Category Archives: Substance Abuse
A new database on pain research established by the National Institutes of Health (NIH) and several other federal agencies might help practitioners choose more effective and safer options for their patients dealing with pain. It could also potentially reduce reliance on opioid drugs, which often turns patients into addicts and creates an easy source of the drugs for potential abusers.
The database, launched last week, is called the Interagency Pain Research Portfolio (IPRP) and offers information on federal pain research projects. According to the NIH, pain is a symptom of many disorders and can be a disease itself; the economic cost of pain is estimated to be hundreds of billions of dollars annually in lost wages and productivity.
“This database [allows] the public and the research community...to learn more about the breadth and details of pain research supported across the federal government. They can search for individual research projects or sets of projects grouped by themes uniquely relevant to pain,” said Linda Porter, PhD, Policy Advisor for Pain at the National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH.
Both in public speeches and private briefings with reporters, U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, has called on physicians to find alternatives to narcotics for pain patients when medically advisable, such as guided imagery and other forms of relaxation. He’s also called for starting with less potent medications than narcotics, in order to reduce the chance of addiction and to introduce far fewer amounts of prescription drugs into the community where they are often taken from medicine cabinets by people—especially young adults—for whom they’re not prescribed. According to the Substance Abuse and Mental Health Administration, approximately 22 million people nationwide have taken narcotic pain relievers for non-medical reasons.
U.S. Food and Drug Administration head Margaret Hamburg, MD, also spoke on the subject during a town hall meeting last week on prescription drug abuse, hosted by the Johns Hopkins School of Public Health and the Clinton Foundation. Hamburg said that “we need to recognize that opiates are... probably most often not the treatment strategy of first choice...but it may be the option a provider knows best. We need to actively engage with the scientific research community and industry to try to develop new non-opiate, non-addictive pain strategies...”
Recent decisions by a number of states to legalize, or consider legalizing, marijuana has prompted the National Institute on Drug Abuse (NIDA) to update two guides: Marijuana Facts for Teens and Marijuana: Facts Parents Need to Know.
According to NIDA, marijuana remains the most abused illegal substance among young adults. By the time they graduate high school, about 46 percent of U.S. teens will have tried marijuana at least once. And although marijuana use among teens dropped dramatically in the last ten years, use of the drug is on the upswing again. Approximately 12.4 percent of students reported use in the month before being surveyed in 2007; in 2013, nearly 23 percent of high school seniors reported current marijuana use and 6.5 percent used marijuana daily.
NIDA’s annual Monitoring the Future survey, which has been tracking teen attitudes and drug use since 1975, shows that use of marijuana over time is directly related to how safe teens perceive the drug to be. The most recent survey shows that the number of teens who think marijuana users risk harming themselves is declining, even though studies have shown that the impacts of marijuana use can include a permanently lower IQ, poor school performance, psychosis, panic and impaired driving. A study earlier this month in JAMA Pediatrics found that college-age men dispute the idea that marijuana can impact their driving.
“The subject of marijuana use has become increasingly difficult to talk about—in part, because of the mixed messages being conveyed by the passage of medical marijuana laws and legalization of marijuana in some states,” said NIDA director Nora Volk. “In addition, many parents of today’s teens may have used marijuana when they were younger, which could make talking openly and setting definitive rules about its use more difficult.”
“Sometimes,” he added, “just beginning the conversation is the hardest part. I hope these booklets can help.”
The updated booklets include new data on marijuana use; new evidence-based information on the potential harms of marijuana; and information on the highly dangerous and even lethal K2/Spice, also referred to as synthetic marijuana.
Marijuana Facts for Teens is also available in print; Marijuana: Facts Parents Need to Know will be available in print soon.
>>Bonus Link: Read an interview with Alexander Wagenaar, PhD, a Professor in the Institute for Child Health Policy at the University of Florida, who recently moderated a webinar on the public health perspectives of legalizing marijuana.
