Category Archives: Substance Abuse
Widely Used HIV Drug Linked to Higher Suicide Risk
People infected with HIV whose treatment includes the widely used antiretroviral drug efavirenz appear to have double the risk of suicidal thoughts, attempts and completion compared to HIV patients not taking the medication, according to a study by several researchers at the Harvard School of Public Health and the University of North Carolina at Chapel Hill. The study was published in the Annals of Internal Medicine.
“When efavirenz is used as a component of antiretroviral therapy, patients should be monitored carefully for exacerbation of depression or evidence of suicidal thoughts or behavior,” according to the study.
The drug has been previously linked to central nervous system side effects and suicide, but until now a clear link to suicidal thinking, attempted suicide, or completed suicide was not clear. The effects persist for the time patients are on the drug. The researchers recommend that patients with HIV use alternative drugs, if possible, if they are at risk for depression. Read more on HIV.
Nutrition Screenings Should Be Regular Part of Geriatric Health Assessment
Most older adults typically have one or more chronic health conditions that can affect their food intake and should be asked about their food intake during health exams, according to a new study in Nutrition in Clinical Practice. The researchers said that health care providers should also look for signs of malnutrition, such as loss of subcutaneous fat, muscle loss and fluid accumulation. Read more on aging.
Many American Teens Follow Pro-Marijuana Twitter Feeds and Receive Pro-Marijuana Tweets
Hundreds of thousands of American teens are following marijuana-related Twitter accounts and getting pro-marijuana tweets several times each day, according to researchers at the Washington University School of Medicine in St. Louis. The researchers say the tweets are cause for concern because young people are especially responsive to social media influences and because patterns of drug use tend to be established in a person’s late teens and early 20s. The study was published in the Journal of Medical Internet Research and relied on tweets sent and received between May 1 and Dec. 31, 2013, from a single popular pro-marijuana Twitter feed. During the study period, the feed posted an average of 11 pro-marijuana tweets per day. Read more on substance abuse.
Inappropriate and dangerous prescription practices for painkillers are driving high addiction and overdose rates—46 people die of a prescription painkiller overdose every day—according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC).
The CDC has also found wide variation in prescription practices across the country:
- Southern states had the most prescriptions per person for painkillers, especially Alabama and Tennessee.
- The Northeast, especially Maine and New Hampshire, had the most prescriptions per person for long-acting and high-dose painkillers.
- Nearly 22 times as many prescriptions were written for oxymorphone (a specific type of painkiller) in Tennessee than were written in Minnesota.
In total, doctors wrote 259 million prescriptions for painkillers in 2012—or enough for a bottle of prescription pain pills for every American adult in the country.
“Prescription drug overdose is epidemic in the United States. All too often, and in far too many communities, the treatment is becoming the problem,” said CDC Director Tom Frieden, MD, MPH. “Overdose rates are higher where these drugs are prescribed more frequently. States and [medical] practices where prescribing rates are highest need to take a particularly hard look at ways to reduce the inappropriate prescription of these dangerous drugs.”
According to the CDC, deaths from drug overdoses have been rising steadily over the past two decades and have become the leading cause of injury death in the United States—linked strongly to the overuse of prescription painkillers. In 2011, of the 41,340 drug overdose deaths in the United States, 55 percent were related to pharmaceuticals, and almost three quarters of those were from prescription painkillers.
AHA to Fund Research Network for the Prevention of Heart Disease, Stroke
With a $15 million grant from the American Heart Association (AHA), four major medical institutions are coming together to form a research network with the goal of preventing heart disease and stroke. The Strategically Focused Prevention Research Network Centers will include investigators at Northwestern University in Chicago, Vanderbilt University in Nashville, the Icahn School of Medicine at Mount Sinai in New York City and the University of Texas-Southwestern Medical Center in Dallas. “Heart attack and stroke can strike suddenly, and frequently without warning. The best way to reduce premature mortality from cardiovascular diseases and stroke is to prevent the development of the risk factors that lead to these conditions,” said AHA President Elliott Antman, MD, professor of medicine at Harvard Medical School and a senior physician in the cardiovascular division of the Brigham and Women’s Hospital in Boston, in a release. “Scientists working in these research centers are helping to discover the mechanisms that will allow all Americans to live healthier lives, helping lead us to a culture of health.” Read more on heart health.
