Category Archives: Prescription drugs
FDA Recommends Tighter Regulations for Hydrocodone
The U.S. Food and Drug Administration (FDA) is recommending that products that contain hydrocodone be reclassified more restrictively, possibly putting them in the Schedule II category that already includes other opioid painkillers such as oxycodone and morphine. Products that contain less than 15 milligrams of hydrocodone, such as Vicodin, are currently classified as Schedule III controlled substances. The change would mean patients would need to present a written prescription at a pharmacy and could not get as many refills before returning to their doctors for a new prescription. While this would help limit access by addicts, these greater restrictions would also affect people with legitimate chronic pain, potentially placing undue hardship on their already painful conditions. The Drug Enforcement Agency (DEA) is pushing for the restrictions in an effort to combat the increasing problem of prescription drug abuse;
the change must be approved by the U.S. Department of Health and Human Services and the DEA, which will make a final scheduling decision. This Saturday is also National Prescription Drug Take-Back Day, sponsored by the DEA, when people can anonymously and safely dispose of expired or unused prescription medicines. Read more on prescription drugs.
ONC Releases New Online Security Tool for Disaster Preparedness
The Office of the National Coordinator for Health Information Technology (ONC), part of the U.S. Department of Health and Human Services, has released a new online security training tool to help health care providers and staff with contingency planning in the case of power outages, floods, fires, hurricanes or other events. Such events can damage important patient information, or even make it unavailable. "We know from recent experiences such as Hurricane Sandy, that these events can very adversely impact the delivery of health care," said ONC Chief Privacy Officer Joy Pritts. "We hope that this video game will raise awareness of contingency planning and help practices begin to develop their own disaster plans, backup and recovery processes and other vital activities." The "CyberSecure: Your Medical Practice” tool is available here. Read more on disasters.
Study: Kids with Concussion at Higher Risk for Depression
Children with concussions or other head injuries are at increased risk of later being diagnosed with depression, according to new findings to be presented today at the American Academy of Pediatrics national conference in Orlando, Fla. Researchers found that about 15 percent of children and teenagers who ever suffered a brain injury were later diagnosed with depression, compared to the national average of 4 percent. While the findings did not determine causation, they do suggest that doctors should make assessments or mood and behavior problems part of and follow-up treatment for head injuries. Read more on mental health.
In 2008, the U.S. Department of Veterans Affairs (VA) sent Army paratrooper Jeffrey Waggoner to an Oregon hospital to recover from an addiction to painkillers. However, once there they instead gave him a steady stream of medications, eventually releasing him for a weekend with 19 prescription drugs in hand. He was found dead of an overdose three hours later.
“As a parent, you’d want to know how this happened to your child,” said his father, Greg Waggoner, according to a new report from The Center for Investigative Reporting (CIR). “You send your child to a hospital to get well, not to die.”
In its investigation, CIR found that, post 9/11, the VA has increasingly been treating addictions with a variety of drugs, “feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.” Over the past dozen years, prescriptions for the four opiates hydrocodone, oxycodone, methadone and morphine have increased by 270 percent.
Waggoner’s weekend leave medications included 12 oxycodone pills.
As part of its investigation, CIR has created a comprehensive interactive tool that shows the VA systems with the highest prescription rates and allows users to search for information by region and system. The data is culled from CIR’s own research, as well as information from the VA and the U.S. Census Bureau.
Trust for America’s Health also recently released an interactive tool on the growing public health issue of prescription drug abuse—about 6.1 million Americans use or abuse prescription drugs. The tool allows users to search state-by-state prescription drug overdose death rates and find out how each scores on 10 key steps to curb abuse.
>>Read The Center for Investigative Reporting’s “VA’s opiate overload feeds veterans’ addictions, overdose deaths”
>>Read NewPublicHealth’s story, “New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse”
University of Maryland Study Shows Need for Improved Communication by Dental Professionals
New research from the University of Maryland School of Public Health found that a majority of dentists and dental hygienists are not regularly using recommended communication techniques with their patients that can contribute to improved oral health literacy and prevention of oral disease. The researchers, who published their findings in the Journal of Dental Hygiene, surveyed 540 Maryland dental hygienists to determine the frequency of the use of 18 recommended communication techniques to effectively communicate science-based information to patients. Only one basic technique—use of simple language—was used by more than 90 percent of dental offices, according to survey responders. The survey also found that dental professionals who had taken a communication course in a non-dental educational setting were more likely to regularly use varying types of communication techniques. Read more on health literacy.
