to the extent that was originally expected'.

The 24-hour impact

The introduction of round-the-clock drinking almost three years ago was one of Labour's most controversial moves.

The Licensing Act swept away longstanding laws on closing times, letting thousands of pubs and clubs stay open into the early hours.

Police and hospitals have since complained of dramatic increases in their workload late into the night.

In the worst-affected areas, alcohol-related cases in hospital have more than doubled.

Public Health minister Dawn Primarolo played down the impact of the changes yesterday, insisting the upward trends in alcohol consumption and harm were already well established and there is no evidence they have become worse.

But hopes of creating a 'Mediterranean-style' cafe culture appear to have come to nothing.
source: Mail Online

Tuesday, July 22, 2008

Success of drug program is celebrated

Inmates hear encouraging words about beating addiction

At 19, Jacoby Smith was sentenced to 55 years because of his cocaine addiction.

He robbed people making late-night bank deposits so he could feed his habit.

"I had a weapon sometimes," Smith, 41, said. "My intentions were never anything more than to [get] money to support my habit."

He finished his prison term in 2006 and now supports four generations of family, from grandmother to grandkids, by working at the Wilmington docks while on probation.

And he thanks the Key Program, a substance abuse program at Young Correctional Institution that celebrated its 20th anniversary Monday.

"I'm proud. I'm proud now of who I am," said Smith, who's been clean for seven years.

Without drug treatment, recidivism rates can top 70 percent, according to the Delaware Department of Correction. While state officials couldn't immediately provide numbers for the Key Program, a similar program in New Jersey boasts of cutting male recidivism by a third and female recidivism by half, said William Palatucci, senior vice president of Community Education Centers, which sponsors the Key Program.

Smith knew he would be at Monday's celebration. He needed to show the success that's possible for those in the program.

"It was heartfelt, just to be in the atmosphere [of Key] and rekindle a lot of experiences that happened here," he said.

The program relies on group and individual therapy to break self-destructive cycles. Participants gradually take on more responsibilities during the program's roughly 18-month regimen. Toward the end of his term, Smith counseled younger inmates.

The prisoners in Key are separated from the general population. They referred to each other as family during the celebration, and a group of them put on a play about life for family members on the outside.

For Smith, it was the one-on-one therapy with a counselor that changed him. He said the one-hour sessions were never enough time to talk. He wrote a lot of essays about self-destructive tendencies and would talk them over regularly.

One realization he had was that using his ability to rile people up and get their attention could be put to better use than getting friends together to cause trouble.

With his long purple T-shirt standing out in the ocean of white prison garb, Smith spoke to the crowd of about 200 inmates currently in the program. He told them of his life of crime and drugs. He gave them encouraging words and drew a standing ovation.

"I was overwhelmed," Smith said. "To receive that response when I'm not being an active participant, that was rewarding."

One of the program's strengths is that it teaches the inmates responsibility, said Smith and Dohn Price, an inmate currently in the program. Their problems are their own and they can't blame circumstances or other people for crimes they commit.

"It's good to come to prison and do more than just jail time and work on yourself," said Price, who is serving a 16-month term.

It's also a tough program, he said. Inmates work seven days a week on their problems, regardless of bad days. That system also keeps out the unmotivated, Price said.

"The process is made to weed out those that aren't ready," he said.
source: Delaware Online,

Monday, July 21, 2008

Binge drinking strategy on rocks

Labor risks falling off the wagon of its national binge drinking strategy after missing by three months its own deadline for tabling options to tackle alcohol abuse.

In May, a meeting of federal and state ministers with responsibility for drug strategy pledged to fast-track an interim report on binge drinking in recognition of the "urgency'' of the issue.

The document was to go before the Council of Australian Governments in July.
Last week, the ministers met again, with the July 3 COAG event behind them but no report at hand.
A spokeswoman for Parliamentary Secretary Jan McLucas, representing the federal Government on drug strategy, attributed the delay to "extensive'' consultations with the alcohol industry and health groups.

"These consultations, and the work required to gather the necessary information, means that the Ministerial Council on Drug Strategy will now make an interim report to COAG in October,'' Ms McLucas said.

Five months ago, Kevin Rudd unveiled his own $53.5 million plan to combat the binge drinking ``epidemic'', promising a hard-hitting TV campaign as well as grant and pilot project funding.

But he needs the states on board if he is to achieve consistency in local laws restricting parents' ability to supply alcohol to their children and ensuring pubs, clubs and restaurants serve alcohol responsibly.

The report was to cover both those issues, together with the tougher areas of possible controls on alcohol advertising and lower-alcohol products for young people, as well as health warnings on alcohol.

