Drinking to excess a big danger for women

By admin | August 22, 2008

A New Study at St James’s Hospital, Dublin has shown that excess drinking can lead to heart problems, with the effects particularly dangerous for women.

Doctors investigating the modifiable lifestyle issues of patients being treated for hypertension have found worryingly high levels of alcohol consumption with the consequences including stiffened arteries, enlarged hearts and greater risk of coronary failure.

Dr Azra Mahmud, a cardiovascular and hypertension specialist at the Trinity Centre for Health Sciences based at St James’s Hospital defines hypertension as “high blood pressure that is persistent and sustained” and refers to it as a “silent killer”. This is because it tends to be an “incidental finding” made for example when someone goes to their GP for treatment for a cold.

Mahmud says that the elevated blood pressure can “often have been going on for years with the implication that other things might have been going on in the meanwhile”.

The problem is that this is linked to three major medical problems: cell death in the brain; kidney problems that can result in renal failure; and stiffness as well as enlargement of the heart which can cause heart failure.

In a study presented this year at the annual conference of the American Society of Hypertension, Mahmud studied 200 people being treated for high blood pressure. Blood pressure over a 24-hour period, stiffening of the arteries and echocardiography measures were taken; among other things, echocardiography measures how the heart contracts, relaxes and whether it is bigger than it should be.

Findings showed that for men, excessive drinking (defined as more than 21 units per week) is “associated with higher blood pressure, more stiff arteries (appearing almost 10 years older) and a stiffer heart muscle”.

The more surprising finding was for women identified as excessive drinkers, those drinking more than 14 units of alcohol per week.

The effects “bypassed the normal pathways of how you damage your heart and something was happening directly to the cardiac structure because of the high alcohol intake,” says Mahmud. The biggest finding was that these women had significantly enlarged hearts.

Since having an enlarged heart is a “prognosticator of increased cardiovascular mortality”, according to Mahmud, and the average age of the men and women in the study was 46, these findings should prove a cause for concern for the medical world and society at large.

A very important point is that a clinical diagnosis of hypertension is not necessary for alcohol to have its dangerous impact.

In a study published in 2002, Mahmud had found that more than 21 units of alcohol per week in males chosen from the general population can lead to elevated blood pressure.

WHY WOMEN ARE more affected by alcohol is not yet well-understood. Mahmud says it is possible that they may have fewer enzymes in their stomach lining, so they cannot break down the alcohol effectively. Additionally, they may have poorer metabolising enzymes in the heart itself, which then affects the organ directly.

One of the host of reasons for increased alcohol use is the misinterpretation of the “French Paradox” Mahmud believes. French people have a low coronary heart disease mortality despite a high fat consumption. This is thought to relate to the consumption of red wine which contains flavonoids, “antioxidants that improve nitric availability in the [blood] vessels which makes them more relaxed.

“We know that in moderation it is good but the message is not taken on board; moderation is the message,” says Mahmud. Recommendations say average intake for men should be no more than three units a day for men and two for women. She warns: “It is high time to recognise the potential of an alcohol excess induced epidemic of cardiovascular disease before it is too late.”
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source: Irish Times

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Ian Oliver: Legalising drugs would only make matters worse

By admin | August 21, 2008

Recently, A great deal of media attention has been focused on a call for the legalisation of drugs by a former civil servant who was responsible for the Cabinet’s anti-drug unit. In The Independent last week, Julian Critchley said that legalisation would be “less harmful than the current strategy” and that an “overwhelming majority of professionals in the field” agree with that view.

Now he has become a teacher, his dangerously naive views appear to be more harmful than an inadequate UK drug policy, and he must associate with a limited group of professionals if his assertion is not gross exaggeration. The majority of people in the UK do not wish to see drugs legalised, and only 6 per cent of the global population between the ages of 15-64 use drugs; this is hardly justification for legalisation.

