For a minority of marijuana users, commonly estimated at 10 per cent, the use of pot can become uncontrollable, as with any other addictive drug. Addiction to marijuana is frequently submerged in the welter of polyaddictions common to active addicts. The withdrawal rigors of, say, alcohol or heroin tend to drown out the subtler, more psychological manifestations of cannabis withdrawal.
What has emerged in the past ten years is a profile of marijuana withdrawal, where none existed before. The syndrome is marked by irritability, restlessness, generalized anxiety, hostility, depression, difficulty sleeping, excessive sweating, loose stools, loss of appetite, and a general “blah” feeling. Many patients complain of feeling like they have a low-grade flu, and they describe a psychological state of existential uncertainty—“inner unrest,” as one researcher calls it.
The most common marijuana withdrawal symptom is low-grade anxiety. Anxiety of this sort has a firm biochemical substrate, produced by withdrawal, craving, and detoxification from almost all drugs of abuse. It is not the kind of anxiety that can be deflected by forcibly thinking “happy thoughts,” or staying busy all the time.
A peptide known as corticotrophin-releasing factor (CRF) is linked to this kind of anxiety. Neurologists at the Scripps Research Institute in La Jolla, California, noting that anxiety is the universal keynote symptom of drug and alcohol withdrawal, started looking at the release of CRF in the amygdala. After documenting elevated CRF levels in rat brains during alcohol, heroin, and cocaine withdrawal, the researchers injected synthetic THC into 50 rats once a day for two weeks. (For better or worse, this is how many of the animal models simulate heavy, long-term pot use in humans). Then they gave the rats a THC agonist that bound to the THC receptors without activating them. The result: The rats exhibited withdrawal symptoms such as compulsive grooming and teeth chattering—the kinds of stress behaviors rats engage in when they are kicking the habit. In the end, when the scientists measured CRF levels in the amygdalas of the animals, they found three times as much CRF, compared to animal control groups.
While subtler and more drawn out, the process of kicking marijuana can now be demonstrated as a neurochemical fact. It appears that marijuana increases dopamine and serotonin levels through the intermediary activation of opiate and GABA receptors. Drugs like naloxone, which block heroin, might have a role to play in marijuana detoxification.
As Dr. DeChiara of the Italian research team suggested in Science, “this overlap in the effects of THC and opiates on the reward pathway may provide a biological basis for the controversial ‘gateway hypothesis,’ in which smoking marijuana is thought to cause some people to abuse harder drugs.” America's second favorite drug, De Chiara suggests, may prime the brain to seek substances like heroin. In rebuttal, marijuana experts Lester Grinspoon and James Bakalar of Harvard Medical school have protested this resumed interest in the gateway theory, pointing out that if substances that boost dopamine in the reward pathways are gateways to heroin use, than we had better add chocolate, sex, and alcohol to the list.
In the end, what surprised many observers was simply that the idea of treatment for marijuana dependence seemed to appeal to such a large number of people. The Addiction Research Foundation in Toronto has reported that even brief interventions, in the form of support group sessions, can be useful for addicted pot smokers.
In 2005, an article in the American Journal of Psychiatry concluded that, for patients recently out of rehab, “Postdischarge cannabis use substantially and significantly increased the hazard of first use of any substance and strongly reduced the likelihood of stable remission from use of any substance.”
source: Addiction Inbox
Wednesday, April 30, 2008
Tuesday, April 29, 2008
By BART O'CONNELL, Tribune correspondent
The Tampa Tribune
Published: April 29, 2008
Last Wednesday at Tampa Bay Downs produced one of those perfect racing afternoons - clear skies, a slight breeze, warm temperatures and a fast track.
Ronnie Allen Jr. grew up winning on days like that in the 1980s. Watching him romp to three wins on the card may have felt like a flashback to loyal followers of the track.
With unquestioned natural talent, many assumed Allen was just passing through back then, on his way to the top of the sport like another young rider who began a Hall of Fame career in Oldsmar - Julie Krone.
But Allen is just happy to be riding again, winning again.
Just as so many people in so many different worlds have come to know, alcoholism can destroy anyone's life. It came close to destroying Ronnie Allen Jr.'s.
"He's such a good kid. All he's ever done is hurt himself," said Ronnie's father, veteran trainer Ron Allen Sr. "It's tough when you know he should be a millionaire."
"I ruined my life. I almost ruined my career, I practically did. Disappointed my family so many times and disappointed myself," said Allen Jr., 44. "I could've been up there with the Jerry Baileys and the Mike Smiths, them guys, if I could have kept my head on straight."
Rise and Fall
Allen won his first of three Tampa Bay Downs rider titles in 1985, at 21. He would add two more in the next three years, becoming the first Downs' rider ever to win 100 races in a single meet in 1987. But it was then that Allen began to sink into the horrible habits that forced him to not only leave racing, but marriage, during a turbulent 20 years since.
"It had a lot to do with when I was younger, getting in the wrong crowd. That's what started me. Because in high school, I never drank," he said. "When I got to the racetrack and started to hang out with people that drank every day, I started drinking every day."
At his worst, Allen, weighing less than 120 pounds, would drink nearly a case of beer a day, opening his first at 6 a.m. after waking up. He also was arrested twice for driving under the influence in the 1980s, attending court-mandated rehabilitation programs each time. He resumed drinking about a month after each stint.
"He'd have a couple beers, and you'd try to tell him about it, and he'd say, 'Oh, I've got it under control,'" Allen Sr. recalls. "They all think they've got it under control, and then it's out of control again."
It was a spiral that extended through the 1990s, a decade punctuated by Allen's third DUI, a felony, in 1999. With his weight battles constant, and his mounts slowly drying up, he finally left racing in 2003, taking a job galloping horses at the Post It Stables in Jackson, Mich., owned by Jerry and Lisa Campbell, two of Allen, Sr.'s biggest clients.
"I really hit bottom, and the only way I was going to save my life was to quit drinking," he said.
Road To Recovery
Last August, a couple months after Allen Jr.'s mother, Betty, entered rehab for a similar alcohol addiction, he checked himself into the Family Recovery Center in Ohio. He spent 15 days there, undergoing detoxification and counseling. He emerged a changed man, attending daily Alcoholics Anonymous meetings and making Diet Coke and Propel Fitness Water his drinks of choice.
But because of his felony DUI, the state initially refused to grant him a license to return to racing. After stewards at Tampa Bay Downs vouched for Allen's soberness, he was granted a license and returned on Feb. 14, winning on his father's 7-year-old sprinter, Tricks of Glory. He has rapidly climbed up the jockey's standings since, and is now seventh overall with 40 victories.
"You couldn't pay him to take a drink, because he really woke up and wants to make something out of himself again," Allen Sr. said.
When the Tampa Bay Downs meet ends this weekend, the Allens will head to Presque Isle Downs in Pennsylvania. Allen Jr. will have the chance to visit his 16-year-old son, Christopher, who never knew his father sober until the past nine months.
"I hope he learns from my mistakes," Allen Jr. said.
Bart O'Connell can be reached at firstname.lastname@example.org.
Monday, April 28, 2008
'Substance and Substitution is an extremely impressive work of scholarship and a genuine advance on existing studies of methadone maintenance treatment and of drug use more generally. It marries innovative theory with diverse empirical materials, and goes beyond a number of well-established binaries (e.g. resistance/conformity, social/material, body/mind, morality/medicine) in trying to understand the ‘co-production’ of substance, time, identities and gender.' - David Moore, Associate Professor, National Drug Research Institute, Australia.
Located between three powerful phenomena, public health, the law and social stigma, methadone maintenance treatment attracts loyal advocates, vociferous critics and innumerable engaged onlookers. This book combines contemporary science studies theory with in-depth interviews, policy documents and media texts to examine this controversial approach to addiction, providing a unique approach to the understanding of illicit drugs. Arguing that methadone maintenance treatment depends for its rationale on two contradictory, yet equally powerful images - the disordered, compulsive heroin user and the responsible, choosing subject of contemporary health care - this book traces the ways the program both reproduces and disrupts conventional understandings of what it means to be human, a citizen, a woman or man, questioning, as it does so, the conditions under which treatment is delivered.
1 Substitution, Metaphor and Authenticity
2 Governing Treatment
3 The Chronotope of the Queue
4 Treatment Identities
5 Repetition and Rupture: The Gender of Agency
Conclusion: Dependence, Contingency and the Productivity of Problems
SUZANNE FRASER is Lecturer at the Centre for Women's Studies and Gender Research, Monash University, Australia. Her research interests include gender, science, the body and health. She is the author of Cosmetic Surgery, Gender and Culture.
KYLIE VALENTINE is a Research Fellow at the Social Policy Research Centre, University of New South Wales, Australia. She is the author of Psychoanalysis, Psychiatry and Modernist Literature.
Publisher : Palgrave Macmillan
Sunday, April 27, 2008
Freda doesn't know how long she's been sober. She won't count the days - it's too overwhelming. All that she knows is that she's feeling a sense of hope for the first time since she first started drinking at the age of 17.
That was 35 years, and several lifetimes ago.