Paul Dillon, director of Drug and Alcohol Research and Training Australia, applauded the report's ambitious agenda and said he could only speculate on the reasons why it had been delayed.

The backlash from related policies - such as the Government's multi-billion-dollar alcopops tax, which it had tied to its binge drinking agenda - may have contributed to the delay.

The alcohol industry had already made inroads in portraying the Rudd Government as wowserish, which could force a more softly-softly approach from Canberra, Mr Dillon said.

"As soon as people think the Government is going to limit what they drink, how they drink, and the cost of what they drink, you run into problems,'' he said.

A spokesman for Health Minister Nicola Roxon denied she was stepping back in any way from the campaign to curb excessive drinking.

"The Government is working very hard and will have more to say on binge drinking,'' she said.
source: The Australian

Saturday, July 19, 2008

Europe's approach to drugs is more enlightened ... it's tougher

In 2006, Governor-General Michaëlle Jean was hosting Queen Silvia of Sweden during the Swedish royal family's visit to Canada when the topic of illegal drug use came up. The GG told the Queen that Canada is taking an enlightened approach. Instead of punishing users, she said, society needs to be understanding of drug use and assist in reducing harm until the addict is ready to quit.

Alas, the Queen was not impressed. She briskly informed the GG that Sweden takes a hard-line approach, that users are given a choice between treatment and jail, and that Sweden's addiction rates are much lower than Canada's. After that, they changed the subject.

Advocates of harm-reduction measures, such as needle exchanges, methadone programs and Vancouver's supervised-injection site, often point to Europe's more enlightened approach to drugs as proof of how far behind we are in Canada. But parts of Europe are having second thoughts. Socially progressive Sweden had a brief but disastrous fling with prescription heroin back in the 1960s. After that, it embraced the hard-line approach. Today its policy is to make drugs very difficult to get, but treatment very easy - and sometimes compulsory. "The vision is that of a society free from narcotic drugs," says Maria Larsson, the Minister for Public Health.

As a consequence of grassroots support for this policy, drug use in Sweden is a third of the European average. "The lessons of Sweden's drug control history should be learned by others," said Antonio Maria Costa, who heads the UN's Office on Drugs and Crime.

Scotland took a different tack. Drug use is widely tolerated, as you know if you saw Trainspotting. Rehabilitation programs are scarce, but the national methadone program has become a vast and ineffective money-pit. Scotland has more than 50,000 heroin addicts. Drug deaths have soared, drug-related crime is high, and tens of thousands of children are growing up with addicted parents. "Methadone has quite literally become the opiate of the masses," warned Neil McKeganey, one of Scotland's foremost drug policy experts.

Two months ago, the Scottish government announced a change in direction. From now on its primary focus will be on "recovery," not just harm reduction. "Harm reduction ideas have failed in Scotland," says Prof. McKeganey. "They have failed to protect injectors from hepatitis C, failed to reduce the scale of the drug problem, failed to reduce many of the harms inflicted on others."

The Netherlands is famous for its permissive drug culture, but even it is not as permissive as it used to be. Although you can still toke up in marijuana coffee shops, pot remains illegal. A parliamentary proposal to allow regulated, large-scale marijuana production was voted down, and the government moved vigorously against the psychedelic drug ecstasy. Switzerland (which runs supervised-injection sites but also has thousands of treatment beds) voted against decriminalizing marijuana. The UK made marijuana possession semi-legal a few years ago, but experienced an explosion of pot use among minors, as well as a sharp rise in harmful effects attributed to more potent strains of weed. It has now reversed course and reclassified marijuana as a harmful drug.

Like Canada, Australia is experimenting with a supervised-injection site, in Sydney. The passionate debate over whether it reduces harm is virtually identical to the one in Canada.

I asked Scotland's Neil McKeganey if he had witnessed the drug scene in Vancouver, a city that is famous for its harm-reduction approach. He had. "I was utterly shocked," he said. "I could hardly believe that in a culturally developed, sophisticated city there could be a drug problem of such magnitude." In his view, too much emphasis on harm reduction invariably undermines prevention efforts. "To provide a setting where someone can inject street drugs is doomed. The next step is saying, maybe we should be providing them with drugs as well."

The provision of "clean" drugs is, in fact, what many advocates of Insite want next. "Many individuals who promote harm reduction believe there's fundamentally nothing wrong with drug use, except the fact that it's illegal," says Prof. McKeganey.

Every nation is different, and drug policies that work in one place may not work in another. But to him, Vancouver is a clear case study in what not to do. "It's a harbinger of what other cities could experience if they do not develop effective prevention methods."
source: The Globe and Mail,

Friday, July 18, 2008

Alcohol + loud music = more alcohol

Trying to limit your alcohol intake is tougher when you're drinking in a bar with loud music, according to a new study.