Study: Online Medical Searches Not a Good Idea for People Who Struggle With Uncertainty, Anxiety
People who struggle with uncertainty and anxiety might want to stay away from online health information searches, according to a new study in the journal Cyberpsychology, Behavior and Social Networking. The study, which included 512 healthy men and women with a mean age of about 33, analyzed how online searchers affected their anxiety, as well as their reactions to statements such as "I always want to know what the future has in store for me" and "I spend most of my time worrying about my health." "If I'm someone who doesn't like uncertainty, I may become more anxious, search further, monitor my body more, go to the doctor more frequently—and the more you search, the more you consider the possibilities," said Thomas Fergus, an assistant professor of psychology and neuroscience at Baylor University. "If I see a site about traumatic brain injuries and have difficulties tolerating uncertainty, I might be more likely to worry that's the cause of the bump on my head." These persistent worries can increase the likelihood of worrying about potential medical bills, disability and job loss, which in turn can lead to even more online searches, doctors visits, unnecessary medical tests and stress. Read more about technology.
Study: TV Drug Ads Are Often Misleading
A study on the veracity of television drug ads by researchers at Dartmouth and the University of Wisconsin-Madison found that six out of 10 claims could potentially mislead a viewer. The study was published in the Journal of General Internal Medicine. The researchers found misleading claims among television ads for both prescription and nonprescription drugs, and that some of the ads omitted or exaggerated information. The researchers studied the 6:30 to 7 p.m. portion of nightly news broadcast, which often contains drug ads, and reviewed 168 different drug advertisements that aired between 2008 and 2010. Trained researchers classified the ads as truthful, potentially misleading or false. The researchers found only one in ten claims were false, while six in ten were misleading and included errors such as leaving out important information, exaggerating information, providing opinions or making meaningless associations with lifestyles. Read more on prescription drugs.
New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse
Prescription drug-related deaths now outnumber deaths from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C.
A new report about prescription drug abuse released today by Trust for America’s Health (TFAH), finds that few states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the U.S. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, shows that only two states – New Mexico and Vermont – have implemented all ten strategies.
According to the National Center for Injury Prevention and Control (NCIPC), nationally, sales of prescription painkillers per capita have quadrupled since 1999 – and the number of fatal poisonings due to prescription painkillers has also quadrupled. Enough prescription painkillers were prescribed in 2010 to medicate every American adult continually for a month.
>>Watch a one-minute video on the scope of the prescription drug abuse epidemic in the United States.
The report also found that the number of drug overdose deaths – a majority of which are from prescription drugs – has doubled in 29 states, tripled in ten states and quadrupled in four states since 1999.
“The rapid rise of abuse requires nothing short of a full-scale response – starting with prevention and education all the way through to expanding and modernizing treatment,” said Jeffrey Levi, PhD, executive director of TFAH. “There are many promising signs that we can turn this around – but it requires urgent action,” says Levi.
In the new report, TFAH, based on consultations with experts in public and clinical health, injury prevention, law enforcement and community organization, reviewed national recommendations and examined strategies currently in use to help curb the epidemic. Recommendations include expanding access to treatment options; ensuring responsible prescribing practices; and improving Prescription Drug Monitoring Programs.
>> Learn how your state scores on the 10 key steps to curb prescription drug abuse, with a new app from the Robert Wood Johnson Foundation.
Ohio is one of several states that have implemented six of the proven strategies recommended in the report and today, in fact, will introduce new prescriber guidelines.
NewPublicHealth spoke with Ted Wymyslo, MD, director of the Ohio Department of Health about that state’s review of drug abuse and recent efforts to reduce the epidemic through a variety of means, including public and provider education.
Average Monthly Cost of Mid-tier Insurance Under Affordable Care Act Estimated at $328
The average monthly cost of a mid-tier health insurance plan under the Affordable Care Act will be $328, and government subsidies will also help reduce that cost for most Americans, according to a new report from the U.S. Department of Health and Human Services. The health exchanges open for enrollment next week and the federal government hopes to enroll as many as 7 million people within the first year. The cost varies from state to state, with Minnesota projected to have the least expensive plan at $192 per month and Wyoming projected to have the highest at $516. Read more on access to health care.
NIH Initiative Will Help Move Science from the Laboratories to the Commercial Sector
The U.S. National Institutes of Health (NIH) has awarded $31.5 million in grants to establish three inaugural NIH Centers for Accelerated Innovations that will work to improve how basic science discoveries move from laboratories to commercial products. The Centers are funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) and will focus on technologies to improve the diagnosis, treatment, management and prevention of heart, lung, blood and sleep disorders and diseases. “These centers essentially will offer a one-stop shop to accelerate the translation of early-stage technologies for further development by the private sector and ultimate commercialization,” said Gary H. Gibbons, MD, director of NHLBI. As a result, the public will gain access sooner to new biomedical products that improve human health while also benefiting from the economic growth associated with the creation of new companies and the expansion of existing ones.” Read more on research.