Living Near Foreclosed Property is Linked to Higher Blood Pressure
Living near foreclosed property may increase the risk of higher blood pressure, according to new research published in the American Heart Association journal Circulation. Researchers reviewed data from 1,740 participants (mostly white, 53 percent women) in 1987-2008 in the Framingham (Massachusetts) Offspring Cohort, which is part of the Framingham Heart Study. The researchers distinguished between real-estate-owned foreclosures, which are owned by lenders and typically sit vacant, and foreclosures purchased by third-party buyers, which are generally put into housing use. The researchers found each additional foreclosed property within 100 meters (328 feet) of participants’ homes was associated with an average increase of 1.71 mm Hg in systolic blood pressure. The association only applied to properties that were real-estate owned and there was no effect from foreclosed properties more than 100 meters from participants’ homes.
“The increases in blood pressure observed could be due in part to unhealthy stress from residents’ perception that their own properties are less valuable, their streets less attractive or safe and their neighborhoods less stable,” said Mariana Arcaya, Sc.D., M.C.P., study lead author and a research fellow at the Harvard Center for Population and Development Studies in Cambridge, Mass. “Safety could also be a concern that affects their ability to exercise in these neighborhoods.”
Research on different populations in urban and rural settings is needed, says Arcaya. The study was funded by the Robert Wood Johnson Foundation, the Harvard School of Public Health and the National Institutes of Health and the Robert Wood Johnson Foundation funded the study. Read more on prevention.
Underage College Men Downplay Danger of Driving after Using Marijuana
Underage male college students who report using marijuana in the month before they were surveyed had a high prevalence of driving under the influence of marijuana and of riding with a marijuana-using driver, at a rate more than double that of driving or riding after alcohol use, according to a recent study by researchers from the University of Massachusetts Amherst School of Public Health and Health Sciences and University of Washington pediatrics department. The researchers also found that among marijuana-using students, 44 percent of males and 9 percent of females drove after using the drug, and 51 percent of males and 35 percent of females rode as a passenger with a marijuana-using driver. The researchers say the study results reflect the widespread belief that driving after using marijuana is safe and that strategies to dispute that belief are needed to help change social norms and encourage using a designated driver not only after alcohol use, but after a driver has used any risky substance. The study was published in JAMA Pediatrics. Read more on substance abuse.
Moderate Exercise Reduces Premature Death Risk in Older Men
Older men with hypertension can lower their risk of premature death with even moderate levels of exercise, according to a new study in Hypertension. The researchers say the needed level of fitness can be achieved by a brisk twenty to forty minute walk on most days. The researchers reviewed the fitness levels of 2,153 men, aged 70 years and older with high blood pressure by a standard treadmill exercise test, using a standard measure of fitness called metabolic equivalents (METs.) An MET is equal to the amount of oxygen the body uses per kilogram of body weight per minute. The peak MET level of a sedentary 50-year-old is about five to six METs; for a moderately fit individual it’s about seven to nine METS; and for a highly fit person it’s 10 to 12 METs. (Marathon runners, cyclists and other long distance athletes often have MET levels of 20 or higher.)
After an average follow-up of nine years, researchers found that the risk of death was 11 percent lower for every one-MET increase in exercise capacity:
- Those in the low-fit category (4.1 to 6 peak METs) had an 18 percent lower risk of death.
- Moderately-fit men (6.1 to 8 peak METs) had a 36 percent lower risk of death.
- High-fit men with peak METs of more than 8 reduced the risk of death by 48 percent.
Read more on heart health.
RWJF Issue Brief Explores Links Between Education and Health
Why is education such a major factor in shaping health? The links are tied closely to income and to the opportunities that people have to lead healthy lives, according to a new issue brief from the Robert Wood Johnson Foundation. Factors such as social networks, early childhood experiences and the type of neighborhood you live in all play a role in connecting education levels to health outcomes. The issue brief and video explore these connections and highlight their impacts through the perspectives of residents of a disadvantaged urban community in Richmond, Va. This is the second brief in a four-part series by the Virginia Commonwealth University Center on Society and Health’s Education and Health Initiative. Read more on education.