On Thursday, she graduated from an addictions treatment program.
One of the keys to the program, she said, was telling her story. It's not a pretty story, nor one she is entirely comfortable telling.
"It's very, very hard on me. I get depressed, a lot of times through my journey," she says.
Denego grew up at Deschambault Lake, and moved to Prince Albert in 1982.
She never finished school.
And, she said, in the last 35 years, alcohol took back far more than it ever gave.
"I lost my husband, my kids and my home," she says. "I never went home. My husband was a mother to the kids - and the father. He's been sober 32 years, now."
Sadness creeps into her voice as she relates that her children are now, like her, facing problems with addictions. Her alcoholism, she admits openly, influenced their lives.
"They followed my footsteps."
Repeatedly, she dwells on the same perspective.
"I didn't see my kids growing up, because of the drinking.
"I'm fighting this addiction for (many) years. There are a few times ... where, I guess it's suicidal, And I get tired of living."
She has seen considerable violence in her life, and she equates alcohol with the violence she has witnessed.
Denego tells of how she recently witnessed a violent crime, but was unable to do anything to prevent it.
"When I see young people drunk, or they do something bad..." she falters, searching for the right words. "What I've seen ... a woman get raped in front of me. I couldn't do anything to help her."
At some point, the booze and its effects on her life became too much to tolerate.
"I got tired of being sick all the time. The doctor warned me about my health. I've got a heart problem, sometimes breathing problems. I was worried about that."
She heard about the merits of an addictions treatment program from other women.
Assistance from her pastor, combined with the addictions treatment program, has been the key to realizing she can craft a new life.
Now, she's asking for the powers-that-be to offer more services to deal with addictions and alcoholism, but specifically programs to aid young people.
"They should have more programs for young people, for addictions, to help themselves as much as they can."
She can't quite explain how she gained the courage to tell her story, other than to say that it seemed to her to be the best way to warn others - specifically youngsters - not to make the same mistakes.
"I don't know. I just wanted somebody to ... I feel bad for the people, feel sorry sometimes. I see a lot of people lost through my time. I see a lot of accidents."
Perhaps it's also a way of cementing her resolve.
"It's time that I do something about my addictions. I want to talk about them," she said.
Now, at the age of 52, she counters the darkness of her past by speaking optimistically of a future.
Simple goals. Achievable goals.
"It's time to change my life around. I want to go back to school, to get a job."
She won't count the days. Her battle is ongoing. Indeed, as many recovering alcoholics discover, the battle never ends.
"I'm just taking it one day at a time. If I count the days, I'll start all over again."
source: Prince Albert Daily Herald
Friday, April 25, 2008
In some parts of this country meth abuse is a large concern. Where there should be concern, the problem with meth abuse is spreading. While the numbers or meth related problems are still small compared to prescription drugs and marijuana, it is on a slow and steady rise. You don't here of the meth problem too often as an 'epidemic' like the crack cocaine problem of the 80's and 90's. However it is still a growing issue and a concern for drug treatment facilities. Many drug rehab programs are seeing an increase of clientele with meth addiction problems.
The street names of meth are amp, crank, glass, jibb, and speed. Methamphetamine is classified as a stimulant. Stimulant drugs heighten awareness, stimulate the senses, and increases the functions of the brain and body. This creates a side effect of hyper activity, a suppressed appetite and results in staying awake. Stimulants are fast acting. To maintain the sensation of meth in the system, a person can fuel up on the drug to maintain the high. When introduced to the central nervous system, a build up of dopamine is created. Dopamine is the neurotransmitter in the brain responsible for feelings of pleasure. The build up of dopamine results in a sensation of euphoria. It is this euphoric sensation that often times develops into increased use, abuse and addiction.
People can begin taking meth for harmless reasons. A student can take the drug to stay awake to study. Athletes have been known to take methamphetamines to have a heightened awareness for performance. As an appetite suppressant, a young woman concerned about her looks, may begin taking meth to lose weight. Over time such practices can result into an abuse and addiction of the drug. Meth addiction can be so difficult that a form of drug rehab becomes the only way out of the problem.
There are many forms of methamphetamine. The pharmaceutical version comes in pill and powder forms from super labs overseas. Growing in popularity in regions of the country is a homemade form of methamphetamine known as crystal meth. Crystal meth is a crystallized rock form of the stimulant that is smoked, similar to crack cocaine. This form of crystal meth is created through a chemical reaction of common store bought pharmacy products. This chemical reaction however is highly potent, hazardous and deadly. Often the result, a clandestine lab used for making crystal meth is deemed uninhabitable, due to the chemical residue in the building. To slow down the increase in this homemade meth, preventative measures and awareness has been raised. Most retail chains that sell these products work with law enforcement in educating their employees on suspicious purchases of products used to create crystal meth.
Meth, in any form, is highly addictive. It is so addictive that for the majority of meth addicts out there, it takes intensified treatment from an addiction and drug rehab program. The physical effects of meth addiction are equally as damaging to the body. Drug rehabs have quite the task when it comes to a meth addict. Treatment is often needed for the physical struggle of meth addiction, as well as the psychological and emotional. With the right help and treatment even the most difficult cases of meth addiction can be overcome. Information was provided by Cirque Lodge. Cirque Lodge is a private addiction treatment program in the mountains of Sundance Utah, dedicated to raising awareness of the treatment of meth addiction.
Thursday, April 24, 2008
More than 6,000 physicians and scientists gathered in Milan, Italy, to attend the 43rd annual meeting of the European Association for the study of the liver to discuss liver disease and treatment improvements.
Liver cancer takes about 40,000 lives a year and liver disease caused by alcohol abuse takes some 13,000 in the European Union, researchers say.
More than 6,000 physicians and scientists from around the world are gathered in Milan, Italy, to attend the 43rd annual meeting of the European Association for the study of the liver to discuss liver disease and treatment improvements.
Acute and chronic conditions affecting the largest internal organ of the body includes diseases that typically result from inflammation or infection due to injurious agents such as viruses, alcohol and drugs.
The most prominent conditions -- each of which may arise in an acute form but then progress to a chronic state -- are alcoholic liver disease; hepatitis B, C, and D; non-alcoholic fatty liver disease and NASH, or non-alcoholic steatohepatitis, the most severe subset of non-alcoholic fatty liver disease.
There are continuing declines in new cases of hepatitis B and C, but stability or increases in fatty liver disease due either to excessive consumption of alcohol or non-alcoholic causes non-alcoholic fatty liver disease, one of the opening presentations said.
source: United Press International
Wednesday, April 23, 2008
CITY OF NEWBURGH — Once set to close, a Newburgh methadone clinic has become the type of place the state wants to see across New York's health-care system.
What makes it interesting isn't so much the clinic itself but its place in a larger network of doctors, dentists, mental health workers and therapists.
The Greater Hudson Valley Family Health Center took over the clinic in January after St. Luke's Cornwall Hospital announced plans to shut it down. The nonprofit also had run the Center for Recovery since 2006. Adding the methadone clinic meant it could fill a piece missing in its plan to treat people through their entire range of health needs.
It's a concept of treating the whole person that Karen Carpenter-Palumbo said has become a priority in New York. Carpenter-Palumbo is the commissioner of the state Office of Alcoholism and Substance Abuse Services.
Former Gov. Eliot Spitzer and Gov. David Paterson mandated that state departments such as Carpenter-Palumbo's begin integrating services into a cohesive system.
That means more networks like the one Greater Hudson Valley now operates at 83 Commercial Place. About 70 service providers, government employees and politicians gathered there yesterday to celebrate its opening.
Chris Loscher, director of the Center of Recovery, said the methadone clinic opened in January with 204 patients and now has about 240. It's licensed for 300. Statewide, about 1 in 7 New Yorkers deals with some sort of addiction.
Methadone is used to help break a dependency on opiates. That used to be almost exclusively heroin addiction, Loscher said, but increasingly includes the patient who gets hooked on prescription pain killers after surgery.
Patients bring with them a variety of medical concerns along with the addiction, Loscher said. A person in the middle of a daily heroin habit might not care about regular dental visits but, as they begin to recover, things like healthy teeth and jobs start to seem more important, Loscher said.
Greater Hudson Valley tries to provide all those services within its network.
That's important, Carpenter-Palumbo said, because too many patients are asked to bounce from one service to another in a disjointed system.
"What happens then is, we lose the person," she said.
Monday, April 21, 2008
An urgent review of the use of naltrexone (including implants) for opioid dependence is needed following reports of severe adverse reactions, according to two articles in the latest Medical Journal of Australia.
In its editorial, Associate Professor Robert Ali, Director of the Drug Alcohol Services Council in Adelaide, and his co-authors said that naltrexone is theoretically an attractive treatment for opioid dependence because it is inexpensive, long-acting, and generally well tolerated.
Oral naltrexone is used as a treatment for heroin and alcohol dependence.
However, the effectiveness and safety of oral treatments is compromised by poor patient adherence to taking regular doses. This has led to the development of long-acting naltrexone implants and depot injections.