‘Cycling’ Drugs Could Help Combat Antibiotic-resistant Bacteria
“Cycling” between antibiotics may extend their life and effectiveness, while also enabling doctors to stay ahead of drug-resistant bacteria, according to a new study in the journal Science Translational Medicine. "You cycle between drugs that have reciprocal sensitivities," said study co-author Morten Sommer, a lead researcher with the Novo Nordisk Foundation Center for Biosustainability at the Technical University of Denmark. "If you become resistant to drug A, you will become more sensitive to drug B. That way, you can cycle between drug A and drug B without increasing resistance in the long term.” With the increased use—and overuse—of antibiotics, antibiotic-resistant bacteria are becoming an increasingly serious public health problem, leading researchers and health care professionals in search of new ways to combat the problem. More than 2 million people are made ill and more than 23,000 people die every year in the United States due to antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.
Study: 40 Percent of Antibiotics Released from 1980-2009 Withdrawn from Market
Safety concerns, lack of effectiveness when compared to existing drugs and weak sales led more than 40 percent of the antibiotics released between 1980 and 2009 to be withdrawn from the market, according to a new study in the Journal of Law, Medicine and Ethics. The rate was three times as high as that for any other type of drug. “This study raises the question whether or not money would be better spent on higher quality antibiotics, rather than a larger quantity” and whether “approving a flood of new lower-quality antibiotics might actually trigger much higher levels of resistance,” said author Kevin Outterson, JD, LLM, professor at Boston University School of Law and co-director of the Boston University Health Law Program. Antibiotic use can lead to bacteria becoming resistant to a strain. A recent report from the U.S. Centers for Disease Control and Prevention found that as many as 50 percent of prescriptions for antibiotics are either not needed or prescribed inappropriately. Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process. Read more on prescription drugs.
Locations of Drinking Can Influence Types of Partner Violence
Where and when a person drinks can affect the type of partner violence that can follow, according to a new study from the journal Addiction. The study looked at six drinking locations: restaurants, bars, parties at someone else's home, quiet evenings at home, with friends in one's own home and in parks/other public places. Researchers from the Prevention Research Center in California and Arizona State University found that men drinking in bars and at partners away from home and women drinking in parks/other public places were linked with an increased rate of male-to-female violence. They also found that men drinking during quiet evenings at home was associated with increased female-to-male violence. The findings could help prevent partner violence by encouraging people in risky relationships not to drink in particular places/situations, which could prove more effective than counseling people simply to drink less. Read more on alcohol.
Multiple Myeloma Group Hopes Opening Records to Hundreds of Patients Will Advance Research
The Multiple Myeloma Research Foundation's (MMRF) Researcher Gateway is opening global online access to genetic and research data on hundreds of patients in an effort to help identify biological targets for future treatments, improve enrollment in studies by pairing them with the right patients and enhance researcher collaboration. The MMRF Research Gateway is a $40-million program funding by the foundation and drug company partners. The main component of the effort will be the Commpass study which will enroll 1,000 new multiple myeloma patients and monitor them throughout the course of the disease; cancer tissue banks typically include only one sample per patient. "There is going to be new information generated there that you would never get unless you followed patients through first relapse and second relapse and beyond," said George Mulligan, director of translational medicine for Millennium Pharmaceuticals, Japan's Takeda Pharmaceutical Co.’s oncology unit, which is one of the co-sponsors. "The size of it in patient numbers and the breadth and richness of it on a biological level, it's going to grow over time and mushroom into something that's going to be really special.” About 86,000 people are diagnosed with multiple myeloma each year, with about 20,000 of those from the United States. Read more on research.
For the last several years, each incoming president of the Association of State and Territorial Health Officials (ASTHO) has introduced a President’s Challenge for the year of their presidency to focus attention on a critical national health issue. Previous challenges have included injury prevention, health equity and reducing the number of preterm births. This year, incoming ASTHO president Terry Cline, PhD, will focus his President’s Challenge on prescription drug abuse, a national public health crisis that results in tens of thousands of deaths each year.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Just before the ASTHO annual meeting began, NewPublicHealth spoke with Cline about the scope of the issue and steps Cline will introduce to help health officers collectively focus their attention on reducing this public health crisis.
NPH: Why have you chosen prescription drug abuse as your President’s Challenge?