Parents with Kids in Car Often Engage in Distracted Driving
Parents with kids in tow are just as likely to engage in distracted driving practices as are drivers in the general population, according to a new study by researchers at the University of Michigan and published in Academic Pediatrics. The study, conducted in two hospital emergency rooms, found that 90 percent of parent drivers said they engaged in at least one of ten distractions examined in the study while their child was a passenger and the vehicle was moving. Distractions included talking on a cell phone, texting, giving a child food and picking up a toy that fell. Each year more than 130,000 children younger than 13 are treated in U.S. emergency departments after motor-vehicle collision-related injuries. The researchers also found that parents with higher education and who were non-Hispanic whites were more likely to report cellular phone and directions-related distractions such as use of navigation systems.
"If this finding is a result of greater access to technology among more highly educated and non-Hispanic white parents, we can expect the problem of technology-based distractions to expand because national rates of cell phone ownership in the U.S. have climbed above 90 percent," said Michelle L. Macy, MD, MS, an emergency medicine physician at the University of Michigan's C.S. Mott Children's Hospital. "Efforts to improve child passenger safety have often focused on increased and proper use of restraining seats. But this study shows that reducing distractions and discouraging unsafe behaviors could prevent crashes.” Read more on injury prevention.
SAMHSA Launches First Spanish-language Web Pages for National Prevention Week
The Substance Abuse and Mental Health Services Administration (SAMHSA) recently launched a series of new Web pages in Spanish to engage the Hispanic/Latino community in SAMHSA’s third annual National Prevention Week. The observance focuses on increasing public awareness of and action around substance abuse and mental health issues. New resources include instructions for participating in SAMHSA’s “Yo elijo” (“I Choose”) Project, Web badges and a 15-second promotional video in Spanish about the observance. Read more on substance abuse.
OSHA Urges Post-Storm Vigilance for Clean Up Workers and the Public
As much of the country begins the cleanup following massive storms since the weekend, the U.S. Department of Labor's Occupational Safety and Health Administration (OSHA) is urging workers and the public to be aware of the hazards they can encounter and take necessary steps to stay safe. Storm and tornado cleanup work can involve hazards related to restoring electricity, communications, water and sewer services. Other hazards relate to demolition activities; cleaning up debris; tree trimming; structural, roadway and bridge repair; hazardous waste operations; and emergency response activities. Information on safe cleanup is available on OSHA’s website. Read more on preparedness.
Study: More ‘Masculine’ and ‘Feminine’ Youth at Higher Risk for Cancer-risk Behaviors
The most “feminine” girls and the most “masculine” boys are also the most likely to engage in behaviors that pose cancer risks, according to a new study in the Journal of Adolescent Health. Researchers at the Harvard School of Public Health (HSPH) analyzed data on 9,354 adolescents in the ongoing Growing Up Today Study, finding that cancer-risk behaviors such as tobacco use, indoor tanning and physical inactivity were significantly more common in adolescents who more closely adhered to the traditional societal norms of masculinity and femininity. "Our findings indicate that socially constructed ideas of masculinity and femininity heavily influence teens' behaviors and put them at increased risk for cancer,” said lead author Andrea Roberts, research associate in the Department of Social and Behavioral Sciences at HSPH. “Though there is nothing inherently masculine about chewing tobacco, or inherently feminine about using a tanning booth, these industries have convinced some teens that these behaviors are a way to express their masculinity or femininity." Read more on cancer.