Researchers have already shown that listening to fast music can speed up the rate of drinking. But now they say loud music has the same effect. Both fast and loud music can heighten arousal, causing people to drink faster and order more drinks, say the authors of the study, published online today in the journal Alcoholism: Clinical & Experimental Research. And there's another reason why people drink more when the band is blasting: They can't converse.

"...loud music may have had a negative effect on social interaction in the bar, so that patrons drank more because they talked less."

The authors of the study suggest that bar owners tone it down a little so that people won't overindulge. Since we know that won't happen, you may have to monitor yourself. If your ears are ringing, slow down before the room starts spinning.
source: Los Angeles Times Blogs,

Thursday, July 17, 2008

Detox centre set for next year

Mattress detox will take the place of police cells or emergency rooms once a new Addictions Treatment Centre opens next year in downtown Regina.

The project is the result of the Regina & Area Drug Strategy Report, which identified the need for a stronger treatment continuum, said Dave Hedlund, executive director of mental health and addictions services for the Regina Qu'Appelle Health Region.

"One part of which was the capacity to deal with people who are drunk or high at the time in a way that was more therapeutic as opposed to only using police cells or emergency rooms," Hedlund said. "That kind of service -- a place to sleep, to get cleaned up and to have a conversation hopefully in the morning about how you could start to think about turning your life around -- they usually refer to that as brief detox or mattress detox."

The new centre will replace the Detox Centre at 2839 Victoria Ave., and integrate services offered by Regina Recovery Homes and the region to help people recover from alcohol and drug addictions. Many individuals who will use the brief detox beds may need observation but not hospitalization, said Foster Monson, executive director of the Detox Centre.

Aside from the one- to three-day program that will have space for up to 20 clients on a 24/7 basis, a comprehensive 10- to 14-day program called Social Detoxification Services will have 25 single rooms.

"Once they're in the brief detox, it gives the staff and especially the client an opportunity to evaluate their situation to the extent that they would move to the social detox, which is a longer period of detoxification," said Monson. He added that one individual went through detox 44 times before he became sober.

The centre's services will include an addictions assessment, physician visits and optional AA meetings. Hedlund said the direct pathway from one level of treatment to the next in the same building will help ensure an addict's success.

Work will begin this fall to renovate the building at 1640 Victoria Ave., where Future Print is currently located. The treatment centre is slated to open at the end of 2009 and will employ 23 full-time addictions workers. The purchase of the building and renovation cost is pegged at $5.8 million and funded by the provincial and federal governments and the RQHR.

The Ministry of Health has provided $5.1 million in capital funding and $1.25 million towards the centre's $1.8-million operating costs, said Joceline Schriemer, legislative secretary for addictions.

"It's a step in the right direction," Schriemer said. "We're maintaining a relationship with Recovery Homes and that's very important ... Enhancing the drug and alcohol services in this province is a top priority for our government."

The health region distributed information sheets to area residents in June and visited 30 nearby agencies to explain the project. Since planning is in the early stages, the region will hold public consultation meetings in September to provide residents with an opportunity to get more information about the centre.

Leila Francis, executive director of the Core Community Association, doesn't dispute the need for addiction services but wonders why the region didn't arrange public consultations before the building was purchased. She questions whether the centre will generate extra traffic, create parking issues and raise security issues.

"The community here doesn't have a lot of resources within its boundaries yet we house the major feeding programs in the city, so is it going to generate any additional clientele?" Francis asked. "We want to ensure that there is minimal fallout to the community with this centre because all the (addictions) services will be concentrated there."

Glen Perchie, executive director of the region's EMS and emergency services, said the brief detox beds will reduce the pressure on emergency departments.

"A lot of times, people with addictions problems and those coming in intoxicated have a chronic underlying problem and we're not so good at that," he said. "This is an opportunity to bypass the emergency department in many cases and take them directly to a place that's actually focused on their care and get them the appropriate help. It's the fast track to the right place."
source: © The Leader-Post (Regina) 2008,

Wednesday, July 16, 2008

Children often innocent victims of adult addiction, drug abuse

For one 12-year-old girl, addiction is a drawing of a green monster with red eyes that has a steel band around her mom, dad and older sister. It carries a bag of alcohol, nicotine and inhalants.

For another child, addiction is a sketch of his mom and dad in a beer can, with the words “please stop” etched above in crayon.

And for a handful of kids, it’s an image of a broken heart, sometimes drawn with parent’s names on each side, or the names of a brother or sister, aunt or uncle.