Naltrexone implants have not been approved for human use in Australia, but these implants are being supplied through some private clinics.
Assoc. Prof. Ali says that naltrexone implants are currently obtained through the TGA Special Access Scheme but without the product being subjected to the usual rigorous scrutiny required for new devices in Australia.
"It is concerning that the recent research on naltrexone implants in Australia has not followed usual scientific processes," he said.
In a related study published in the journal, Dr Paul Haber, Head of Drug Health Services at Royal Prince Alfred Hospital, and his co-authors studied 12 patients who were admitted to hospital soon after receiving naltrexone in oral or implant form.
Eight of the cases were definitely or probably related to the naltrexone implant, including cases of severe opiate withdrawal and dehydration, infection at the implant site requiring surgery, and a psychiatric disorder.
The authors said these severe adverse events challenge the notion that naltrexone implants are a safe procedure.
"These events suggest a need for careful case selection, careful clinical management, and for closer regulatory monitoring to protect this marginalised and vulnerable population," Dr Haber said.
"Patients should be warned of the associated risks, and appropriate procedures planned to respond to any complications."
Dr Haber also emphasises the importance of screening patients for underlying medical or psychiatric conditions and, importantly, coordinating with relevant service providers.
"Similarly, a close relationship between naltrexone implant providers and local emergency departments is important."
"The widespread and unregulated use of naltrexone implants without appropriate safeguards for patients, their families and service providers should be restricted until this therapeutic product has been assessed for safety and effectiveness," he said.
source: The Medical Journal of Australia
Saturday, April 19, 2008
As concerned as we rightfully are about the methamphetamine plague, and other forms of drug abuse, it is a fact that alcohol is the number one drug of choice among youth in the United States today, and Oregon has the notoriety of ranking among the highest in the nation for its incidence of underage drinking.
Columbia County’s underage drinking rates are below the state’s rate for 30-day use rates - thanks in large part, we believe, to the efforts of the Clatskanie Together Coalition, the Columbia Community Mental Health, Columbia County Commission on Children and Families and other programs that are working together to raise awareness and educate our youth and communities, not just in April, but all year long.
However, Columbia County’s 30-day use rates are still above the national average, and “binge” drinking rates at both the 8th and 11th grade level are above the state average. In Clatsop County, the most recent surveys indicate that 8th grade drinking is below the statewide average, but 11th graders drink at a higher rate than the state.
Underage drinking qualifies as a leading public health problem across the United States, according to a recent declaration by the U.S. Surgeon General.
Now that’s a pretty powerful statement - Underage Drinking Qualifies As A Leading Public Health Problem! That statement has been a long time coming.
For most of the 80 years since the end of the failed experiment of prohibition, the attempts to change society’s attitudes about alcohol have been largely ignored, except by those actively involved in recovery programs - alcoholics, their families and the professionals who work with them.
It’s about time that alcohol be recognized for the public health problem it is, in a way similar to the campaign against tobacco.
Thirty-one percent of Oregon's eighth graders and half the state’s 11th graders reported regular alcohol use last year. Approximately 38,000 youngsters in Oregon have a serious alcohol problem.
Binge drinking on college campuses is “practically an epidemic,” according to a press release from the Oregon Partnership, a highly-respected statewide nonprofit organization that works to promote healthy kids and communities by raising awareness about drug and alcohol issues.
Alcohol use is associated with the leading causes of death of young people - vehicular crashes, drownings and accidents of all kinds, suicide. For those who begin drinking young and continue (and don’t die first of alcohol-caused “accidents”), alcohol takes a terrible - ultimately fatal - toll on their livers, their hearts, their brains and other organs. It is linked to several kinds of cancer. Recent research proves that adolescent drinking severely damages children’s (including young people up to their early 20s) still developing brains.
According to the Pacific Institute for Research and Evaluation, underage drinking costs Oregonians $697 million a year in medical expenses, pain and suffering and work loss costs. And, that doesn’t include the even higher costs associated with adult alcohol abuse.
In Oregon, approximately 66 percent of men and 50 percent of women drink. Nearly six percent of older adults and 20 percent of 18-to 25-year-olds abuse or are dependent on alcohol and need treatment.
And, all of that does not speak to the tremendous loss of potential caused by alcohol use and abuse. To state the obvious, alcohol negatively impacts students’ performance in school and adults’ performance at work. Its costs to relationships, families, our society and our economy are incalculable.
Time to End a “Rite of Passage”
The recent U.S. Surgeon General’s report found that underage drinking is viewed as a rite of passage and facilitated by adults.
I don’t see why we needed the surgeon general to tell us that. It has been considered a “rite of passage” by much of the population for years, including the communities this newspaper serves - but that attitude desperately needs to be changed.
Parents must understand that they are the biggest influence in children’s lives, and the more they talk to their children about the dangers of drugs and underage drinking (and that conversation should start in grade school, the Oregon Partnership emphasizes) the less likely their kids will give in to peer pressure.
Parents who drink more, who exhibit the attitude that drinking is an important part of their lives - if they drink to relax, to have a good time, to reduce stress, to deal with problems that arise - those parents’ children will be more likely to drink - sooner and in greater amounts
And, vice versa. Research shows that parents who don’t drink frequently, or at all, and who talk with their children about why they should not engage in underage drinking or excessive drinking at any age, will have children who are less likely to drink abusively.
“Alcohol is everywhere...it is probably harder for teens to get into an R-rated movie than to get alcohol. It’s a joke.” A 14-year-old boy from California is quoted in a report on underage drinking by the Center on Alcohol Marketing and Youth at Georgetown University.
The most common place for youth to get alcohol? Their home, or the homes of their friends.
In the face of the U.S. Surgeon General’s “Call to Action to Prevent and Reduce Underage Drinking,” which declares that underage drinking is a major public health problem across the United States - and Oregon’s statistics are among the worst - certain ironies are glaring.
I glanced up at the television news while writing this to see Senator Hillary Clinton tossing back “boilermakers” on the campaign trail in Pennsylvania.
Oregon music industry promoters are backing a proposed rule change that would allow teens into more establishments where alcohol is served because “teens who want to listen to live music have little opportunity because they are unable to attend venues where drinking is allowed.” How about providing some live music for teens in a non-drinking venue?
TV shows, web sites, and alcoholic beverage companies recently promoted spring break binge drinking.
During the past holiday season, Kohl’s, the national department store chain with more than 800 locations nationwide - including Portland - sold drinking games involving darts, roulette, and ping pong which promote high-risk drinking. Complaints lodged and publicized by the Oregon Partnership about the sale and promotion of the drinking games caused the retailer to pull the games from the shelves.
The Oregon Partnership points out that the now infamous Oregon legislators’ trips to Hawaii funded by the Oregon Beer and Wine Distributors Association, and campaign contributions by that lobbying group are “part of a bigger problem.”
“This peddling of influence has a profound effect on dealing with one of our top public health issues - underage drinking,” says Judy Cushing, executive director of the Oregon Partnership. “One of the beer industry’s top priorities in Oregon is to prevent the raising of the beer tax, which hasn’t been raised in nearly 30 years in the state, and is one of the very lowest in the nation. We are at the bottom of the barrel on this issue and it’s because of the powerful lobbying by the industry.”
Proceeds from an increase in the beer tax would support alcohol prevention, treatment, recovery and enforcement. Some 17 percent of the alcoholic beverages sold in Oregon are consumed by underage drinkers. States that have higher taxes on beer have been found to have lower death rates among young people involved in alcohol-related accidents.
The simple truth is, we need more citizens and more elected leaders who are willing to take a stand on underage drinking.
source: Clatskanie Chief
Thursday, April 17, 2008
It's elementary. If you smoke, you are at greater risk for certain kinds of cancer. But how about this: you drink and you're at a greater risk of breast cancer. That's based on a bold new study making a lot of waves in the medical community. We wanted to give you a closer look at what this study actually means through the eyes of doctors.
The study looked at more than 184,000 post-menopausal women.
"That number of people being studied is immense and that really lends a lot of credibility," said KLTV 7 med-team Dr. Ed Dominguez.
And the results are jaw-dropping. Consume one or two drinks a day and you're looking at a 32% greater risk of developing breast cancer. Make it three or more drinks, and that risk shoots up to over 50%.
"When a post-menopausal woman drinks alcohol and if she has an enzyme, or the ability to metabolize that alcohol quickly, and people will metabolize that at different rates, the faster that woman will metabolize that the higher her risk of breast cancer," said Dominguez.
Some doctors said they're shocked by the study.
"All this is people sitting around in a room scratching their chins going 'how do we explain this?' I mean, you cannot say at this point this is proof positive," said Dr. Gary Gross from the Blood & Cancer Center of East Texas.
Gross said while the findings are interesting, more research is needed to confirm the link.
"I could count on one hand probably the women I've treated for breast cancer who I knew were alcoholics," said Gross. "The vast majority say they don't drink or they have an occasional social drink."
Regardless of the research, women are urged to know their risks. If you have a family history of breast cancer, doctors said it's a good idea to avoid alcohol completely. They also still said, one drink a day will reduce cholesterol and your risk of developing heart disease.