The UK has the highest rate of drug misuse in Europe and the abuse of illicit drugs is a major social problem, not least because of the public health implications. Aids/HIV and other blood-borne diseases are global pandemics and there is a huge ignorance in the UK about these, and sexually transmitted infections, which are also linked with drug abuse. The legalisation of drugs would lead inevitably to a greater number of addictions, an increased burden on the health and social services, and there would be no compensating diminution in criminal justice costs as, contrary to the view held by legalisers, crime would not be eliminated or reduced.

Perhaps it is not widely known that there is a global movement to overturn the United Nations Conventions and secure the legalisation of all drugs driven by people who see huge profits to be had from marketing another addictive substance. Research has demonstrated that the dependency rate for “legal” drugs among those who chose to use them would be around 50 per cent, the same as tobacco, which is why major companies are turning to developing countries in order to encourage smoking.

Recently, a TV programme discussed the issue, and several members of the public phoned in their views, most of which were responsibly opposed to the misuse of drugs. However, it was alarming to hear several people say that they thought that legalising drugs would be the most effective way of dealing with the problem. All of these good people believed that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely. There was no consideration given to the fact that there is a thriving black market in the legal drugs of alcohol and tobacco, and no awareness of the huge administrative burden that would be created by setting up a government department to tax and administer drugs if legalisation had occurred. There was no awareness of the devious ways in which drug traffickers would circumvent the legislation and no thought given to the huge increase in addiction/dependency that would automatically follow such an ill-advised move, with the tremendous damage that would be visited on the health services in perpetuity. The tax demands would rocket as a consequence.

It is always asserted that legalisation would take the profit out of drug trafficking and would result in a huge drop in crime but, short of the Government distributing free drugs, those who commit crime now to obtain their drugs would continue to do so if they became legal.

It is seldom made clear which drugs the legalisers are referring to and to whom they should become available. Is it the position that they wish to legalise “crack” and will all people, regardless of age and mental condition, be able to buy them?The cumulative effects of prohibition and interdiction, combined with education and treatment during 100 years of International Drug Control, have had a significant impact in stemming the drug problem. Legalisation would be likely to convince people that any legal activity cannot be very harmful, increase the availability of drugs, increase the harmful consequences associated with drugs and remove the social sanctions normally supported by the legal system.

All drugs, including prescription and over-the-counter medicines, can be dangerous if they are taken without attention to appropriate medical advice. Instead of calling for legalisation, it would be far more sensible, as Nick Harding suggested in his article about cannabis use in yesterday’s Independent, to seek improved policies. The compassionate and sensible approach should be that we do everything possible to reduce addiction and drug abuse, not encourage it.

Dr Ian Oliver is a former Chief Constable of Grampian Police and the author of ‘Drug Affliction’
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source: The Independant, http://www.independent.co.uk

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Keep legal drinking age where it is – at 21

By admin | August 20, 2008

If there’s a deeply compelling reason for dropping the minimum legal drinking age to 18, the distinguished academic supporters of the Amethyst Initiative haven’t made it yet.

Granted, the statement signed by 100 college presidents – including Pacific Lutheran University’s Loren Anderson – doesn’t come right out and say they want a lower drinking age, only that they seek “an informed and dispassionate debate” over the issue. But it clearly states that they believe the current legal drinking age of 21 isn’t working.

They note that “clandestine binge-drinking” is pervasive on college campuses and that in order to buy alcohol, many underage students resort to using fake IDs, a choice that erodes “respect for the law.”

The presidents fail to show how making alcohol easier to get at a younger age would have a dampening impact on binge-drinking. If anything, it would almost certainly worsen the problem and shift it to an even younger age group – high school seniors.

As for using fake IDs, that should become less of a problem as the states comply with tougher federal rules on identification. Much of the fake ID problem could be addressed by getting tougher with drinking establishments that don’t adequately check customer ID. And since when do we do away with good laws just because there are those who choose to break them?

While the proponents fail to make the case for a legal drinking age of 18, those arguing to keep the legal drinking age at 21 are highly persuasive.

Mothers Against Drunk Driving cites a number of well-supported studies that show raising the drinking age to 21 has significantly reduced drunk-driving deaths. The National Highway Traffic Safety Administration said it saves about 900 lives a year. And the National Institutes of Health reports that delaying the legal age of drinking reduces future rates of alcoholism; binge drinking; and alcohol-related traffic accidents, injuries and violence.