Whatever the image, the picture is the same for kids who were asked to describe the disease: drug and alcohol addiction hurts families, especially children.

“It’s now a huge issue. Almost one out of three, one out of four kids are living in a family with alcohol or drug abuse,” said Jerry Moe, vice president and national director of children’s programs at The Betty Ford Center in California. “They’re the No. 1 at-risk group.”

Moe, speaking Monday at Indiana University of Pennsylvania to kick-off the 20th year of the Mid-Atlantic Addiction Research Training Institute Summer School, said that, though the issue is prevalent now, this is the time to stop the multi-generational disease and push back the first age a child may use a substance. Children in families with addiction are at a higher risk of getting the disease than those without any family history, he said.

“If one takes a coin that says at-risk and turns it over, it says at-promise. Some kids have the most incredible strength and promise. They just need safe people to guide them,” he said.

Ten years ago, the average age for a child to have his or her first drink was 15 years old, he said, but today the average age is 12 years old.

“Younger kids start regardless of any other risk and are more likely than ever to get harmfully involved,” he said.

Part of the reason for such prevalent effects on children has been a change in the family form over the last 35 to 40 years, said Robert Ackerman, director of MARTI.

“I don’t think children today are different than when I was a child. If you let a child do what they want, they’ll do what they want,” he said. “What has changed dramatically is adult behavior. Children in many cases are trying to survive changes in adult behavior in our culture.”

Child abuse, neglect, abandonment and divorce are some of the many interrelated problems that affect families suffering from addiction.

“We hear the African saying ‘It takes a village to raise a child.’ Well it takes that same village to stop the parents,” he said.

Pictures drawn by kids in the programs at the Betty Ford Center illustrate the feelings of guilt, shame, hopelessness, anger and sadness that children in families with addiction experience.

One girl drew a picture of her dad passed out on a couch the entire time she was with him for the weekend while she sat alone on a chair crying. Another drew an image of his mom with a bottle on a bed while he was on the phone with his grandpa, asking for help.

Conflict, Moe said, is what hurts families the most, but children are also hurt by what doesn’t happen in the family place, especially when they know something is wrong.

“They may not be able to name it specifically. They may not be able to name addiction. But they know something is wrong because they love their parents more than anything else,” he said. “… Kids know a lot. We don’t give them enough credit for how much they know and some feel they’re going crazy because no one validates.”

But the situation is not hopeless as treatment and research organizations are shifting their focus to advocate and work for all children, not just those from addicted families, Ackerman said.

Another step is for people to become conscious of the effects on children. It is important, he said, for adults to admit that kids are affected by their behavior, whether they realize it or not.

For Moe, anyone that can get involved in the life of a child can help. Forming relationships and letting a child know someone safe is there for them can help tremendously, he said.

“What are their strengths? Build them. Skills? Give them some new ones. Supports? Be one,” he said. “Help kids find the beauty and goodness inside.”

In his arsenal of games and techniques at the Betty Ford Center, his most potent weapon is love.

“It’s our most basic human need that from the time we’re conceived to when we take our last breath. We need to love and be loved,” he said.

Tuesday, July 15, 2008

The Failure of the Office of National Drug Control Policy

As an insider in the nation's war against drugs, I spent almost fifteen years in the executive office of the President. Eleven of these years were in the Office of National Drug Control Policy where I served four of the nation's so-called drug czars preparing the federal drug control budget, writing many of the national drug control strategies, and conducting performance measurement and analysis of the efficacy of those strategies. I left government in 2000, but continue to be highly involved in shaping drug policies and measuring performance in drug policy both nationally and internationally.

In the latest 2008 National Drug Control Strategy, the Office of National Drug Control Policy (ONDCP) -- the federal executive office agency charged with shaping this nation's national drug control strategy -- claims that America has reached a turning point in the war on drugs. In reality, we have little reason to believe a significant change has occurred. ONDCP based its claim on declining use for youth -- a trend that long precedes this administration's tenure -- but ignores the lack of progress with regard to adult drug use, rates of drug addiction, the inaccessibility of substance abuse treatment, and new emerging drugs of demand such as pharmaceutical drugs and methamphetamine. If America is to be successful in the fight against drugs, the first priority for the next administration -- Republican or Democrat -- must be to reinventing ONDCP as an effective policy office capable of leading the nation's struggle with drugs.