Study: Casual Marijuana Use Can Cause Dangerous Changes in Youths’ Brains
Casual marijuana use in young people can lead to potentially harmful changes in the brain, according to a new study in the Journal of Neuroscience. Researchers from Northwestern University's medical school, Massachusetts General Hospital and Harvard Medical School determined that casual marijuana smoking—defined as one to seven joints per week—could lead to changes to the nucleus accumbens and the nucleus amygdale, which help regulate emotion and motivation. "What we're seeing is changes in people who are 18 to 25 in core brain regions that you never, ever want to fool around with," said co-senior study author Hans Beiter, PhD, professor of psychiatry and behavioral sciences at Northwestern University, according to Reuters, adding, "Our hypothesis from this early work is that these changes may be an early sign of what later becomes amotivation, where people aren't focused on their goals.” Read more on substance abuse.
CDC: ‘Herd Immunity’ Helped Reduce H1N1 Flu Strain’s Impact This Season
While the H1N1 influenza strain was the predominant strain in the United States this past flu season, prior widespread exposure and its inclusion in the current flu vaccine meant it did not have nearly the impact it did in 2009, according to the U.S. Centers for Disease Control and Prevention (CDC). According to Michael Jhung, MD, a medical officer in the CDC’s influenza division, an overall “herd immunity” helped stop this season from turning into the worldwide pandemic seen in 2009. "This year, not only do we have a vaccine that works well, but millions of people have already been exposed to the H1N1 virus," he said, according to HealthDay. The flu strain also hit differently this season, peaking earlier, although once again younger adults were affected more than the elderly. Read more on the flu.
On Thursday, April 17, from 1-2 p.m. (ET), the Network for Public Health Law, Public Health Law Research and the American Society of Law Medicine and Ethics (ASLME) will be holding a free webinar around public health perspectives on regulating non-medical marijuana in states where it has been made legal or decriminalized. Whatever course a state may take, public health’s expertise and experience in public policy means it should be a major voice in the discussion surrounding legislation from the very start. The issue is a critical one now as Colorado and Washington State have legalized the commercial production, distribution and sale of marijuana for non-medical use and a number of other states are considering similar legislation.
“Policy-makers, advocates and others are grappling with how to process licenses, develop regulations and manage production in an industry that is still largely illegal both in the U.S. and around the world,” said Alexander Wagenaar, PhD, Professor in the Institute for Child Health Policy at the University of Florida who will be the moderator for the webinar.
The webinar’s aim is to provide an overview of issues related to non-medical marijuana regulation through, among other things, the lessons learned from decades of alcohol and tobacco regulation and through insights from Washington State’s recent implementation of a marijuana law with participant Laura Hitchcock, JD, Policy, Research & Development Specialist in the public health department of Seattle & King County in Washington State. Additional speakers include Beau Kilmer, PhD, Co-Director of the RAND Drug Policy Research Center and Amanda Reiman, PhD, the Policy Manager of the Drug Policy Alliance of California.
>>Register for the webinar Regulating Non-Medical Marijuana: Lessons Learned and Paths Forward.
Ahead of the webinar, NewPublicHealth spoke with Wagenaar about who in public health will find the webinar important, as well as public health’s role both before and after a jurisdiction considers legalizing non-medical marijuana.
NewPublicHealth: Who is the webinar primarily geared toward?
Alexander Wagenaar: There are lots of different audiences that are interested in this, including the public health research community such as academics, scientists, health department and agency staff who are looking at the issue or will be looking at it in the future.
Under Tobacco Control Act Authority, FDA Orders Stop to Sale, Distribution of Four Tobacco Products
For the first time the U.S. Food and Drug Administration (FDA) has used its authority under the Family Smoking Prevention and Tobacco Control Act to order a stop to the continued sale and distribution of four tobacco products. The FDA ruled that Sutra Bidis Red, Sutra Bidis Menthol, Sutra Bidis Red Cone, and Sutra Bidis Menthol Cone were not “substantially equivalent” to products commercially available as of Feb. 15, 2007. The FDA determined that Jash International did not identify a product by which to assess substantial equivalence, as well as other required information. “Companies have an obligation to comply with the law—in this case, by providing evidence to support an SE application,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products, in a release. “Because the company failed to meet the requirement of the Tobacco Control Act, the FDA’s decision means that, regardless of when the products were manufactured, these four products can no longer be legally imported or sold or distributed through interstate commerce in the United States.” Read more on tobacco.
