Category Archives: Substance use
Later this week a final rule goes into effect from the U.S. Drug Enforcement Agency (DEA) aimed at reducing the misuse of controlled substances. The new rule will allow pharmacies and other approved outlets to accept unused controlled substances from people who want them out of their home so they can’t be abused by people with no medical need for the medications.
Previously, the drugs could only be disposed of at home, brought to a law enforcement agency or brought to one of two annual community “take back” days that the DEA started in 2011. Unused drugs are often found in homes because physicians typically prescribe thirty days’ worth of painkillers after surgery or illness, which can lead to addiction or to the drugs being left in home medicine cabinets where they are ripe for misuse.
Under the rule, certain outlets (including manufacturers, distributors, narcotic treatment programs, retail pharmacies and hospitals/clinics with an on-site pharmacy) can apply to the DEA to become authorized collectors. The public can find authorized collectors in their communities by calling the DEA Office of Diversion Control’s Registration Call Center at 1-800-882-9539.
Experts say the rule is a good start toward getting millions of controlled substances out of the hands of abusers and potential abusers. Data clearly demonstrates the need:
- According to the 2012 National Survey on Drug Use and Health, almost twice as many Americans (6.8 million) currently abuse pharmaceutical controlled substances than those using cocaine, hallucinogens, heroin and inhalants combined.
- Nearly 110 Americans die every day from drug-related overdoses, and about half of those overdoses are related to opioids, a class of drug that includes prescription painkillers and heroin.
- More than two-thirds of people who misuse prescription painkillers for the first time report obtaining the drugs from friends or relatives, including from a home medicine cabinet.
Writing for the Network for Public Health Law blog, lawyer Corey Davis said that while the new rule doesn’t address some key issues—such as who will pay for the returned drugs to be destroyed and whether pharmacies will face any liability if returned drugs are stolen—“it’s an important step forward in drug abuse and overdose prevention.”
Michigan, Minnesota, North Carolina and Wisconsin have been tapped to join the second round of the National Governors Association’s (NGA) Prescription Drug Abuse Project, tasked with developing comprehensive, evidence-based statewide action plans to help combat the growing public health problem. Nevada Gov. Brian Sandoval and Vermont Gov. Peter Shumlin will lead the project, with their states also taking part.
Over the next year, the states participating in the project will accomplish the following:
- Attend two, two-day meetings with other policy academy states;
- Host an in-state workshop coordinated by NGA Center for Best Practices staff;
- Develop a strategic plan for reducing prescription drug abuse;
- Participate in regular conference calls and other meeting activities; and
- Receive state-specific technical assistance from NGA staff and national experts.
“We are united by a common goal to reduce prescription drug abuse,” said Sandoval, in a release. “Bringing states together will help each of us learn ways to combat this growing problem. It is an honor to serve as co-lead on this timely and important issue.”
“Communities across the country continue to be affected by the abuse of prescription drugs,” added Shumlin. “That is why this initiative remains so important for governors. As the leaders of our states, our primary concern is for the health and safety of our citizens.”
According to the U.S. Centers for Disease Control and Prevention (CDC), prescription drug overdose is now the leading cause of death from injury, with approximately 113 U.S. deaths each day and 6,748 people treated daily for misuse or abuse in the nation’s emergency departments (EDs).
Additional data on prescription drug abuse from the CDC includes:
- In 2011, among people ages 25 to 64, drug overdose caused more deaths than motor vehicle traffic crashes;
- Drug overdose death rates have been rising steadily since 1992, with a 118 percent increase from 1999 to 2011 alone;
- In 2011, 33,071 (80 percent) of the 41,340 drug overdose deaths in the United States were unintentional, 5,298 (12.8 percent) were of suicidal intent, 80 (0.2 percent) were homicides, and 2,891 (7 percent) were of undetermined intent;
- In 2011, drug misuse and abuse caused approximately 2.5 million ED visits, with more than 1.4 million of these related to pharmaceuticals;
- Between 2004 and 2005, an estimated 71,000 children were seen in EDs annually because of medication overdose (excluding self-harm, abuse and recreational drug use); and
- Among children under age 6, pharmaceuticals account for roughly 40 percent of all exposures reported to poison centers.
>>Bonus Links: Read more of NewPublicHealth’s coverage of prescription drugs and prescription drug abuse. Below is a selection of our most recent coverage of the public health crisis:
- CDC: Physicians are Fueling Prescription Painkiller Overdoses
- Study: Today’s Drugged Drivers More Likely to Mix Alcohol and Drugs, Have Taken Multiple Prescription Medicines
- New NIH Pain Research Database Could Be a Key Tool in the Fight Against Prescription Drug Abuse
- Saturday is National Prescription Drug Take-Back Day
- Recommended Reading: FDA Approves Handheld Treatment for Prescription Drug Overdose
Binge drinking is an increasing concern in the United States. A recent report from the U.S. Centers for Disease Control and Prevention (CDC) finds that one in ten adult deaths is linked to binge drinking through illnesses the binge drinker contracts—such as hepatitis—or accidents that happen to the drinker or that he or she causes—including homicide and domestic abuse. The CDC defines binge drinking as five or more drinks in a row for males and four or more drinks in a row for females.
Binge drinking also remains a concern among young adults. A new report from the Johns Hopkins Bloomberg School of Public Health and the Boston University School of Public Health finds that liquor now trumps beer as the drink of choice for underage (ages 13 to 20) binge drinkers, likely because of increased marketing by alcohol companies.
“Spirit firms have taken a page from the beer playbook in their marketing to young people,” said David Jernigan, PhD, director of the Center on Alcohol Marketing and Youth at Johns Hopkins in a conversation with NewPublicHealth.
The report on youth binge drinking was published in the Journal of Substance Use and found that spirits accounted for 43.8 percent of binge episodes, while beer accounted for less than one-third (31.4 percent) of binge episodes. “The inclusion of some relatively expensive brands in the top twenty-five binge brand list suggests that variables other than price are driving youth brand preferences with respect to binge drinking,” said Jernigan.
“Binge drinking accounts for most of the alcohol consumed by youth in the United States, and is associated with a host of negative consequences, including drunk driving, sexual assaults and suicide,” according to Timothy Naimi, MD, MPH, a lead author of the study and an associate professor at the Boston University School of Public Health.
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.
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.
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.
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.
While men are more likely to die of a prescription painkiller overdose, since 1999 the percentage increase in deaths has been greater among women than among men, according to the Vital Signs monthly health indicator report released today by the Centers for Disease Control and Prevention (CDC). The increase in deaths between 1999 and 2010 has been 400 percent in women compared to 265 percent in men, according to the new report. The overdoses killed nearly 48,000 women during that time period.
“Prescription painkiller deaths have skyrocketed in women…” says CDC Director Tom Frieden, MD, MPH. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”
Key findings include:
- About 42 women die every day from a drug overdose.
- Since 2007, more women have died from drug overdoses than from motor vehicle crashes.
- Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010.
- More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.
For the Vital Signs report, CDC analyzed data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network public use file (2004-2010).
According to the CDC, studies have shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).