In the 1980's, the United States essentially focused on supply reduction, largely in response to a cocaine epidemic, and with the belief that source and transit zone interdiction was the most effective means of reducing drug use in the United States. By the 1990's we had learned that interdiction was a relatively ineffective way of reducing drug use -- and expensive besides. So we focused our efforts on demand reduction. Now, at the beginning of the new millennium we have...inexplicably...come to believe again that source and transit zone interdiction is an effective way to reduce drug use in America. There is no evidence to support this belief. And it is all the more surprising that we have refocused our efforts in this way at a time when many of the major drugs of abuse -- including marijuana, methamphetamine, and controlled pharmaceuticals, are produced domestically.

The central task of ONDCP -- and what must now become the central political debate -- is determining how best to combine and fund the five essential ingredients of drug control policy: prevention, treatment, domestic law enforcement, international or source country programs, and interdiction.

Though Congress created ONDCP to formulate research-driven and performance-based policy, assess and modify policy through performance measures, and give a precise accounting of the federal drug control budget, ONDCP fails at all of those tasks. In the 90's ONDCP created a performance measurement system for evaluating the effects of its policies on drug use, drug availability, and the negative consequences of drug use; however, this decade, no such performance measurement system has been utilized. As a consequence, policy is now flying blind resulting in lost opportunities for more success.

Simply put: the cornerstone of all evidence-based policy driven by reliable performance data. Currently, ONDCP has failed to establish baseline measures link to the ingredients of an effective drug policy. This is inhibiting our nation's ability to better assess future action. The first step of any administration must be to reassert ONDCP as the flagship substance abuse organization by instituting a performance measurement system to allow Congress, the American people, and ONDCP itself access to crucial data. To stay ahead of emerging drug trends, ONDCP must once again make knowledge development, data systems and research a priority. Leading drug use indicators must steer drug control policy rather than outdated trends.

Second, ONDCP's budgetary role must be fixed. A review of the Federal drug control budget for this decade shows the following: the Administration's drug control budget since FY02 has emphasized supply reduction programs over demand reduction programs; resources for supply reduction (interdiction of drugs, source country programs, and law enforcement), grew by almost 57% from the FY 02 baseline level to the FY 09 request now before Congress; and by comparison, demand reduction resources (prevention and treatment, including resources for research for agencies like the National Institute on Drug Abuse) grew by only 2.7 percent--prevention is actually cut 25 percent.

This budget trend runs counter to what research would otherwise suggest: that efforts to reduce demand are best addressed through treatment and prevention rather than supply reduction.ONDCP must fully exercise its budgetary authority. Working with the Office of Management and Budget to formulate and distribute an accurate drug control budget to implement its policy priorities is the only way to ensure that research findings are reflected in the drug control budget.

Finally, a new administration must retool and reemphasize ONDCP as an effective policy leadership organization. Right now, ONDCP administers many programs that could be better managed by other federal agencies responsible for drug program administration. ONDCP rediscover its roots by again becoming a leader in policy formulation to develop a drug policy that is evidence-based and includes performance measurement to hold it accountable for results. An outdated organizational structure reflecting the 1980's cocaine war must be abandoned in favor of one that addresses today's multifaceted drug threat, recognizing that drug use occurs in drug markets where the most common drugs are more often domestically produced. Programs which distract from ONDCP's policy-setting mission must be jettisoned to agencies more suited to those particular tasks (e.g. Drug Free Communities to SAMHSA). ONDCP must focus exclusively on policy and budget.

The new administration will face a unique opportunity to reshape American drug policy. ONDCP must develop a strategy that is research- and performance-based. It must present a federal drug control budget that emphasizes effective programs that support an evidence-based, comprehensive drug control policy. It is now up to the next president, be he or she Democrat or Republican, to enable ONDCP to meet the nation's needs to reduce drug use and its damaging consequences.
Author: John Carnevale
source: Huffington Post,

Monday, July 14, 2008

Methamphetamine use stable but causing more problems

New research suggests methamphetamine use has stabilised over the past three years, but frequent users are experiencing more health and legal problems.

Massey’s Centre for Social and Health Outcomes Research and Evaluation (SHORE) has released the 2007 Illicit Drug Monitoring System (IDMS), which offers a snapshot of trends in drug use and drug related harm in New Zealand.

Lead researcher Dr Chris Wilkins says frequent users of methamphetamine were more likely to have needed an ambulance, accident and emergency department, drug and alcohol worker, counsellor or GP in relation to their drug use in 2007 compared to the previous two years.

“Overall levels of methamphetamine use appear to be fairly stable but this research indicates there is a growing population of heavy users experiencing health and legal problems.” Dr Wilkins says.

Frequent methamphetamine users were also more likely to have committed violent or property crime last year compared to the 2005 findings.

“Users are under increasing financial pressure, however only minorities of frequent users reported paying for their drug use with money from property crime and even smaller minorities committed violent crime.”