Dealing with a college population whose ages vary widely can be a hassle for school administrators – no doubt about it. Their lives would be a lot easier if they could treat all students the same. But lowering the drinking age is a wrong-headed solution. It would only result in more deaths, more ruined lives.

That’s too high a price to pay for convenience.
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source: The News Tribune, http://www.thenewstribune.com

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100 college presidents seek debate on drinking age

By admin | August 19, 2008

College presidents from about 100 of the nation’s best-known universities, including Duke, Dartmouth and Ohio State, are calling on lawmakers to consider lowering the drinking age from 21 to 18, saying current laws actually encourage dangerous binge drinking on campus.

The movement called the Amethyst Initiative began quietly recruiting presidents more than a year ago to provoke national debate about the drinking age. So far, no Washington-based schools are on board.

“This is a law that is routinely evaded,” said John McCardell, former president of Middlebury College in Vermont who started the organization. “It is a law that the people at whom it is directed believe is unjust and unfair and discriminatory.”

Other prominent schools in the group include Syracuse, Tufts, Colgate, Kenyon and Morehouse.

But even before the presidents begin the public phase of their efforts, which may include publishing newspaper ads in the coming weeks, they are already facing sharp criticism.

Mothers Against Drunk Driving says lowering the drinking age would lead to more fatal car crashes. It accuses the presidents of misrepresenting science and looking for an easy way out of an inconvenient problem. MADD officials are even urging parents to think carefully about the safety of colleges whose presidents have signed on.

“It’s very clear the 21-year-old drinking age will not be enforced at those campuses,” said Laura Dean-Mooney, national president of MADD.

Both sides agree alcohol abuse by college students is a huge problem.

Research has found more than 40 percent of college students reported at least one symptom of alcohol abuse or dependence. One study has estimated more than 500,000 full-time students at four-year colleges suffer injuries each year related in some way to drinking, and about 1,700 die in such accidents.

A recent Associated Press analysis of federal records found that 157 college-age people, 18 to 23, drank themselves to death from 1999 through 2005.

Moana Jagasia, a Duke University sophomore from Singapore, where the drinking age is lower, said reducing the age in the U.S. could be helpful.

“There isn’t that much difference in maturity between 21 and 18,” she said. “If the age is younger, you’re getting exposed to it at a younger age, and you don’t freak out when you get to campus.”

McCardell’s group takes its name from ancient Greece, where the purple gemstone amethyst was widely believed to ward off drunkenness if used in drinking vessels and jewelry. He said college students will drink no matter what, but do so more dangerously when it’s illegal.

The statement the presidents have signed avoids calling explicitly for a younger drinking age. Rather, it seeks “an informed and dispassionate debate” over the issue and the federal highway law that made 21 the de facto national drinking age by denying money to any state that bucks the trend.

But the statement makes clear the signers think the current law isn’t working, citing a “culture of dangerous, clandestine binge-drinking,” and noting that while adults under 21 can vote and enlist in the military, they “are told they are not mature enough to have a beer.” Furthermore, “by choosing to use fake IDs, students make ethical compromises that erode respect for the law.”

“I’m not sure where the dialogue will lead, but it’s an important topic to American families and it deserves a straightforward dialogue,” said William Troutt, president of Rhodes College in Memphis, Tenn., who has signed the statement.

But some other college administrators sharply disagree that lowering the drinking age would help. University of Miami President Donna Shalala, who served as secretary of health and human services under President Clinton, declined to sign.

“I remember college campuses when we had 18-year-old drinking ages, and I honestly believe we’ve made some progress,” Shalala said.

Duke President Richard Brodhead wrote in a statement on the Amethyst Initiative’s Web site that the 21-year-old drinking age “pushes drinking into hiding, heightening its risks.”
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source: Seattle Post

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Getting drunk drivers off roads a costly, complex problem

By admin | August 18, 2008

Mark says he is learning how to “live life on life’s terms.”