NGA Releases Report on Prescription Drug Abuse Epidemic
As part of the National Governors Association’s (NGA) 2014 Winter Meeting, NGA Vice Chair Colorado Gov. John Hickenlooper and Alabama Gov. Robert Bentley have released a report, Reducing Prescription Drug Abuse: Lessons Learned from an NGA Policy Academy, detailing their year-long look on how to reduce the growing epidemic; prescription drug abuse is the United States’ fastest growing drug problem and the second most-common type of drug abuse for youth ages 12-17. Among the findings:
- Leadership matters
- Prescribing behavior needs to change
- Disposal options should be convenient and cost-effective
- Prescription drug monitoring programs are underused
- Public education is critical
- Treatment is essential
- Data, metrics and evaluation must drive policy and practice
“The abuse of prescription drugs continues to be seen in communities across the nation,” said Hickenlooper. “This initiative helped states develop effective strategies to help decrease the number of individuals who are misusing or abusing prescription drugs and the resulting number of people who are harmed or die.” Read more on prescription drugs.
HHS Issues Proposals for Next Edition of EHR Technology Certification Criteria
The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) has issued proposals for the next edition of the electronic health record (EHR) technology certification criteria. “The proposed 2015 Edition EHR certification criteria reflect ONC’s commitment to incrementally improving interoperability and efficiently responding to stakeholder feedback,” said Karen DeSalvo, MD, MPH, national coordinator for health IT. “We will continue to focus on setting policy and adopting standards that make it possible for health care providers to safely and securely exchange electronic health information and for patients to become an integral part of their care team.” Compliance with the 2015 Edition would be voluntary (if EHR developers are in compliance with the 2014 Edition, they would not need to recertify) and the final rule will be issued later this summer. Read more on technology.
NIDA Releases Resources on Identifying, Treating Teen Drug Abuse
As part of the annual National Drug Facts Week, the National Institute on Drug Abuse (NIDA) has released a collection of resources to help parents, health care providers and substance abuse treatment specialists identify teens at risk and help those struggling with drug abuse. The new resources include:
- Thirteen principles to consider in treating adolescent substance use disorders
- Frequently asked questions about adolescent drug use
- Settings in which adolescent drug abuse treatment most often occurs
- Evidence-based approaches to treating adolescent substance use disorders
- The role of the family and medical professionals in identifying teen substance use and supporting treatment and recovery.
“Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” said NIDA Director Nora D. Volkow, MD. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.” Currently only 10 percent of adolescents ages 12 to 17 who need substance abuse treatment receive it, according to the 2012 National Survey on Drug Use and Health. Read more on substance abuse.
Study: Public Transit Drivers Distracted an Estimated 39 Percent of their Time on the Road
Public transit bus drivers spend an estimated 39 percent of their time on the road distracted, according to a new study in the journal Traffic Injury Prevention. Researchers in the Department of Epidemiology at the University of Alabama at Birmingham observed and recorded distraction behaviors for three months, then compared them by route characteristics. Interactions with other passengers are the most common source of distraction. Drivers younger than 30 or older than 50, on city streets or highways, or who were driving more than 20 passengers were the most likely to be distracted. Researchers concluded that more needs to be done to educate drivers on the hazards of distracted driving and ways to avoid distractions. Read more on transportation.
Improved Education on Subsidies, Medicaid Could Reduce Number of Uninsured U.S. Adults
The number of U.S. adults who are uninsured could be significantly reduced with improved education on available subsidies and Medicaid expansion, according to the new quarterly Health Reform Monitoring Survey, conducted by Urban Institute researchers with funding from the Robert Wood Johnson Foundation and the Ford Foundation. The survey found that 39.3 percent of uninsured adults expect to have health insurance in 2014, and that four in 10 adults who expect to remain uninsured also think they will have to pay some sort of penalty. Read more on access to health care.