Study: One-Third of U.S. Total Knee Replacements ‘Inappropriate’
Approximately one-third of all total knee replacements in the United States are unnecessary and “inappropriate” under a patient classification system used in Spain, according to a new study in the journal Arthritis & Rheumatology. Researchers said the findings demonstrate a need for the United States to develop similar patient selection criteria so as to limit the unneeded surgeries. There are more than 600,000 total U.S. knee replacements annually—meaning that approximately 200,000 are unnecessary, according to the study—and from 1991 to 2010 the number of Medicare-covered replacements climbed by approximately 162 percent annually. Read more on aging.
Kids’ ADHD Medications Not Linked to Increase Risk of Substance Abuse
While children with attention-deficit/hyperactivity disorder (ADHD) are twice as likely to abuse drugs, the medications prescribed to treat ADHD do not play a role in the increased risk, according to a new study in the journal Pediatrics. In fact, researchers determined that the combination of behavioral techniques and ADHD medications actually lowers the risk of substance abuse. "Obviously, the medications that are used to treat ADHD have the potential for abuse, but the vast majority of children with ADHD do not develop a substance abuse problem," said Michael Duchowny, MD, a pediatric neurologist at Miami Children's Hospital. "More research has to be done to find out why some children are more susceptible than others." Common ADHD medications include amphetamines such as Adderall or Dexedrine, and methylphenidates such as Concerta, Metadate CD or Ritalin. Read more on substance abuse.
FDA Approves for Marketing a Motorized Walking Suit for People with Spinal Cord Injuries
The U.S. Food and Drug Administration has approved for marketing a device called the ReWalk, which is the first motorized device intended to act as an exoskeleton for people with lower body paralysis from a spinal cord injury. According to the U.S. Centers for Disease Control and Prevention, there are about 200,000 people in the United States living with a spinal cord injury. ReWalk consists of a fitted, metal brace that supports the legs and part of the upper body; motors that supply movement at the hips, knees and ankles; a tilt sensor; and a backpack that contains the computer and power supply. Crutches provide the user with additional stability when walking, standing and rising up from a chair. Using a wireless remote control worn on the wrist, the user commands ReWalk to stand up, sit down or walk. Read more on disability.
One in 10 Deaths Among Working-Age Adults is Due to Excessive Drinking
Excessive alcohol use accounts for one in 10 deaths among working-age adults ages 20-64 years in the United States, according to a report from the U.S. Centers for Disease Control and Prevention and published in Preventing Chronic Disease. Excessive alcohol use led to approximately 88,000 deaths per year from 2006 to 2010, and shortened the lives of those who died by about 30 years. The deaths were due to health effects from drinking too much over time, such as breast cancer, liver disease and heart disease; and health effects from drinking too much in a short period of time, such as violence, alcohol poisoning and motor vehicle crashes. In total, there were 2.5 million years of potential life lost each year due to excessive alcohol use. Nearly 70 percent of deaths due to excessive drinking involved working-age adults, and about 70 percent of the deaths involved males. About 5 percent of the deaths involved people under age 21. The highest death rate due to excessive drinking was in New Mexico (51 deaths per 100,000 population) and the lowest was in New Jersey (19.1 per 100,000). Read more on substance abuse.
Men and Women Use Mental Health Services Differently
Women with chronic physical illnesses are more likely to use mental health services than men with similar illnesses, and they also seek out mental health services six months earlier than those same men, according to new study from St. Michael's Hospital in Toronto, Canada and published in the Journal of Epidemiology & Community Health. The study looked at people diagnosed with at least one of four physical illnesses: Diabetes, high blood pressure, asthma or chronic obstructive pulmonary disease. The researchers found that among those with at least one of these four illnesses, women were 10 percent more likely to use mental health services than men, and within any three-year period women with physical illness used medical services for mental health treatment six months earlier than men. The researchers say the results may imply that women are more comfortable than men with seeking mental health support; that symptoms are worse among women, requiring more women to seek help and sooner; or that men defer seeking treatment for mental health concerns. Read more on mental health.
Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
The profile of a drugged driver has changed substantially since 1993, according to a new study released today in the journal Public Health Reports, which shows that more drivers are now testing positive for prescription drugs, marijuana and multiple drugs.
“While we’ve seen a decrease over the years in motor vehicle fatalities involving people under the influence, the nature of those crashes is changing,” said study author Fernando Wilson, PhD, an associate professor at the University of Nebraska Medical Center.
The study examines trends in the characteristics of U.S. drivers who were involved in fatal crashes between 1993 and 2010 and tested positive for drugs. The study, funded by the Public Health Law Research program of the Robert Wood Johnson Foundation, was set up to investigate the relationship between state laws and the consumption of alcohol and other drugs in fatal car crashes. It found that the percentage of drugged drivers with three or more drugs in their system nearly doubled from 1993 to 2010, increasing from 11.5 percent to 21.5 percent.
“In 1993, about one in eight drivers were using multiple drugs concurrently. By 2010, it was closer to one in five. That’s a large increase in drug use,” Wilson said. “Beyond that, we’re also seeing more and more people using drugs and alcohol together. About 70 percent of drivers who tested positive for cocaine had also been consuming alcohol, and almost 55 percent of drivers who tested positive for cannabis also had alcohol in their systems.”
- Almost 60 percent of cannabis-only users were younger than 30 years.
- Thirty-nine percent of prescription drug users were 50 years old or older, which seems to be in line with an overall increase in the use of prescription drugs by Americans, and the older population in general.
“These trends are likely to continue into the future given the aging U.S. population, an increasing reliance on prescription medications by medical providers and increasing initiatives to legalize marijuana,” said Wilson. “However, it is unclear whether current state policies are completely up to the challenge of addressing the growing issue of drugged driving.”
NewPublicHealth recently spoke with Wilson about the study. He said he embarked on the research because of the tens of thousands of motor vehicle crashes each year and the need to figure out the most effective policies to curb distracted driving. According to Wilson, eighteen states have zero-tolerance laws for drugged drivers, but recent studies suggest that these laws may not be effective enough in decreasing traffic deaths.
Adolescents ages 12-17 in foster care are significantly less likely to talk to a parent or guardian about the dangers of substance use compared to other adolescents, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report found that while 58.9 percent of adolescents living with biological parents have these discussions and 57.6 percent of adolescents living with adoptive parent have the talks, that percentage drops to 51.1 for adolescents in foster care. “Youth in foster care may face special challenges that make it essential that they, like other youth, get effective substance use prevention messaging,” said Frances M. Harding, director of SAMHSA’s Center for Substance Abuse Prevention. “We need to explore innovative approaches to providing this prevention messaging to them—especially in ways that also engage parents and guardians. That’s why we’re very excited about our new national public service campaign, Talk. They Hear You....[which] empowers parents and caregivers to talk to their children as young as nine years old about the dangers of underage drinking.” Read more about substance abuse.
DOT Announces Grants to Improve Transportation that Gets People to Job Training and Other Services
The U.S. Department of Transportation has announced about $100 million in competitive grant funds through the Federal Transit Administration’s (FTA) new Ladders of Opportunity Initiative. The funds can be used to modernize and expand transit bus service specifically for the purpose of connecting disadvantaged and low-income individuals, veterans, seniors, youths and others with local workforce training, employment centers, health care and other vital services.
Proposals from organizations seeking grants must directly address ladders of opportunity for riders, including:
- Enhancing access to work for individuals lacking ready access to transportation, especially in low-income communities
- Supporting economic opportunities by offering transit access to employment centers, educational and training opportunities, and other basic needs
- Supporting partnerships and coordinated planning among state and local governments and social, human service and transportation providers to improve coordinated planning and delivery of workforce development, training, education and basic services to veterans, seniors, youths and other disadvantaged populations
“Over half of the roughly 10 billion transit trips taken each year in the United States are by bus—and nearly half the buses people depend on are in marginal or poor condition,” said FTA Deputy Administrator Therese McMillan. “This new initiative will help ensure that millions of riders can count on safe, efficient, reliable bus service that connects them with opportunities and services so and services so essential to daily life.” Read more on transportation.