This study was led by a doctor from the U.S. National Cancer Center Institute. The findings are expected to be presented this weekend at the annual meeting of the American Association For Cancer Research.
Wednesday, April 16, 2008
The Arkansas City Police Department is teaming up with community members to fight a common cause: underage drinking.
According to the ACPD, underage drinking has risen in the past couple years, and so have crimes associated with it; such as sexual assault.
The ACPD held a town hall meeting held in the on the Cowley County Community College campus Monday night. Ark City Police Chief Sean Wallace hosted the meeting and narrated the presentation. Several community experts were also invited to speak and answer questions at the end of the presentation.
All the speakers agreed that underage drinking is an important issue in Cowley county.
"Our youth are our greatest resource in this county," said Cowley County Undersheriff Don Reed. He said he was surprised to find that Cowley County was No. 1 in alcohol arrests out of 10 counties that he compared it to. Reed urged cooperation between parents, community members and law enforcement. "We've all got to work together to figure out how to fix this problem," he said.
State Sen. Greta Goodwin (D-Winfield) attended on an invitation from Wallace. She praised the ACPD for organizing the meeting.
"I pride you for putting together this meeting this evening, because we need to talk," said Goodwin. She said that "15.6 percent of 100 children" binge drink every week.
Wallace spoke to parents and audience members about the effects of alcohol; notably the effects that occur at each age level. The mind does not completely mature until age 24. Wallace called the 21 year old minimum a "good compromise" between 18 and 24. Wallace warned of the effects that alcohol can have on a person during their developmental teen years. He said that many of the decision making skills present in adults at ages of 21 and up are not there yet in teenagers.
"If you add alcohol to that developmental stage you only inhibit it," he said.
Wallace said that the number of rapes in the county have risen in the past three years , along with issued Minor In Consumption charges.
"There's a direct correlation between the two," he said.
Wallace warned that abuse of alcohol can lead to abuse of other drugs. "Alcohol is traditionally a gateway drug," he said.
Steve Lungren, an Ark City resident, parent and business owner said he was surprised by the statistics relating to underage drinking.
"Twenty-five percent of the kids have a problem, it's just that simple." Lungren urged parents to take a stronger role.
"Parents, it starts with us," he said. Lungren said that he has opened up an "information highway" with his children that allow him to talk about issues like underage drinking.
Jean Laymon, a panelist who works with troubled teenagers at Cowley County Mental Health echoed Lungren's sentiments on parenting.
"Kids drink because of lack of supervision, she said, adding, "An absent parent is a huge, huge factor in the kids that I see."
She said most of the adults she counsels for excessive DUIs have said they started drinking between the ages of 14 and 16.
All of the speakers condemned alcoholic parties hosted by parents.
"Parents that are allowing their kids to drink, or let their kids drink at home are simply not good parents," Laymon said. Reed echoed her statements. "Even when you have the best intentions these things just don't work out," he said, citing examples that he has seen in his career.
Teenagers were encouraged to speak out against drinking to their peers. "You can make a difference with just a simple message," said Wallace. Reed said that attention should also be focused on those who do not drink underage. "We've got a lot of good kids in this county who aren't in trouble, so let''s not forget them," he said.
One of the most personal accounts of drinking and its dangers came from panelist Rebecca Heimer, Ark City High School senior and president of Students Against Destructive Decisions (SADD). Heimer struggled with alcoholic parents.
"We never really lived a stable life." She said the issue of underage drinking was "very, very personal."
"Kids are our future and I don't want them to go down the same path that my parents did," said Heimer. SADD now has 234 members at ACHS. Heimer has been a member for four years.
Speakers praised the teenagers who attended the meeting. "You guys are the ones that say no, and you guys do make an impact on those around you," said Laymon.
"You are our most precious asset and resource," said Wallace, speaking to the teens.
There were some high school students in the crowd that appreciated what was being said.
High school senior Kip smith said "It does change your outlook. It gives you statistics to look off of."Senior Kosh Metzinger said "the statistics really stuck in my head. Number one (out of 10 counties), that's pretty bad."
source: Arkansas City Traveler
Tuesday, April 15, 2008
TALLAHASSEE -- Julie St. Clair kisses her 7-year-old son's head as she describes her life just two years ago when she smoked crack cocaine, lost her job and could not see her son.
She was in such bad shape, she walked into to the emergency room with thoughts of suicide.
Her fiance, Mike Gurin, 42, had an alcohol addiction that caused him to become homeless and resort to stealing Listerine from convenience stores for a taste of alcohol.
Their life today is a sharp contrast from the days before they entered treatment programs at Serenity House.
St. Clair, 33, works as a waitress at a diner in Daytona Beach and attends Daytona Beach Community College seeking a bachelor's in business administration. Gurin works as a waiter and a manager at a restaurant in the Volusia Mall.
But the treatment programs that got them back on track -- along with other substance abuse and mental health programs statewide -- are at risk because of millions of dollars of proposed budget cuts.
Lawmakers coping with a multi-billion-dollar revenue shortfall are making wide-ranging cuts this year, including large amounts now spent for health- and humans-services programs.
"It's a formula for disaster for our state and for people who are just basically hanging on," said Bob Butterworth, secretary for the state Department of Children & Families. "If this budget comes down the way it's coming down, we are going to see very, very serious repercussions."
Lawmakers are expected to begin negotiations this week on a spending plan for the fiscal year that starts July 1.
The House has proposed deeper cuts than the Senate in substance abuse funding, including a $9.75 million cut in a program that provides treatment primarily to women who are trying to get off welfare, said Mark Fontaine, executive director of the Florida Alcohol and Drug Abuse Association.
The House also proposed cutting about $10.3 million from community programs that deal with substance abuse, mental health and other issues, Fontaine said.
The Stewart-Marchman Center, the area's largest substance abuse treatment agency, could lose about $1.3 million, which would cause service and program cuts across its adult services programs, including Project Warm, which lets mothers stay with their newborns and young children while going through treatment.
"These folks are going way overboard," said Chet Bell, chief executive officer at The Stewart-Marchman Center, the area's largest substance abuse treatment agency.
Randy Croy, Serenity House executive director, said his agency could lose about $500,000 if proposed cuts are approved.
If the funding cuts are made, Bell said, the state will end up spending "more money on hospitals, jails and they will put more people in the morgues."
The Senate proposes cutting about $4 million from adult substance abuse programs, but it would use one-time money to avoid making other cuts proposed by the House. But that one-year solution would leave agencies facing cuts again in 2009-10.
Those cuts along with proposals to cut child welfare funding, local and state officials fear, will cause an increase in child abuse cases.
"We already have a very small safety net, and that safety net is now going to be gone," DCF's Butterworth said.
Butterworth added that the proposals are "mean and it's nuts. It affects real people."
He said Gov. Charlie Crist gave legislators a road map to use trust funds to help with budget woes and the state should follow it.
House Healthcare Chairman Aaron Bean, R-Fernandina Beach, said substance abuse programs are like other areas of the health and human service budget that have taken cuts. He said it's "not that we didn't like them," but it just came down to a lack of available money.
"We're still looking to do all we can to restore (funding for) them," Bean said last week.
Proposed cuts also could heavily hit programs funded through the state Department of Corrections, including local programs run by Serenity House and Act Corp. The House has proposed cutting $31 million starting in July for the department's substance abuse programs, said Gretl Plessinger, a spokeswoman for the agency.
St. Clair and Gurin, who met at Serenity House and plan to marry in September, said they can't imagine where they'd be without the help they received.
They spend their weekends enjoying time with St. Clair's son, Cameron Dicus, which includes attending church and watching him bowl in a league. They've lived the past 10 months in their rented condo, one of 15 Serenity House owns throughout Volusia County. The agency rents on a sliding scale to people who have successfully completed treatment programs.
"They saved my life, but I had to do the work," Gurin said. "They build up your self esteem and confidence."
St. Clair, who had abused drugs since she was 15, now receives medication and treatment for bipolar disorder from Act. Serenity House also still checks on the couple, including doing random drug testing.
"I never knew it could be this good," St. Clair said, looking down at her son, whom she now sees every Wednesday and every weekend.
source: Daytona Beach News Journal
Monday, April 14, 2008
Community homes for recovering drug and alcohol addicts are revived after a DePaul study proves their worth
A five-year study by DePaul�s Center for Community Research made Illinois lawmakers take notice. They recently passed funding for the multiplication of non-institutional, democratically self-governing substance abuse rehabilitation centers known as Oxford Houses.
The new funding was a product of the Illinois Department of Human Services, Division of Alcohol and Substance Abuse (DASA). The grant provides for the opening of four new Illinois Oxford Houses this spring among the 11 new homes DASA hopes to subsidize by the end of the year. The creation of up to 20 new Oxford Houses annually across the state is the goal of DASA beyond 2008.
The Study's Results
The Center for Community Research, headed by DePaul professor of psychology Dr. Leonard A. Jason, has advocated the liberal approach of the Oxford House system. Its research on the system was heavily considered by DASA and was cited by the government department in support for the new funds.