There has been some decline in the availability of crystal methamphetamine (ice), the research shows.

“This is likely to reflect the impact of some very large seizures of crystal methamphetamine made by police and customs in 2006 and 2007,” Dr Wilkins says.

Frequent drug users, interviewed as part of the ongoing research, stated that more people they knew were using ecstasy last year compared to 2006.

“The situation with ecstasy is somewhat confused by the previous ready availability of BZP party pills [now outlawed], which are sometimes fraudulently sold by drug dealers as ecstasy. Increasing use of ecstasy may also reflect the declining reputation of methamphetamine which is increasingly associated with serious psychological problems and addiction.”

The full report can be found at:
source: Massey University,

Saturday, July 12, 2008

Mixed progress for bupe

As city includes hard-core addicts, more drop out

Baltimore has doubled the number of people using the medication buprenorphine to shake off heroin addiction but has struggled to keep them in treatment.

As the Baltimore Buprenorphine Initiative has accepted more hard-core drug addicts dealing with complications such as mental illness, more drop out. At the start of the initiative in October 2006, officials had picked mostly highly motivated participants.

The retention rate dropped to 52 percent for the year that ended June 30 compared with 65 percent in fiscal year 2007. That is prompting city health officials to question which patients do best on buprenorphine, sold as Suboxone and widely known as "bupe."

"Who is the right candidate for bupe?" asked Dr. Joshua M. Sharfstein, Baltimore's health commissioner. "It's just really hard to tell." He said officials will examine that issue closely.

The initiative, which cost about $2 million last year, is "continuing to gain momentum," he said. "More clinics are participating. More patients are being treated. More doctors are interested in seeing patients."

The novel program introduces addicts to Suboxone in city-backed clinics that stabilize patients before transferring them into the care of private doctors who have become qualified to prescribe the drug.

The city has streamlined its process of securing health insurance for the mostly low-income participants and added clinics and doctors to expand access.

But the 771 patients who entered the program over the past year are taking longer than the first year's 388 patients to make the transfer because they still abuse drugs other than heroin, such as cocaine.

Some studies have shown that methadone is better for longtime heroin addicts while Suboxone is best for people who are newly addicted or who are hooked on pain pills like OxyContin. Sharfstein hopes that pairing public and private resources will render buprenorphine an effective new weapon to battle heroin addiction.

In 2006, more than 10,000 city residents were admitted to facilities for heroin addiction treatment. Each year more 200 die from overdoses of heroin and other narcotics.

Valarie Clark abused heroin for nearly 20 years. After enrolling in the city initiative nearly two years ago, she has experienced her longest stretch without using heroin.

But her struggles demonstrate the challenge of getting even the best patients - Clark was held up as model before the City Council last summer - to stick with treatment.

Last month, after a dispute in her recovery house, Clark moved out and stopped taking Suboxone, without consulting her doctor or therapist at Total Health Care, the city's largest participating clinic.

She fell into a depression that left her with a choice: heroin or bupe.

"I would have used," said Clark, 52.

But she chose the bupe, starting again with the pills left over from her earlier prescription. "The depression went away and I'm continuing my therapy," she said. "I'm back in the [recovery] house."

A recent report showed that fewer addicts stuck with Suboxone treatment after 90 days than in the first year. The city's goal was to retain 67 percent at least that long. In the period from October 2006 to June 2007, the initiative succeeded in keeping 65 percent that long. But that dropped to just over half in the 12 months ending June 30.

"The retention rate has fallen," Sharfstein said.

One major reason is that the initiative has broadened its reach to take in people who are new to treatment, who suffer from other psychological problems or addictions and who engage in high-risk activities like prostitution.

It also took longer for patients to get off all drugs so they could be transferred out of city-backed clinics into the care of private doctors. Many patients stop using heroin but continue to abuse cocaine, leaving them ineligible to transfer. The city had wanted to transfer patients to the medical system after 90 days. In the first year, it took an average of 155 days. For the year that ended June 30, it took 163 days.

In addition, the initiative's pace of training doctors has lagged. Sharfstein had wanted 100 doctors to receive the federal waiver required to prescribe the pills. So far, 82 have received the clearance after completing an eight-hour training course.

The initiative also made a special effort to recruit more psychiatrists to deal with patients suffering both addiction and other mental illnesses.

"I would characterize this as good progress," Sharfstein said in an e-mail. "While we have not had 100 new waivered doctors yet, I am confident we will get there."

Suboxone's expense remains an issue. Methadone for heroin addiction costs about $8,000 per person over two years, the city reported last year. Suboxone treatment costs nearly twice that and has gotten more expensive.