Terry Cline: If you look at the trend lines in the United States, we’ve seen a very rapid increase in the number of deaths from the misuse of prescription drugs. We’ve also seen a huge increase in the number of children born with neonatal abstinence syndrome, which has actually tripled in the last decade. Prescription drug abuse has created an incredible burden on the health of people in the United States. Deaths are just one indicator; others include lost productivity, absenteeism and health care costs. Just using neonatal abstinence syndrome as an example, in 2000 the total hospital charges were about $190 million and in 2009, which is the last year we have that data, it was $720 million. Because in many states Medicaid pays for a large percentage of the births, in 2000 that amount was about $130 million out of the $190 million, and in 2009 it was $560 million of the $720 million. So that is becoming a larger and larger financial burden on states as well, and that does not include the long-term effects on babies.
The President’s Challenge will be looking at the absolute number—bringing down the number of deaths, which stand at more than 16,000 deaths per year. We’ve seen opioid deaths increase and continue every year over the last decade. And in most states now, the number of deaths from prescription drugs is actually greater than the number of deaths from automobile accidents, which has steadily gone down over the last decade. So, one is an example of a public health success; the decrease in motor vehicle deaths stems from a comprehensive approach and work with multiple sectors to bring that death rate down. The other, prescription drug deaths, is an alarming increase. My hope is that with the President’s Challenge, we can really increase awareness and leverage public health agencies across the country to mobilize around this issue.
Antibiotic-resistant Infections on the Rise; Threat Called "Urgent"
Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The report ranked the threats according to seven factors, including health impact, economic impact, how common the infection is and how easily it is spread. It classified carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile as “urgent." C. difficile alone causes about 250,000 hospitalizations and at least 14,000 deaths each year. Excessive antibiotic use is the number one cause of the increase in antibiotic-resistant infections, with as many as 50 percent of prescriptions either not needed or prescribed inappropriately. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.” Antibiotic-resistant infections also add as much as $20 billion in excess direct health care costs and account for as much as $35 billion in lost economic productivity. Read more on prescription drugs.
Survey: Nearly 80 Percent of College Students Oppose Concealed Handguns on Campus
Nearly 80 percent of the students in 15 Midwestern colleges and universities oppose allowing concealed handguns on their campuses, according to a new study in the Journal of American College Health. Ball State University researchers surveyed 1,649 undergraduate students, finding 78 percent were against the handguns and would not apply for a permit if they were legal. “Firearm morbidity and mortality are major public health problems that significantly impact our society,” said study co-author Jagdish Khubchandani, a member of Ball State’s Global Health Institute and a community health education professor in the university's Department of Physiology and Health Science. “The issue of allowing people to carry concealed weapons at universities and colleges around the U.S. has been raised several times in recent years. This is in spite of the fact that almost four of every five students are not in favor of allowing guns on campus.”
The study also found that:
- About 16 percent of undergraduate students own a firearm and 20 percent witnessed a crime on their campus that involved firearms
- About 79 percent of students would not feel safe if faculty, students and visitors carried concealed handguns on campus
- About 66 percent did not feel that carrying a gun would make them less likely to be troubled by others
- Most students also believed that allowing concealed carry guns would increase the rate of fatal suicides and homicides on campus
Read more on violence.
‘Bath Salts’ Drugs Led to 23,000 ER Visits in 2011
The use of “bath salts” drugs accounted for almost 23,000 emergency department visits in the United States in 2011, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The report is the first national study to analyze the link between the street drugs and emergency department visits. "Although bath salts drugs are sometimes claimed to be 'legal highs' or are promoted with labels to mask their real purpose, they can be extremely dangerous when used," said Elinore McCance-Katz, MD, SAMHSA's chief medical officer. The drugs can cause heart problems, high blood pressure, seizures, addiction, suicidal thoughts, psychosis and even death. About two-thirds of the visits also involved at least one other drug, with 15 percent of the visits also being linked to marijuana or synthetic forms of marijuana. There were approximately 2.5 million U.S. emergency department visits linked to drug misuse or abuse in 2011. Read more on substance abuse.
EHRs Linked to Lower Rates of Hospitalization
The use of electronic health records (EHRs) is linked to lower rates of hospitalization, according to a new study in the Journal of the American Medical Association. Researchers tracked approximately 170,000 people treated for diabetes between 2005 and 2008, finding that changing from paper records to EHRs was associated with a decrease in hospitalizations of between 5 and 6 percent. There was no link to a change in the number of overall doctors’ office visits. The U.S. government has committed about $30 billion for the widespread implementation of EHRs. Rainu Kaushal, MD, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York, who was not involved in the study, said while the study shows that investment in EHRs is important, it is also just one piece of what needs to be done to improve overall care. "An EHR is a critical infrastructural tool to change the way in which healthcare is delivered, but it is one of a set of tools that needs to be employed," she said. "It's when you start getting those pieces together…that you really start finding some significant changes in utilization." Read more on technology.