"[The Center for Community Research] did a study which indicated that if you provided these types of support and care after people have been in treatment for substance abuse, you could get about twice as many people to stay sober over a two year period of time," Jason said.
Jason worked alongside DePaul colleague and fellow-psychology professor Dr. Joseph Ferrari among others, including Northwestern professor of research Brad D. Olson, in studying the effects of the Oxford House democratic rehab method.
The two studies released by the group in 2006 showed drug abstinence rates of 65 to 87 percent among recovering addicts who lived communally in the self-supporting Oxford House system. The results bucked prior notions that a majority of recovering substance users relapsed after treatment.
Jason�s reasoning is simple. "If you have someone who is dealing with substances and drugs and then they get released back to the same family and neighborhoods that might have high levels of substance abuse and you don�t provide them any types of support, the likelihood is that many of those people will relapse," he said. "If you provide housing, opportunities for employment, peer support�you can reduce that rate by half."
Ferrari, a Vincent DePaul Distinguished Professor, credited the Oxford House system�s success to the reality that "a sense of home is very important for people" and that the method respects the "individuality and dignity" of each person who lives in an Oxford House.
Resident Turned Landlord
Stephanie Marez is a shining example of the system�s benefits. After bouncing from treatment center to treatment center for her alcohol abuse, Marez spent just under a year as an Oxford House resident in 2004.
"It worked itself out to be the best thing that ever happened to me," she said. "Who better to understand an addict than another addict?"
After moving out of her Oxford House clean about three years ago, Marez now serves on the State Board of Illinois for Oxford Houses while working at DePaul on a study of ex-drug offenders� post-treatment options. She is also the landlord of an Oxford House and trains new residents in particular positions they will hold in their house.
This recent expansion of funding is not the first time that Oxford Houses have been subsidized by the Illinois government.
According to Ferrari, state governments were federally mandated to provide $100,000 in annual funding for Oxford Houses throughout the 1990s, a small price to pay for effective substance abuse recovery. By 2003, however, DASA discontinued the funding based on a lack of data supporting the Oxford House system.
"There was no data to show that it did not work," said Ferrari in reaction, who gives much credit to the DePaul study for the reinstatement. "We were able to show how cost-effective it is; these people are getting their own jobs and paying their own rent."
Ferrari insisted that the government�s bias towards the institutions it funds heavily such as hospitals and traditional rehabilitation centers was the real reason DASA cut funding for Oxford Houses.
"Oxford Houses are controversial because they are showing that people can take care of themselves. [Oxford House residents] don�t need the medical community."
Since residents must be employed, pay rent and work to pay off the initial government loans provided to each group home, Oxford Houses are, as Ferrari pointed out, an extremely cost-effective rehabilitation method.
"There are so many people that are incarcerated for nonviolent drug offenses, the prisons are just overcrowded. There is such a need for sober living and recovery homes," Marez said.
Jason indicated that the high abstinence rates of former addicts coming out of Oxford Houses contribute to the system�s public thrift. With a population of ex-offenders less prone to relapse, there is a lesser chance that the recovered will end up in prisons, hospitals or other publicly funded institutions in the future. Fewer relapses equal less taxpayer money.
Though it should not be viewed as an end, Marez believes that the new funding is "a step in the right direction." Ferrari is looking forward to the locations of the new houses, emphasizing that they are necessary in both urban and rural communities. Jason hopes the supportive research for Oxford Houses leads to a similar treatment of social outcasts including criminals and the homeless.
The Study and the Oxford House
The DePaul study was performed through interviews with Oxford House residents every six months for two years. After two years, Jason noted, most of the residents had left their Oxford House rehabilitated. Many of the interviews were done by DePaul students, graduate and undergraduate, while Jason and Ferrari directed the research, which took place between 2000 and 2005.
A network overseen by the nonprofit, publicly dependent corporation Oxford Houses, Inc., Oxford Houses are located across the United States as well as in countries such as Canada and Australia. Currently, there are 39 Oxford Houses in Illinois, including three in Chicago.
Each group home houses six to 15. An initial $5,000 loan is given to each house for furnishings and basic start-up costs.
Saturday, April 12, 2008
With British Prime Minister Gordon Brown poised to reclassify marijuana as a more serious drug subject to stiffer penalties, the United Kingdom appears to be in the grip of an outbreak of Reefer Madness that would make Harry Anslinger blush. Fueled by the country's widely-read tabloid press and used by opposition Conservatives as a club with which to beat Brown's Labor government, the marijuana moral panic is a key element in what appears almost certain to be Brown's retreat from marijuana law reform.
If, as is widely expected, Brown actually does order marijuana reclassified from Class C to Class B, which would mean a return to routine arrests for simple possession and an increase in penalties for trafficking, he will be ignoring the recommendation of the government's own drug policy-setting panel, the Advisory Council on the Misuse of Drugs (ACMD), which has called for marijuana to remain Class C. Instead, Brown will be siding with law enforcement, concerned moms, and the mental health-drug treatment complex, all of whom are loudly howling that the drug is so dangerous it must be reclassified.
The British tabloid press, exemplified by the Daily Mail, has become a leading actor in the debate over reclassification, breathlessly reporting scary story after scary story about marijuana and its effects, particularly on youth. Here are just a handful of recent Daily Mail Reefer Madness headlines: "Son twisted by skunk knifed father 23 times," "How cannabis made me a monster," "Escaped prisoner killed man while high on skunk cannabis," "Boys on skunk butchered a grandmother," and "Teen who butchered two friends was addicted to skunk cannabis."
In another article, "How my perfect son became crazed after smoking cannabis," the Mail consults an unhappy mother whose child ran into problems smoking weed. Last fall, the Mail was warning of "deadly skunk."
While the Mail's preoccupation with skunk, a decades-old indica-sativa hybrid, is novel, it has also been hitting some more familiar themes. In an article headlined "Cannabis: A deadly habit as easy for children to pick up as a bag of crisps," after blaming marijuana for the problems of British youth culture and prohibition-related violence, the Mail breathlessly reports that skunk isn't your father's marijuana.
The other problem for the Government and others who urged the then Home Secretary David Blunkett to downgrade cannabis in the run-up to 2004, is that the drug on sale to young people on the streets today is very different from the one ministers thought they were downgrading.
Doctors believe that this new strain has the potential to induce paranoia and even psychosis.
Some of those we met who work with young criminals link the advent of the new drug with the growth and intensity of street violence.
Uanu Seshmi runs a small charity in Peckham, where gun crime is rife, which aims to help boys excluded from school escape becoming involved in criminal gangs.
He has seen boys come through his doors who are "unreachable" and he blames the new higher strength cannabis sold on the streets as "skunk" or "super skunk" for warping young minds.
"It isn't the cannabis of our youth, 20 or 30 years ago," he told me.
"This stuff damages the brain, its effects are irreversible and once the damage is done there is nothing you can do."
While such yellow journalism from the likes of the tabloid press is no surprise, even the venerable Times of London is feeling the effects of skunk fever. Under the headline Cannabis: 'just three drags on a skunk joint will induce paranoia', the Times managed to find and highlight a gentleman named Gerard who doesn't like that particularly variety of pot:
I smoke around six joints of regular cannabis every week, mostly at the weekends. What I like about smoking hash or weed is that it keeps me calm and gives me a more amusing outlook on life. With skunk, it's a completely different story. Just three drags on a skunk joint will induce paranoia on a massive scale.
As Britain's pro-cannabis reform media outlet Cannazine noted, "As a result of Gerard's personal experience with cannabis, The Times published a story to Google News which will ultimately go on to form part of the over-all anti-cannabis diatribe we are all subjected to daily. Is there any wonder at all why the world has such a confused view of what is really a hugely important social issue within the UK?"
Fortunately for British pot-smokers, smoking high-potency strains is not likely to turn them into mental patients or psycho-killers, said Dr. Mitch Earleywine -- and it may even be better for them than smoking low-potency weed. "The tacit assumption that increased potency translates into greater danger from the drug is untrue," he said. "In fact, marijuana with greater amounts of THC may is probably less hazardous than weaker cannabis. Stronger cannabis leads to smoking smaller amounts. Smoking smaller quantities could provide some protection against the health problems normally associated with inhaling smoke. Smokers may take smaller, shorter puffs when using more potent marijuana. Smoking less may decrease the amount of tars and noxious gases inhaled, limiting the risk for mouth, throat, and lung damage. Obviously, avoiding smoke completely would eliminate these problems," he said, suggesting that eating cannabis may be an alternative.
While marijuana potency has increased over the years, claims of dramatic potency increases "suffered from exaggeration or misinformation," said Earleywine.
The same could be said about claimed links between marijuana and schizophrenia, he suggested. "The obvious stuff, that pot doesn't cause schizophrenia but schizophrenics like pot, tends to apply here," he said. "The longitudinal studies often do a great job of assessing psychosis at the end of the period but a poor job of assessing symptoms at the beginning of the study. There are now about five longitudinal studies suggesting increases in 'psychotic disorders' or 'schizophrenic spectrum disorders' in folks who are heavy users of cannabis very early in life. There are also six studies to show more symptoms of schizo-typal personality disorder in cannabis users. Note that none of these are full-blown schizophrenia, the rare, disabling disorder that affects about 1% of the population," he said.