After two drunken driving convictions and two marijuana possession convictions, the 34-year-old father of four is learning that it is time to grow up and make better choices. He’s learning how in an intensive DWI/Drug Court under the close supervision of McLennan County Court-at-Law Judge Mike Freeman, probation officers, counselors and fellow defendants in the program.

Mark says he is lucky to get this extra chance, especially with recent intoxication manslaughter trials that ended in prison terms grabbing headlines and raising public awareness about the tragedy often associated with drinking and driving.

“When I think about those cases or hear something about a drunk driver, I just think, a few years ago that could have been me,” Mark said. “If I have taken anything away from this it is that I don’t have to make the choices that I made, that I can live life on life’s terms and if I take everything that I have learned in this program and practice it, I will be OK.”

Mark, a packaging plant employee who asked that his real name not be used so his wife would not be embarrassed, was raised by his mother, who worked two jobs to make ends meet for him and his younger brother. When he got older, despite his mother’s teachings, he started smoking pot and drinking. Both led him to jail.

“I paid $10 for a bag of weed, and it cost me about $3,000. It was an expensive lesson,” he said.

One that didn’t quite sink in. Not until a second marijuana bust, more probation time and two DWI arrests, both coming on New Year’s Eve a couple of years apart. He got probation for those, too, and was two months away from being discharged on his last case when his probation was revoked because he got behind on court costs and fees.

That ultimately led him to Freeman’s DWI/Drug Court, which combines intensive supervision, more frequent substance abuse testing, counseling, faith-based motivation and principles of Alcoholics Anonymous.

Working the program into his busy schedule was hard, Mark said. He was working 12-hour shifts at times, picking his kids up from school and sleeping when he could.

“I was really bitter for the first two weeks I was in this program because I was like, ‘They are going to nail me. There is no way I can do this.’ But when I sat down and prioritized and thought about it and got with family members, my mom and wife, and we just worked out a system and everything just became easy.”

Freeman said Mark has made great progress in the program. He should be released from probation in about six months.

Larry Courtney, a courthouse security deputy and pastor of Mt. Pleasant Baptist Church, has known Mark and his family for 25 years.

“He is an example of someone who made a mistake,” Courtney said of Mark. “We have criminals and we have people who make mistakes. He made a mistake, a case of poor judgment.”

Mark said he is learning that it is all about making the right choices.

“I tell my kids pretty bluntly that Dad screwed up enough for all of us. I have taken enough money out of this family because I have had to pay for my mistakes, and I don’t want them to go through that. I just try to keep an open relationship with them so if they need to talk to me, we can talk about anything.”

Teran Yaklin, a licensed master social worker at the DePaul Center in Waco, such stories of repeated offenses aren’t unusual. Strict penalties against drunken driving make some people think twice about getting behind the wheel while intoxicated. They are people who are not dependent on alcohol but rather occasionally drink to excess. The issue for them is simply modifying their behavior to what is safe and expected, she said.

But for people who have an alcohol addiction, laws against drunken driving have little to no effect, Yaklin said. Such people know driving drunk is dangerous. They are either in denial about being intoxicated when they drive or they can’t stop themselves from doing it despite a desire not to, she said.

“For people who are addicts, external boundaries don’t mean a whole lot,” said Yaklin, who coordinates a program that provides inpatient detoxification and intensive outpatient treatment to people with chemical dependency. “. . . So many times I hear them talking about (getting a DWI) like it happens randomly to people, like getting struck by lightning.”

Addicts can change only if they realize they have a disease and decide they want to manage it, Yaklin said. Legal trouble can help spur that realization. But it often takes a mix of problems, including struggles at work and home, to really get their attention, she said.

A major barrier to people getting treatment is the prevalent belief that alcohol dependency is a behavior problem, Yaklin said. That mind-set causes addicts to feel a lot of guilt and shame, and that in turn fuels their urge to drink, she said.

“I think the minute we start looking at it as a disease instead of a behavioral problem, people are much more apt to seek treatment, admit they have a problem,” she said. “Right now it has that stigma that you’re a bad person.”