Many teens are unaware of how drug abuse can negatively affect their lives. The Fourth Annual National Drug Facts Week, which runs Jan. 27 to Feb. 2, is an initiative of the National Institute on Drug Abuse (NIDA) that aims to change that. The week-long health observance arms communities with the materials and tools they need to debunk myths and educate teens about drug abuse.
Featured in a piece on Reclaiming Futures’ website, NIDA Public Affairs Officer Brian Marquis highlights the science-based information NIDA has provided to teachers, counselors, social workers and community members, as well as the teen-focused events that community leaders are hosting across the country to communicate with young adults about the dangers of drug abuse. Reclaiming Futures, a program funded by the Robert Wood Johnson Foundation, helps young people in trouble with drugs, alcohol and crime by reinventing the way police, courts, detention facilities, treatment providers and communities work together to meet this urgent need.
“Using ideas and resources provided by NIDA, there is a way for everyone to learn the facts and help shatter myths about drug abuse during National Drug Facts Week and beyond,” Marquis wrote in his post.
Spurred by new recommendations from the Robert Wood Johnson Foundation’s Commission to Build a Healthier America, NIDA is encouraging communities to use its resources to improve the nation’s health by investing in children.
Learn more about National Drug Facts Week events across the country.
The January 2014 VitalSigns report, a monthly report from the U.S. Centers for Disease Control and Prevention (CDC) on leading health indicators, looks at the failure of too many health care professionals to counsel patients on the risks of consuming too much alcohol and binge drinking. According to a recent survey cited in the new report, only one in six adults reports counseling by a health care professional during routine visits, and that number drops to one in four for binge drinkers, despite the fact that studies show that counseling could save lives and reduce health care costs.
Research by the CDC finds that having physicians ask patients about alcohol consumption and brief counseling could reduce the amount of alcohol consumed on an occasion by 25 percent. At least 38 million adults drink too much and most are not alcoholics, according to the CDC. Drinking too much includes binge drinking, high weekly use, and any alcohol use by pregnant women or those under age 21. And it causes about 88,000 deaths in the United States each year, costing the economy about $224 billion.
Significantly, alcohol screening and brief alcohol counseling are now covered by many health insurance plans without a copay as a result of the Affordable Care Act.
A review of studies by CDC researchers found that brief (6-15 minutes) intervention sessions were effective in significantly reducing weekly alcohol consumption. A patient survey conducted following brief counseling sessions found that patients reported:
- 3.6 fewer drinks per week for adults
- Binge level drinking was reported by 12 percent fewer participants
- Increased adherence to recommended drinking limits was achieved by 11 percent more participants.
“Drinking too much alcohol has many more health risks than most people realize,” says CDC Director Tom Frieden, MD, MPH. “Alcohol screening and brief counseling can help people set realistic goals for themselves and achieve those goals. Health care workers can provide this service to more patients and involve communities to help people avoid dangerous levels of drinking.”
In a briefing for reporters today, Frieden said that for every one alcoholic in the United States there are about six people who drink too much, and many don’t realize that their drinking is excessive.
The Dietary Guidelines for Americans recommend that adults who drink only do so in moderation, which is defined as up to one drink a day for women and two for men.
The National Institute on Alcoholism and Alcohol Abuse recommends that health professionals discuss alcohol use with all patients and has a screening tool to help determine how much patients drink, assess problems associated with drinking and refer patients for specialized treatment if needed.
- Read a recent NewPublicHealth interview with Lori Butterfield, who produced the recent documentary, Lipstick and Liquor, about hidden drinking by too many women.
- The Guide to Community Preventive Services provides evidence-based strategies for helping to reduce alcohol consumption among individuals and in communities.