"The best argument against this idea comes from work showing that schizophrenia affects 1% of the population in every country and across every era, regardless of how much cannabis was used at the time or up to ten years before," Earleywine added.
For California court-certified cannabis cultivation expert Chris Conrad, the British obsession with skunk is somewhat mystifying. "Skunk is just another hybrid cannabis strain," he said. "It was developed by Dave Watson, and I believe it is 75% sativa and 25% indica with a strong aromatic flavor, hence the name. There is also 'Super Skunk' that adds more indica, which is what differentiates it from regular skunk. But the name and any alleged "skunk effect" are not related in any reality-based way, because that same effect is derived from all hybrid strains."
While scoffing at the sensationalized claims of skunk's powers, Conrad pointed to one real, but minor, risk associating with using high-potency marijuana. "Individuals with low blood sugar, low blood pressure and a tendency toward fainting may pass out after smoking a few hits of very strong cannabis, usually indica strains grown indoors. That's it. The only danger seems to be bumping your head if you fall over."
If the British press wanted to warn readers of real potential problems with high-potency marijuana, it would tell them to be careful around strong cannabis if they have low blood pressure and/or a history of fainting, said Conrad. "But instead of responsibly advising the public that certain individuals who are easily identified by their medical history should be careful to sit down when they smoke very strong cannabis -- the media instead uses this to fan fears, glamorize the drug war and sell newspapers without even bothering to give their readers the only useful information they need to know about the topic. Somebody should be fired for allowing them to publish lies like they have been doing. Shame on them."
"We are in the middle of a full-blown Reefer Madness moral panic," said Steve Rolles of the Transform Drug Policy Foundation. "It is, of course, political -- opponents of the government are attacking it using the 2004 reclassification as a basis. Any bad things that happen involving cannabis can be blamed on the government, and any research that illustrates cannabis harms used to show how weak and irresponsible the government is. The government is on the verge of caving into the pressure, rather than arguing the case for the policy," he noted.
And while the Daily Mail is a tabloid (a rough American equivalent would be the New York Post), it is influential, Rolles said. "It influences the government because it is read by a large number of floating voters who switched from Tory to Labor and will potentially switch back," he argued. "The Mail has a disproportional impact on politicians because of its reader demographic and correspondingly has a disproportional impact on the news agenda and general popular political discourse. The memes about cannabis harms -- particularly mental illness and young people, the potent new 'skunk', links to violent crime -- and the fact that reclassification, and by implication the government, are responsible for it all are very much perpetuated by the Mail. It's the old story about the Government 'sending out messages' to young people," he said.
The Daily Mail is a political actor in opposition to the Labor government, Rolles noted. "The Mail despises the government for various reasons -- mostly to do with its editor who is a reactionary-right moral authoritarian with a classic conservative view of a traditional Britain under attack from various wicked modern cultural forces."
The Daily Mail's Reefer Madness reporting serves the political ends of the Conservatives, Rolles explained. "Their home affairs spokesman, David Davis, is like a drug war jack in the box, popping up at every opportunity and deploying one of a selection of set phrases linking all of the above; government being weak, sending out the wrong message, cannabis harms, reclassification being the cause of all the problems, and his solution -- ignore the ACMD, reclassify, and most absurdly; 'secure our borders'. It's fear mongering and sound-tough drug war idiocy on a quite epic scale."
But that idiocy will most likely be sufficient to sway the Labor government into moving resolutely backwards on marijuana policy. For American readers in particular, for whom such reporting seems like something out of the 1930s, the role of the reactionary British press in setting marijuana policy should be an object lesson.
Friday, April 11, 2008
Simple steps, applied to all patients, can help identify illicit use and steer addicted patients to treatment -- while protecting doctors' ability to help others
Every day, thousands of doctors around the United States walk a tightrope stretched between their duty to help patients in pain -- and the risk of abetting illegal and life-destroying drug addiction and dependence, and losing their medical license for doing so.
They walk this tightrope every time a patient asks for a prescription for a powerful opioid narcotic painkiller, such as Oxycontin or Vicodin. These drugs have eased the pain of millions, but have also become lucrative street drugs that are used by millions of people not for pain control, but to get high.
Now, a new study from the University of Michigan and the Ohio State University shows how doctors and their office staff might be able to keep their balance.
Today at the meeting of the Society for General Internal Medicine, a U-M physician will present the results of an approach she designed and implemented while at OSU.
The results show how a busy multi-physician clinic was able to get a better handle on which patients were misusing opioid medications – and steer dependent patients to treatment – through a policy that logged and carefully screened all patients who were receiving the drugs for non-cancer pain. The clinic also required patients and doctors to sign an agreement about conditions for receiving such medicines. The initiative helped identify patients who were using other illicit drugs, which can interact dangerously with narcotic painkillers.
In all, the study revealed that 35 percent of the 167 patients in the clinic’s opioid registry violated the new policy in some way – with the most common violations being a mandatory urine test that showed illegal street drug use, or a check of state prescription records that showed they were getting the drugs from more than one physician at the same time.
Patients who were receiving Oxycontin or another medicine that contained its active ingredient, oxycodone, were twice as likely as other opioid registry patients to violate the clinic policy in some way.
“Many of us in the clinic were surprised at what we found, because a doctor’s job is first and foremost to trust the patient as they tell us about their pain,” says study author Jennifer Meddings, M.D., who implemented the policy in collaboration with pharmacist Stuart Beatty, Pharm.D., and internal medicine residency program director Catherine Lucey, M.D. Meddings, now a clinical lecturer in the Division of General Medicine at U-M Medical School, continues, “But in order to confront this issue, and protect our ability to prescribe these drugs to the patients who truly need them, we need to have a uniform approach for all patients.”
Meddings is now working with her U-M colleagues to improve implementation of a similar program in the Taubman General Medicine clinic of the U-M Health System, with hopes of having it spread to other U-M clinics — as it did at OSU. She also hopes to study the effectiveness of such a policy more fully and prospectively.
She led the design and implementation of the policy while she was chief resident of internal medicine at OSU, treating patients at a busy resident-staffed, faculty-supervised clinic. In such a clinic, where a patient is not likely to see the same doctor at every visit, the risk of prescription opioid misuse may be higher.
In fact, the police had alerted the clinic about several patients who had sold narcotic drugs prescribed by residents, or who had tried to fill a single prescription at multiple pharmacies. Under some circumstances, such violations of the law can come back to haunt the prescribing physician and his or her entire clinic – including the loss of the license to prescribe those medicines to any patient.
At the same time, the experience of managing so many opioid-using patients, and deciding whether to trust them, was turning younger resident physicians away from pursuing a career in primary care – at a time when such doctors are in short supply. Clinic staff also complained of abuse from some patients.
“Everyone was frustrated with the situation, and aware that this was a growing problem we had to do something about,” says Meddings.
But, she adds, the clinic also wanted to ensure that it didn’t punish the patients who legitimately needed the medications — and that it offered help to those who had developed a dependence or addiction to narcotics, or whose urine tests showed they were using other illegal drugs. Also important was the need to show patients that they could still receive their other primary medical care from the clinic, even if they violated the opioid policy and could no longer receive prescriptions for Oxycontin or other drugs.
And, since Meddings had learned from national experts that it’s hard to predict which patients will misuse opioids, it was decided to apply the policy to all patients receiving opioid prescriptions – not just those who the physicians or staff suspected of having an opioid problem.
The first step was to create a registry of all patients receiving opioid prescriptions and their prescribing clinic physicians, in order to establish a clear relationship between the patient and a specific clinic physician to oversee the opioid management plan. Clinic staff also helped screen new patients, from the moment they called for an appointment, so that patients were aware that an evaluation process was necessary before new patients could receive opioid prescriptions from the clinic.
Second, Meddings and Beatty taught their physician colleagues how to use the state of Ohio’s online prescription database, which allows doctors and pharmacists to see whether a single patient has been “doctor shopping” to get prescriptions for the same drug from several providers. Michigan has a similar online service.
Third, the team developed a mandatory agreement that patients and doctors would sign – listing the monitoring steps that were now standard for clinic patients requesting opioids, the types of behaviors that would result in ending the patient’s eligibility for opioid prescriptions, and the conditions (such as forging prescriptions or being abusive to staff) that would result in immediate barring of a patient from the clinic.
Fourth, the team implemented annual and random urine screening for all patients requiring opioids for non-cancer pain, to monitor for illegal drugs such as cocaine and unexpected use of other prescribed medications that can interact dangerously with the prescribed opioids.
Meddings stresses that patients whose monitoring turned up signs of dependence or abuse weren’t reported to the police, but rather were referred for treatment. Pain specialists who are licensed to provide buprenorphine can help wean patients from an opioid dependence, while others can get help from drug and alcohol abuse specialists, and community services such as Narcotics Anonymous.