As for what can be done to keep people from getting addicted to alcohol in the first place, Yaklin said it all boils down to education. Specifically, she said, high school students need to be told that some people are more prone to becoming addicts than others and, unfortunately, there is no way to know which category they fit in. Many teens don’t understand that, she said.

Reita Hill, grants administrator for the Texas chapter of Mothers Against Drunk Driving, agreed that education is key. But the organization would also like to see stricter enforcement of current laws.

Many law enforcement agencies don’t have enough officers to dedicate a lot of time to watching for drunken drivers, Hill said. Aggravating that problem is that the paperwork required for a drunken driving arrest usually takes several hours to complete, causing some officers to not aggressively pursue enforcement, she said.

Similarly, the Texas Alcoholic Beverage Commission doesn’t have enough agents to do repeated stings at stores that sell alcohol to minors, Hill said. Under state law, such places can be shut down if they are caught three times in two years. But the chances are slim of TABC having enough manpower to conduct multiple sting operations at the same place in that time period, she said.

If citizens want to get serious about stopping alcohol-related tragedies, they have to agree to fund more officers, she said.

MADD also pushes for expanding existing punishments to more offenders, Hill said. The group would like ignition interlock systems to be mandatory for everyone who gets a DWI.

Such systems are similar to having a breathalyzer installed in a vehicle’s dashboard. Drivers must breath into the device, and the vehicle won’t start unless their blood-alcohol level is within certain limits.

Use of the devices has lowered drunken driving incidents in other states, Hill said. In Texas, judges are supposed to order the use of the devices — paid for by the offender — after a second DWI offense, but not all do, she said. MADD also advocates longer sentences for people who kill someone while driving drunk, Hill said.

Locally, Hill said she has been heartened to see that prosecutors are taking more alcohol-related crimes to juries.

“They are beginning to hold people accountable, which they haven’t done before,” she said. “. . . I remember a few years back I felt lucky if we were getting a five-year sentence (in McLennan County) and now we’re getting the maximum (on some cases). I think it’s just the community finally saying enough is enough.”
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source: Waco Tribune-Herald

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Methadone Rises as a Painkiller With Big Risks

By admin | August 17, 2008

Suffering from excruciating spinal deterioration, Robby Garvin, 24, of South Carolina, tried many painkillers before his doctor prescribed methadone in June 2006, just before Mr. Garvin and his friend Joey Sutton set off for a weekend at an amusement park.

On Saturday night Mr. Garvin called his mother to say, “Mama, this is the first time I have been pain free, this medicine just might really help me.” The next day, though, he felt bad. As directed, he took two more tablets and then he lay down for a nap. It was after 2 p.m. that Joey said he heard a strange sound that must have been Robby’s last breath.

Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.

A synthetic form of opium, it is cheap and long lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill seekers and badly prescribed by doctors unfamiliar with its risks, methadone is now the fastest growing cause of narcotic deaths. It is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.

“This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately,” said Dr. Howard A. Heit, a pain specialist at Georgetown University. “Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death.”

Federal regulators acknowledge that they were slow to recognize the dangers of newly widespread methadone prescribing and to confront physician ignorance about the drug. They blame “imperfect” systems for monitoring such problems.

In fact, a dangerously high dosage recommendation remained in the Food and Drug Administration-approved package insert until late 2006. The agency has adjusted the label and is now considering requiring doctors to take special classes on prescribing narcotics.

Between 1999 and 2005, deaths that had methadone listed as a contributor increased nearly fivefold, to 4,462, a number that federal statisticians say is understated since states do not always specify the drugs in overdoses. Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003. In most cases it was mixed with other drugs like sedatives that increased the risks.

The rise of methadone is in part because of a major change in medical attitudes in the 1990s, as doctors accepted that debilitating pain was often undertreated. Insurance plans embraced methadone as a generic, cheaper alternative to other long-lasting painkillers like OxyContin, and many doctors switched to prescribing it because it seemed less controversial and perhaps less prone to abuse than OxyContin.