Study Finds Link Between Risk of Breast Cancer and Number of Moles
In the future, physicians may be able to improve early breast cancer screening and treatment with a quick count of the number of moles on a patient’s arm, according to a two new studies in the journal PLOS Medicine. American and French researchers, in two separate studies, found a link between the number of moles on a woman’s arm and their risk of breast cancer—one study found that women with 15 or more moles on a single arm were 35 percent more likely to develop breast cancer than were women with no moles. The scientists said one plausible reason for the link is that these women have higher estrogen levels; estrogen can feed the growth and spread of many breast tumors, and research also connects the hormone to moles. However, researchers also noted that more study was needed to reach a definitive conclusion. "Don't panic,” said Barbara Fuhrman, an assistant professor at the University of Arkansas for Medical Sciences in Little Rock, in an editorial accompanying the studies. “This is very interesting biologically, but it probably doesn't tell us a lot about an individual woman's risk of breast cancer. It probably tells us more about the general etiology [causes] of breast cancer." Read more on cancer.
NIH Researchers Publish Review of Key Marijuana Adverse Health Effects
As more states consider legalizing marijuana, researchers at the National Institute on Drug Abuse (NIDA)—a division of the National Institutes of Health—have published a review of adverse health effects of the drug, including impaired driving. The review was published last week in the New England Journal of Medicine and the study authors consider a number of key concerns including:
- Rising marijuana potencies
- Possible health consequences of secondhand marijuana smoke
- Long-term impact of prenatal marijuana exposure
- According to the reviewers, research suggests that marijuana impairs critical thinking and memory functions during use and that these deficits persist for days after using
- A long-term study showed that regular marijuana use in the early teen years lowers IQ into adulthood, even if users stopped smoking marijuana as adults.
“It is important to alert the public that using marijuana in the teen years brings health, social, and academic risk,” said lead author and NIDA Director Nora D. Volkow, MD. NIDA offers additional information on the consequences of marijuana here. Read more on substance abuse.
Social Media is a Largely Untapped Communications Tool for Health Policy Researchers
As social media use continues to expand, it also presents a growing opportunity for health policy researchers to communicate with both the public and policy makers. However, few of these researchers appear to be using social media to the best of its potential in this field, according to a new study in the journal Health Affairs. The study, which was funded by the Robert Wood Johnson Foundation, examined 325 health policy researchers, finding that only 14 percent of participants reported tweeting and only 21 percent noted blogging about their research in the past year. Many cited fears that social media would not be compatible with their research, the creation of professional risks and the lack of respected it is given by their peers or their academic institutions as obstacles to social media use. “Historically, the communication gap between researchers and policy makers has been large,” concluded the authors. “Social media are a new and relatively untested tool, but they have the potential to create new communication channels between researchers and policy makers to help narrow that gap.” Read more on technology.
Study: Many Preschool-aged Children Spending Too Much Time in Front of TVs, Computers
Many three- and four-year-olds are spending more than twice the recommended amount of time—two hours—in front of computers and television screens, according to a new study in the journal Child Indicators Research. Utilizing data on 2,221 preschool-aged children from the 2007 Head Start Family and Child Experiences Survey, researchers found that 55.7 percent of children had a television in their bedroom and 12.5 percent had high home screen time, defined as more than four hours each weekday. They also found that 56.6 percent of children had access to a computer at home and 37.5 percent had used it on the last typical weekday. In addition, 49.4 percent of children used a classroom computer for more than one hour each week and 14.2 percent played computer games at school for more than five hours each week. “This research should be used as a foundation for additional studies-- particularly those that look at educational screen time versus entertainment screen time,” said Erica Fletcher, a PhD student at Ohio State’s College of Public Health and lead on the project. “It’s a critical time to dive deeper into that. Since the data were collected, devices with screens like tablets and smart phones have become more affordable and are increasingly being used in the classroom. That has helped narrow the economic ‘digital divide’ on accessibility.” Read more on pediatrics.
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.