FDA Proposes Stronger Safety Labels of Opioids
In response to the growing public health problem of opioid-related overdose and death, the U.S. Food and Drug Administration (FDA) is calling for stronger safety labeling for long-acting and extended-release opioids. New labeling will emphasize both the dangers of abuse and possible death—there were 16,651 in 2010, according to FDA—and the risk for women who are pregnant. "The FDA is invoking its authority to require safety labeling changes and postmarket studies to combat the misuse, abuse, addiction, overdose and death from these potent drugs that have harmed too many patients and devastated too many families and communities," said FDA Commissioner Margaret Hamburg in a release. “Today’s action demonstrates the FDA’s resolve to reduce the serious risks of long-acting and extended release opioids while still seeking to preserve appropriate access for those patients who rely on these medications to manage their pain.” Read more on prescription drugs.
IOM: Nation Faces Looming ‘Cancer Crisis’
An aging population, rising health care costs, the complexity of care and other issues are leading the United States toward a future cancer crisis, according to a new report from the Institute of Medicine (IOM). Current estimates predict as many as 2.3 million new cancer diagnoses per year by 2030, with the total cost of cancer care expected to climb to $173 billion by 2020. The report concluded that what’s needed is a shift toward patient-centered, evidence-focused care. "Most clinicians caring for cancer patients are trying to provide optimal care, but they're finding it increasingly difficult because of a range of barriers," said Patricia Ganz, chairwoman of the committee that wrote the report and a professor at the School of Medicine and School of Public Health at the University of California, Los Angeles. "As a nation, we need to chart a new course for cancer care. Changes are needed across the board, from how we communicate with patients to how we translate research into practice to how we coordinate care and measure its quality." Read more on cancer.
CDC: 200,000 Lives Lost Each Year to Preventable Heart Disease, Stroke
Healthier living and improved preventative efforts could help save more than 200,000 U.S. lives lost each year to preventable heart disease and stroke, according to a new report from the U.S. Centers for Disease Control and Prevention. That’s approximately one in four of heart disease deaths. More than half of those deaths were people younger than 65, with blacks twice as likely as whites to die of the preventable conditions and men more likely than women. Still, the overall rate fell approximately 30 percent from 2001 to 2010. To further improve these rates, health care providers should encourage healthy habits such as not smoking, increasing physical activity, eating a healthy diet, maintaining a healthy weight and taking medicines as directed. At the community level, health departments can promote healthier living spaces, including tobacco-free areas and safe walking areas, as well as access to healthy food options. Read more on heart health.
Patients More Likely to Take Multiple Medications When Combined in Single Pill
Patients are more likely to take multiple medications if they are combined into a single pill—or “polypill”—according to a new study in the Journal of the American Medical Association. This finding could be especially important for people dealing with chronic conditions such as heart disease, who are often prescribed a combination of blood pressure medication, cholesterol medication and aspirin to break up blood clots. Only about half the patients in prosperous countries take all three prescribed pills and as few as 5 percent of patients in developing countries do so. One of the obstacles is simply remembering to take the many medications on time. "The simplification of the delivery of care we provide to our patients is a significant part of the improvement we can gain by this type of strategy," said David May, MD, chair of the board of governors for the American College of Cardiology. "Oftentimes we become enamored with the idea of how much improvement we get with this or that medication, on top of the other drugs a patient has been prescribed. The short answer is, if they don't take it, you don't get any improvement." Read more on prescription drugs.
Common Hospital Infections Cost $10B Annually
In addition endangering patients’ health and lives, the five most common hospital-acquired infections cost the U.S. health care system an estimated $10 billion annually, according to a new study in the journal JAMA Internal Medicine. About one in 20 patients contract an infection after being admitted to a hospital, according to the U.S. Centers for Disease Control and Prevention, and studies indicate that as many as half may be preventable. The found that central line-associated bloodstream infections averaged about $45,000 per case, pneumonia infections that lead to ventilators cost about $40,000 per case and surgical site infections—a result of about one in 50 operations—cost about $21,000 per case. In a previous study, Trish Perl, MD, a professor of medicine and pathology at the Johns Hopkins School of Public Health in Baltimore, found that eliminating surgical site infections alone would save the four hospitals in the Johns Hopkins Health System approximately $2 million in revenue each year. Perl was not involved in the new study. Read more on infectious diseases.