From 1998 to 2006, the number of methadone prescriptions increased by 700 percent, according to Drug Enforcement Administration figures, flooding parts of the country where it had rarely been seen.

But too few doctors, experts say, understand how slowly methadone is metabolized and how greatly patients differ in their responses. Some prescribe too much too fast, allowing methadone to build to dangerous levels; some fail to warn patients of the potential dangers of mixing methadone with alcohol or sedatives, or do not keep in contact during the perilous initial week on the drug. And some patients do not follow the doctor’s orders.

“Those problems were not soon recognized,” said Dr. Bob Rappaport, a division director at the Food and Drug Administration. He added: “Methadone is an extremely difficult drug to use, even for specialists. People were using it rather blithely for several years.”

Dr. James Finch, an addiction specialist in Durham, N.C., said, “In the clinical and regulatory communities, everyone is trying to run and catch up with and deal with the causes of methadone overdoses.”

This year the federal government started sponsoring voluntary classes that teach doctors the elaborate precautions they should take with methadone, like inching upward from low starting doses and screening patients for addictive behavior. (While Robby Garvin’s doctor could argue that the dosage he was taking was reasonable — one to two 10-mg tablets, three times a day — and he was cleared by his state medical board, many specialists would have started him on a lower dose.)

In what critics call a stunning oversight, the F.D.A-approved package insert for methadone for decades recommended starting doses for pain at up to 80 mg per day. “This could unequivocally cause death in patients who have not recently been using narcotics,” said Dr. Robert G. Newman, former president of Beth Israel Medical Center in New York and an expert in addiction.

The F.D.A. says that in the absence of reports of problems by doctors or surveillance systems, “we would have no reason to suspect that the dosing regimen” might need to be adjusted.

In November 2006, after reports of overdoses and deaths among pain patients multiplied and The Charleston Gazette reported on the dangerous package instructions, the F.D.A. cut the recommended starting limit to no more than 30 mg per day. “As soon as we became aware of deaths due to misprescribing for pain patients, we began the process of instituting label changes,” Dr. Rappaport said.

Methadone, which is made by Roxane Laboratories Inc. of Columbus, Ohio, and Covidien-Mallinckrodt Pharmaceuticals of Hazelwood, Mo., creates dependency and is sometimes sought by abusers who say they experience a special buzz when mixing it with Xanax.

While the greatest numbers of methadone-related deaths have occurred among the middle-aged, the fastest growth — an elevenfold jump between 1999 and 2005, to 615 — occurred among those age 14 to 24, which experts say may be mainly a result of pill abuse.

Pain experts say the country is seeing a reprise of the abuse and tragedies that followed the introduction of OxyContin, a time-release form of oxycodone that was heavily marketed in the late 1990s. It became a factor in hundreds of deaths and a focus of law enforcement.

OxyContin is still widely prescribed, but a survey of Medicare plans in 2008, by the research firm Avalere Health LLC, found that many did not even include OxyContin on the list of reimbursable drugs. Critics like Dr. June Dahl, professor of pharmacology at the University of Wisconsin, fault the insurance companies for favoring methadone simply because of its monetary cost. “I don’t think a drug that requires such a level of sophistication to use is what I’d call cheap, because of the risks,” Dr. Dahl added.

Yet for the right patients, methadone can be a godsend. Alexandra Sherman, a patient of Dr. Heit’s at his Fairfax, Va., clinic, suffered for years from hip and shoulder pain that “felt like somebody stabbing me with a knife,” she said. Pain began to rule and ruin her days.

Dr. Heit gave her OxyContin and later, because it seemed to work better and because of the expense, switched her to methadone. Her insurance at one point covered only $500 in prescriptions, which paid for just one month’s worth of OxyContin, compared with methadone’s cost of $35 a month.

Methadone “has given me my life back,” Ms. Sherman said.

But Dr. Heit did not just throw drugs at her problem. He told her that she would also have to try physical therapy as well. They signed a contract listing mutual obligations — she would follow directions, he would be on call. He starts patients at low doses, makes them bring in their pill bottles so he can count how many are left, and may give urine tests to deter mixing drugs.