In the end, Meddings says, the policy appears to have achieved much of what it set out to do. Now, she hopes that other clinics around the country can adopt the same strategy – to help them walk the tightrope safely, and patch up the holes in the safety net that allow opioid abuse and diversion to persist.
Meddings and her co-authors note that the policy’s implementation was enabled by the efforts of the OSU Internal Medicine residents and General Medicine Clinic faculty and staff. The review and preparation of the research results being presented at the SGIM meeting was greatly assisted by Meddings’ colleagues in U-M General Medicine.
Wednesday, April 9, 2008
Consumers are often unaware that hundreds of liquid preparations — prescription and over-the-counter medications, and personal-care products — contain alcohol. This can be a problem because alcohol is a sedative and in sufficient quantity can cause sleepiness, a fact noted on the label of medications containing alcohol. Also, the alcohol can react with medications taken for other conditions and result in serious consequences.
Alcohol (ethanol, as opposed to isopropyl, which is in some topical formulations) is added because it easily dissolves ingredients and gives the product a longer shelf life. The amount of ethanol in a product can range from 1 percent to 80 percent. Mouthwashes, for example, can contain up to 25 percent alcohol. The Food and Drug Administration requires that all active and inactive ingredients be listed on the product label.
Patients taking the prescription medication disulfiram (Antabuse) to control their consumption of alcoholic beverages have to be very careful to not ingest any products containing alcohol. Disulfiram, when mixed with alcohol, causes an extremely unpleasant experience. Within 10 minutes of mixing the two, nausea, vomiting, intense flushing, headache, increased heart rate and a drop in blood pressure can occur and last for hours. This reaction has occurred with as little as one tablespoon of some cough medication.
Although not as common, application of topical products containing alcohol also can cause this reaction. Patients are told to avoid aftershaves, perfumes, mouthwash, shampoo and any other product that contains alcohol. This reaction can occur up to 14 days after discontinuing disulfiram therapy.
Metronidazole (Flagyl) is a commonly prescribed antibiotic which may cause a disulfiram-like reaction when combined with alcohol. Patients are warned to avoid alcohol during and 72 hours after therapy. This reaction has been reported with the intravenous, oral and vaginal dosage forms.
Because alcohol is so widely used in many liquid medications — pain relievers, laxatives, antidiarrheals, iron, cough-cold-allergy, vitamins, canker sore and toothache products — consumers should be on the lookout and always read labels. If more information is needed about specific alcohol content, check the package for a toll-free number and talk with the manufacturer, or ask your pharmacist.
source: Rochester Democrat and Chronicle
Tuesday, April 8, 2008
After giving up drugs, boredom made Cheryl Powell turn to learning.
I can clearly remember the turning point. Three deaths in the space of a month: my boyfriend, cousin and then my dad. My boyfriend died of a heroin overdose, a couple of days before Christmas. My cousin died on Boxing Day; another heroin overdose. In January, my dad died of a terminal illness. I was 23.
Up until then, I'd been doing OK. I'd ended up in foster care during my final year of school, which had disrupted my education. I'd left school with no qualifications, but I'd managed to get a job as a dental technician, a job I'd held down for over two years. I enjoyed the work and it was good money. What happened that Christmas sent me to a dark place; I just couldn't cope anymore.
I started cutting myself. I tried to commit suicide so many times I lost count. Sometimes I'd take an overdose, sometimes I'd cut myself. I was constantly in and out of hospital. Everything was so black. I couldn't see any happiness in life. On the rare occasions I did feel happy, I was guilty about it.
I developed anorexia. By that time, I had a new boyfriend, but he was abusive and controlling. Starving myself was the only way to feel in control. And then there were the drugs. Before I lost my boyfriend and cousin, I only did cannabis, speed and "street" Diazepam. After they died, I started taking heroin.
Heroin affects different people differently. Some people commit horrendous crimes to get money for drugs. I didn't. I worked at a lap-dancing club practically every night and earned up to £500 a week. I didn't think about what I was doing. When you're an addict, you spend all day running around to get your drugs. Some days you haven't got enough money to buy any. Other days you can't buy enough. Sometimes you can't find a dealer to supply you. When you come off drugs, one of the most difficult things to deal with is boredom. What else do you do with your time?
My family and friends knew I was a heroin addict. They also knew I was working as a lap dancer. I've got five siblings and they were all disappointed in me. My younger brother disowned me for a while. I lost a lot of friends, and gained a lot of acquaintances.
I remember the day I decided to stop. I found my boyfriend was in bed with my best friend. I knew I had had enough. I called my mum, took my things and moved out. I started taking the prescription drugs I'd been given to help me stop. A friend from the lap-dancing club took me to Tenerife for a holiday to sweat it out. I've been clean ever since.
A few months later, my little sister brought home a leaflet about the Prince's Trust - a charity that helps young people get into work, education or training. It was just what I was looking for. At 30, I was five years over the age limit of 25, but because I was so enthusiastic, they made an exception for me. I did a 12-week personal development course, which included work experience and community projects. When I finished the programme, the college offered me a job. I now work on a number of programmes aimed at getting young people into work, education or training.
I work with many vulnerable people: ex-offenders, asylum seekers and recovering addicts. Because of my experiences, I can see where they are coming from.
I'm 36 now, and I'd never go back to my old life. The college gave me a second chance and I am so grateful for that. Now I have a reason to get up in the morning and I love it.
· Cheryl Powell is a training officer in the work-based learning department at City College, Plymouth
source: The Guardian
Monday, April 7, 2008
Renovated Limen House for Women renews its commitment to sobriety
WILMINGTON -- Just as they celebrated the completion of a massive renovation project, supporters and staff of the Limen House for Women rededicated themselves to a mission of mercy.
"It's about saving lives," said Sister Margie Walsh, drug and alcohol counselor at the halfway house -- whose name, Limen, comes from a psychological term for threshold. "It represents human beings who have been restored to sanity."
Many see symbolism, too, in the house, a rescue job itself. Built in 1899, the stately three-story house on North Broom Street was spared the wrecking ball and restored from a state of boarded-up windows and deterioration. Many of the guests at a weekend reception there said the house has never looked better.
Beyond celebrating completion of donation-financed renovations, including an electrical system replacement and extensive repainting, supporters at the reception honored not only those who changed their lives here, but all who established it and kept the place going.
Former executive director Tommie Reid, who traveled from Virginia for the rededication, said many alcohol-recovery programs closed decades ago after overextending themselves by trying to be all things to all people. Vocational, emotional and medical needs also are important -- and Limen House residents get such support -- but the house succeeds by staying focused on recovery, Reid said.
The recovery aspect of the program, where women 18 and older live at least a year, is based on the 12 steps of Alcoholics Anonymous, board of directors President Gini Rogers said.
Since opening in 1973, the nonprofit house has served about 250 residents, Rogers said.
The residential therapeutic treatment program for recovering alcoholics began with its men's house, which opened in 1969 and is believed to be the nation's oldest continuously operating halfway house for recovering alcoholics. Limen House was created by St. Andrew's Episcopal Church of Wilmington, which raised private donations to run the program, named it and assembled its first board of directors.
Aside from longevity, Limen House is singular, Executive Director Reginald Irby said, because it is the only facility of its type in Delaware and is not part of any other program, hospital or business. Mainly run on donations, Limen House receives limited funds from the state and through United Way.
Among its requirements are that residents share chores, plan and make meals, and find and keep employment, all while developing their sobriety in what Reid called "a little tough love."
As a resident, she recalled, "we got up and we lived without drinking ... and nobody was honey-babying us."
New residents arrive with little left and their lives broken.
"They come in with just the clothes they are wearing," said Debbie Pisan, counselor in training.
By the time they leave, Rogers said, they have changed their habits to those of sober living, having gained employment and worked long enough to have cars and bank accounts as well as established support systems, including a sponsor they can reach out to in any sobriety-threatening crisis.
The weekend celebration also included the house's rededication as the Irene Rego Residence, honoring a resident who became executive director.
Next year, the Limen House for Women will mark its 40th year with celebrations, Dana Edwards told Saturday's crowd of fellow Limen House supporters in its refurbished foyer, lit by its original hanging light, restored by a donor.
Because of donations, which also included wallpapering and window treatments given by Mary Cairns Interiors, the renovation project's value topped its $150,000 cost, Irby said, acknowledging grants including support from the Gannett Foundation, the charity program of The News Journal's parent company.
Edwards thanked supporters on behalf of the women whose lives have changed here -- or can in the future because of their help -- saying, "It couldn't be done without all of you."
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source: Delaware Online
Sunday, April 6, 2008
LOS ANGELES -- Steven Ford was 18 when his father was sworn in as the 38th president of the United States.
"I was getting ready to go to college," said Ford, who will share his story with guests at the ninth annual Oaklawn Spring Spectacular on May 9. "When my dad became president, I decided to take a year off to get used to his being president."
So he headed west toward a longtime dream and started working on ranches.
"When my dad was in the White House, I was cowboying and rodeoing," said Ford, who has never lost his love for the "wild west."