Wendy Merrick, who directs addiction care at Total Health Care in West Baltimore, said the price per bottle of 30 pills has increased from $107.15 to $111.70.

To help cut costs, the Baltimore Substance Abuse Systems Inc., which manages most of the budgets for nearly all of the participating addiction treatment centers in Baltimore, has started buying in bulk, said Marla Oros, a consultant with BSAS.

The city's first report on its initiative in July 2007 made little mention of efforts to prevent misuse and illegal sales of buprenorphine. In December, The Sun published a three-part series that showed that abuse of Suboxone was on the rise across the nation as its availability increased. The drug was rolled out in 2003 after the federal government allowed doctors to prescribe it from their offices, unlike methadone, which is dispensed from highly regulated clinics.

The latest report devotes an entire section to efforts that the city has taken to minimize misuse of the drug: counting pills, testing urine and monitoring patients when they first start taking the pills. But the report states that "there is no evidence of a significant public health threat from buprenorphine diversion in Baltimore at this time."

A survey of 30 Baltimore physicians conducted by a consultant with the drug's manufacturer, Reckitt Benckiser Pharmaceuticals Inc., found that 67 percent were "aware of buying and selling of Suboxone, a percentage higher than the national average," the report states.

Clark, who was profiled in the series and has returned to treatment at Total Health Care, said she has seen the street demand for Suboxone increase.

"I was just at Lexington Market getting lunch and, wow, it's amazing," said Clark, who first tried Suboxone on the street. "It's almost like people are asking for Suboxone more than other things. The bupes. They ask for bupes."

Copyright © 2008, The Baltimore Sun

Thursday, July 10, 2008

Wellstone son launches push on mental health bill

The son of the late Minnesota Sen. Paul Wellstone made a big push Wednesday for mental health insurance long championed by his father, leading a call-in effort urging Congress to take up the legislation before its August recess.

David Wellstone wants Congress to approve legislation that would mandate equal health insurance coverage for mental and physical illnesses when policies cover both, known as mental health parity. The bill is co-sponsored by Rep. Patrick Kennedy of Rhode Island.

The Senate and House have already passed different versions of the bill, but negotiators have reached a compromise. Now, the sticking point is finding a way to pay for it.

The Congressional Budget Office has estimated the House bill would cost the federal government around $3.9 billion over 10 years -- $820 million in increased Medicaid costs, and $3.1 billion in lost tax revenue. That latter figure assumes that employees would receive more of their compensation in nontaxable employer-paid premiums, and less in taxable wages.

"Now that the House and Senate have agreed on a compromise bill, we are so close," David Wellstone wrote to supporters. He said in a telephone interview that he expected thousands of people would call in to push for passage -- and he was hopeful for a vote next week.

Under the compromise, House backers agreed to drop a requirement that said that if a plan provides mental health benefits, it must cover mental illnesses and addiction disorders listed in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, which is used by mental health professionals. The Senate bill did not have that requirement.

But the Senate negotiators made concessions, too, including agreeing to some of the House language requiring parity for out-of-network coverage.

The House bill was sponsored by Kennedy, who has battled depression, alcoholism and drug abuse, and Rep. Jim Ramstad, R-Minn., a recovering alcoholic who is Kennedy's Alcoholics Anonymous sponsor.

"This is literally a life-or-death issue for millions of Americans suffering from mental illness and addiction," Ramstad said, "and I'm grateful we are so close to enacting legislation for which we've fought so long and hard." Ramstad is retiring at the end of the term.

The House bill was named for Paul Wellstone, a Minnesota Democrat who died in a plane crash in 2002. In 1996, he and Sen. Pete Domenici, R-N.M., won passage of a law banning plans that offer mental health coverage from setting lower annual and lifetime spending limits for mental treatments than for physical ailments. The new legislation would build on that by adding things like co-payments, deductibles and treatment limitations, a longtime goal of Wellstone's.

The Senate bill was sponsored by Kennedy's father, Massachusetts Democrat Edward Kennedy, Domenici, and Mike Enzi, R-Wyo.
source: Associated Press

Tuesday, July 8, 2008

Drinking to destruction

With a difficult exam behind or a weekend ahead, a college student goes drinking. After the youth ties one—or make that several—on, he or she is noticeably drunk, but friends simply put the inebriated to bed to "sleep it off." Instead of passing out, the student passes away—and becomes another troubling statistic of alcohol poisoning. Drinking games play a deadly role, which explains the flat reception for a video game called "Beer Pong."

Rising toll
An Associated Press analysis of federal records found that 157 college-age people, 18 to 23, drank themselves to death from 1999 through 2005, the most recent year for which figures are available. The number of alcohol-poisoning deaths per year nearly doubled over that span, from 18 in 1999 to a peak of 35 in 2005, though the total went up and down from year to year and dipped as low as 14 in 2001.

Point of oblivion
A separate AP analysis of hundreds of news articles about alcohol-poisoning deaths in the past decade found that victims drank themselves well past the point of oblivion — with an average blood-alcohol level of 0.40 percent, or five times the legal limit for driving.

Fighting bingeing
Schools and communities have responded in a variety of ways, including programs to teach incoming freshmen the dangers of extreme drinking; designating professors to help students avoid overdoing it; and passing laws to discourage binge drinking.

This week, a Las Vegas-based company changed the name of an upcoming video game to "Pong Toss," instead of "Beer Pong" — the name of a popular college drinking game. Connecticut's Atty. Gen. Richard Blumenthal had said Monday that a video-game-rating board's decision to approve "Beer Pong" for children as young as 13 showed the organization needed to take the issue of teen drinking more seriously.

Spike on weekends
The federal data showed deaths spiking on weekends — when young people are more likely to go out with the goal of getting drunk — and in December, when college students wrap up finals. Most of the dead were young men.

College students on average drink only a little more than adults in a typical week or month, said Scott Walters, an assistant professor of behavioral sciences at the University of Texas School of Public Health. College students "tend to save the drinks up and drink them all at once."

Fears for Freshmen
Freshmen were found to be at greatest risk, with 11 of 18 freshmen deaths occurring during the first semester.

Walters said one reason is that freshmen are on their own for the first time and trying new things. Also, there is a mentality that "if you're under 21 and someone's got alcohol, you've got to drink it, because you never know when somebody's going to have it again."

One practice—drinking 21 shots on a 21st birthday—has proven especially lethal. Of the college-age deaths reviewed, 11 people, including eight college students, died celebrating their 21st birthdays.
source: Chicago Tribune

Monday, July 7, 2008

State of Drinking: Alcohol woven into small-town economy

The bar at Coppershot, a jumping downtown nightspot, gleams.

Owner Scott Hanadel has plenty of help keeping the bar's copper surface polished: the elbows of all those drinkers.

The popular bar frequently is packed, especially when there's live entertainment -- no small feat in a town with so much competition for a drinker's dollar.

Including restaurant bars and those inside other gathering spots such as the local VFW post, New London has one bar for roughly every 420 residents. That ranks among the higher numbers nationwide but is not unusual by Wisconsin standards. A 1990 study by the National Institute on Alcohol Abuse and Alcoholism found that Wisconsin was home to seven of the country's top 10 metropolitan areas with the most bars per capita.

Hanadel has no doubt what would happen if the town ever ran dry.

"It would die," he said. "There would be no reason to come downtown unless you wanted to catch a movie. This town would be a ghost town."

In Wisconsin, where drinking is inextricable from the fabric of life, alcohol informs not only the culture but also the economy. Nowhere is that more evident than in the state's small towns.

Notwithstanding the well-documented human and financial toll of alcohol abuse, which can be overwhelming, officials say the production and sale of alcohol infuses Wisconsin's economy by providing livelihoods, generating revenue and breathing life into city centers that otherwise would wither.

Such dichotomy makes for a complicated and sometimes rancorous debate.

Liquid assets

Wisconsin's drinking establishments rang up $598 million in sales in 2002, the last year for which full figures are available, according to the 2002 Economic Census. There were 14,038 people employed in alcohol-serving capacities, census data show.

Currently, Wisconsin has 10,571 drinking establishments that operate with beer-liquor licenses, according to Jessica Iverson, spokeswoman for the Wisconsin Department of Revenue. That includes standalone bars, restaurants, recreational venues such as bowling alleys and hotel lounges.

Another 1,760 operate with beer-only licenses. The vast majority of those are restaurants, Iverson said.

A 2007 survey conducted by the Washington, D.C.-based Beer Institute reports that the brewing industry was responsible for more than 30,000 jobs in Wisconsin in 2006. The industry had a $3.35 billion impact on the state when based on brewers, wholesalers and retailers, the survey reports.

Wisconsin ranks near the top for per capita alcohol consumption. In 2005, Wisconsin ranked fifth, averaging 2.92 gallons of booze sold per person.

Terry Harvath, president of the Outagamie County Tavern League, said downtowns in many small towns likely would fizzle after dark without alcohol.

"When people do go out for entertainment, I think drinking and dancing goes with it," Harvath said. "When you can cover all aspects of somebody going out -- if you can serve food, the beer and the liquor, and wine at the same time -- you're cornering the market."