The third of Gerald and Betty Ford's four children, he shared his urge for ranching with a desire to be an actor. Today, he has the best of both worlds, with a little ranch in California and intermittent side trips to movie and TV locations.
But first he studied range management at Utah State University and majored in animal science and equine studies at California Polytechnic State University.
"I thought I was going to run a ranch," he said, an ambition that proved a bit difficult with 10 Secret Service agents always around.
In '81, he earned the role for which most longtime fans of CBS hit daytime drama "The Young and the Restless" remember him, private investigator Andy Richards. It was an assignment he carried out until 1987 and again, briefly, in 2002.
"Soap fans are the best," Ford said, noting that daytime audiences then numbered between 9 million and 10 million, a long way from the estimated 2 million today. But the years don't matter.
"I can always spot a fan," he said. "I know by the way they look at me that they've recognized me."
And he is not complaining. His cinematic career includes "When Harry Met Sally," "Black Hawk Down," "Heat" and "Escape from New York."
His entry into the world of keynote speaking was another oblique segue. As an actor, "I was around some great storytellers," Ford said. "Ben Johnson, Slim Pickens, Roy Rogers ... all great storytellers. I think it was the combination of being an actor and being around great storytellers that did the trick. I'd tell some White House stories and my friends said put seven or eight together and do a speech."
And that's just what he did, except the stories expanded from tales of life in the White House to include some of his experiences with his mother's alcoholism and his own.
But not right away.
Ford, who has 14 years of sobriety, said he is able to talk about some of those issues because of his own experiences.
"Early on, I never talked about it to anybody," he said. "Betty Ford's son should have known better."
He started his sobriety because "life was going to come crashing down if I didn't" and plunged into the Alcoholic Anonymous program with no rehab prelude anywhere ... not even the Betty Ford Clinic.
"There was no family rate," he joked. "So it was AA and a lot of very hard work."
His life is now divided according to a somewhat academic calendar, speaking engagements from September through May, with time for a TV show or movie in the summer.
"A wise person in the program told me to keep my mouth shut for six years and work the program, then maybe I'd have something to offer," he said. He did and eventually began with talks in schools and for corporations
"I want the audience to walk away feeling that the White House is more personal to them," Ford said, adding with a chuckle, "When you can't afford Bill Clinton or George Bush Sr., you can afford me. You get the same stories but a lot cheaper.”
Saturday, April 5, 2008
Inherited variations in the amount of an innate anxiety-reducing molecule help explain why some people can withstand stress better than others, according to a new study led by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH).
"Stress response is an important variable in vulnerability to alcohol dependence and other addictions, as well as other psychiatric disorders," noted NIAAA Director Ting-Kai Li, M.D. "This finding could help us understand individuals' initial vulnerability to these disorders."
Scientists led by David Goldman, M. D., chief of the NIAAA Laboratory of Neurogenetics, identified gene variants that affect the expression of a signaling molecule called neuropeptide Y (NPY). Found in brain and many other tissues, NPY regulates diverse functions, including appetite, weight, and emotional responses.
"NPY is induced by stress and its release reduces anxiety," said Dr. Goldman. "Previous studies have shown that genetic factors play an important role in mood and anxiety disorders. In this study, we sought to determine if genetic variants of NPY might contribute to the maladaptive stress responses that often underlie these disorders." A report of the findings appears online today in Nature.
Analyses of human tissue samples led by researchers at NIAAA identified several NPY gene variants. Collaborations with NIH-supported scientists at the University of Michigan, University of Pittsburgh, University of Helsinki, University of Miami, University of Maryland, the University of California at San Diego, and Yale University, showed that these variants result in a range of different effects including altered levels of NPY in brain and other tissues, and differences in emotion and emotion-induced responses of the brain.
The researchers evaluated the NPY gene variants' effects on brain responses to stress and emotion. Using functional brain imaging, they found that individuals with the variant that yielded the lowest level of NPY reacted with heightened emotionality to images of threatening facial expressions. "Metabolic activity in brain regions involved in emotional processing increased when these individuals were presented with the threatening images," explained Dr. Goldman.
In another brain imaging experiment, people with the low level NPY variant were found to have a diminished ability to tolerate moderate levels of sustained muscular pain. Previous studies had shown that NPY's behavioral effects are mediated through interactions with opioid compounds produced by the body to help suppress pain, stress, and anxiety. "As shown by brain imaging of opioid function, these individuals released less opioid neurotransmitter in response to muscle discomfort than did individuals with higher levels of NPY," said Dr. Goldman. "Their emotional response to pain was also higher, showing the close tie between emotionality and resilience to pain and other negative stimuli."
In a preliminary finding, the low level NPY gene variant was found to be more common than other variants among a small sample of individuals with anxiety disorders. The researchers also found that low level NPY expression was linked to high levels of trait anxiety. "Trait anxiety is an indication of an individual's level of emotionality or worry under ordinary circumstances," explained Dr. Goldman.
The researchers conclude that these converging findings are consistent with NPY's role as an anxiety-reducing peptide and help explain inter-individual variation in resiliency to stress. "This inherited functional variation could also open up new avenues of research for other human characteristics, such as appetite and metabolism, which are also modulated by NPY," said Dr. Goldman.
source: Science Daily
Friday, April 4, 2008
For many untreated alcoholics, there may be an alternative to staying in a specialized facility for weeks.
The proposed alternative is the family doctor.
New research says the primary care physician's office can become the new base for alcoholism treatment.
Doctors can prescribe new drugs that help alcoholics start treatment and stay sober, refer them for outpatient behavioral therapy and also direct them to local support groups -- never requiring a stay in a residential rehab facility, according to an article published last December in the Journal of the American Medical Association .
Jim Cowser, a chemical dependency therapist in the Center for Behavioral Health at Baptist Hospital East, thinks it is a treatment model that is long overdue for some people who abuse alcohol. For example, "women who are single parents can't just leave for a month to go to an alcoholism facility," he said.
Some people who are abusing alcohol also face employment issues or lack insurance that covers a residential facility, Cowser noted.
New drugs are a big part of the reason for the shift to more office-based treatment, according to the JAMA article. In April 2006, the Food and Drug Administration approved an injectable form of the drug naltrexone, which curbs alcohol cravings. An injection lasts for a month, greatly aiding patients who use it on their journey to abstinence. The same drug in the oral form has to be taken daily, and it's easy for a patient to skip pills and start drinking.
"If they are planning a bender, they can stop taking their oral naltrexone on Thursday and be able to feel the effects of alcohol again on Friday," Cowser said.
Naltrexone blocks opioid receptors involved in the rewarding effects of drinking alcohol and the craving for alcohol after establishing abstinence. It has been shown to reduce relapse among heavy drinkers. It also has been shown to benefit patients with a family history of alcohol problems.
Another drug in the family physician's arsenal is acamprosate, which is used when patients have been abstinent, not while they are still drinking, or it may not work. It affects the biochemical systems involved in alcohol dependence.
Acamprosate is taken several times a day, said Dr. Billy O. Barclay, a Louisville psychiatrist who treats patients at University Hospital and the Norton Psychiatric Center. He said taking pills that often can represent a challenge for some patients, while others use the act of taking their pills as a frequent reminder that they are trying to stay sober.
There is also disulfiram, a long-available drug for treating alcoholics. It interferes with the activity of the liver enzyme that processes and metabolizes alcohol. A person on disulfiram becomes ill if alcohol is consumed.
Physicians are also turning to topiramate, an anti-convulsive drug, which has not been approved by the FDA for treating alcoholism, but is being prescribed off label to help alcoholics stay sober.
"I think the fact that this medication is being looked at in this way is good. It's going to lead to better things and the use of drugs (for treating alcoholism) that doctors in general are used to."
For now, topiramate is out of reach for many patients, Barclay said, because it is expensive, and insurance often doesn't pay for it.
Cowser and Barclay both said that some patients who suffer with alcohol dependency regard taking any medication as another form of dependence on chemicals and refuse.
"People have all kinds of attitudes that prevent the use of these medications," Barclay said.
"They feel the only solution is abstinence and have a sense that to take anything is a crutch or cop-out," Cowser reported.
He said the use of medications need not be long-term. "I have worked with people who stopped the medication after a few months and did well. Some have used them for a year or two. They are usually not taken for the rest of your life," he said.
After abstaining from alcohol, it takes the brain a year or two to recover, Cowser noted.
Barclay said the role a primary care physician plays in helping a patient fight alcoholism may depend on the physician's interest in the problem.
"Some are gun-shy about it and quickly refer a patient to a specialist. Some have more experience and interest in it and might do a nice job of it," he said.
"There are studies that show that even brief interventions about smoking by a family doctor make a difference," Barclay said. Perhaps that would prove to be true of family-doctor interventions with the addiction to alcohol as well, he suggested.
Doctors step up
"I'm seeing a lot more confidence on the part of family doctors," Cowser said. "There is a very promising swing. A lot of people who have had a barrier to getting help with their alcohol problems are now able to start with their family doctor."
Dr. Mark Willenbring, director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism, recommends that physicians consult the NIAAA's recently updated "Helping Patients Who Drink Too Much: A Clinician's Guide."