Some doctors, like Dr. Theodore Parran of Case Western Reserve University, also require methadone patients to give them the names of relatives or friends they can call from time to time.

But not all doctors have taken such precautions. Tony Davis, a contractor in Victorville, Calif., had just turned 38 in 2004 when, after years of migraines and back pain, he saw a new pain doctor in his Kaiser Foundation Health Plan. The doctor, who had already given him the sedative Xanax, prescribed methadone because of his continued pain.

The second day on the two medications, Mr. Davis said, “I’m feeling really weird,’ ” recalled his wife, Pebbles Davis. The two lay down for a nap and when she woke up, her husband was dead.

Ms. Davis recalled that the coroner had told her, “Given the medicines he was on, his brain forgot to tell his heart to beat and his lungs to pump.” The case went to an arbitrator, who ruled that although Mr. Davis had overused his drugs in the past, the doctor had failed to warn him about the new risks of starting methadone together with Xanax and that the care was substandard. Ms. Davis was awarded more than $500,000. “I never had any idea of the risk nor did my husband,” she said.

Another source of danger has been the conversion tables that doctors use when switching patients from one opioid to another — telling, for example, how many milligrams of methadone would be equivalent to the level of morphine a patient had been taking. These charts, until recently, indicated dangerously high doses for methadone. Newer ones suggest lower levels but many experts say these may be useless because methadone affects patients so variably.

Now, as the government is making new efforts to teach methadone’s challenges, some officials and doctors would go further, requiring prescribers to take a course before using methadone.

But many physicians and patient groups are wary of any steps that would slow access to pain treatments.

As early as 2003, alarmed by the rise in methadone-related deaths, the Substance Abuse and Mental Health Services Administration made an urgent call for more systematic and detailed state and national reporting about opioid deaths — a call that still goes unanswered.

Misuse by abusers was first seen as the problem, but now, said Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment of SAMHSA, “We know that a significant share of the methadone deaths involve doctors making well-intended prescriptions.”

A majority of victims also used large quantities of alcohol or benzodiazepine sedatives but few would have died without an opioid as the primary culprit. “You can take a lot of benzodiazepines without dying,” said Dr. Charles E. Inturrisi of Weill Cornell Medical Center, who said they strengthen the depressive effect of methadone.

Some doctors prescribe to patients who may be expected to court danger, like Anna Nicole Smith, who died from a drug cocktail including methadone.

Last February, Margaret Moore, 54, who lived alone in South Pasadena, Fla., with a history of alcoholism, depression and chronic back pain from a car accident, was found dead at home. Her doctor had prescribed methadone and valium and, he told investigators, warned her to stop drinking.

Her body was surrounded by empty vodka bottles and a host of pills including bottles of methadone tablets and sedatives. Her death was declared an accident from methadone toxicity.

Since April, SAMHSA has sponsored nine voluntary training courses on the safe prescribing of opioids, and many more are planned, though they will only reach a fraction of prescribers. The agency is also contracting with the American Society on Addiction Medicine to set up a mentoring program, through which prescribing physicians can receive expert advice. The State of Utah has a plan to educate every doctor and pain patient in the state about safe use of methadone and other opioids.

Nancy Garvin, Robby’s mother, is one of many relatives of victims who, in the absence of a national registry, have started educational and pressure groups to fight bad prescribing and abuse of the drug.

Still, the death rate appears to be rising, raising the question of what more may be necessary, in law enforcement and in doctor training.

“Methadone can be important for patients when other drugs don’t work,” said Dr. Inturrisi, ”but unless the doctor has the training and resources to manage the patient properly, he’s going to get in trouble at a rate that’s unacceptable.”
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source: The New York Times

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Getting drunk shouldn’t be normal

By admin | August 16, 2008

We have such a great place to live. We have great schools, good jobs and beautiful lakes and natural resources to enjoy. There’s another distinction, though, we shouldn’t be so proud of: our cultural acceptance of the overconsumption of alcohol. We drink just to get drunk.

As a result, we see so much human misery and face enormous public safety, health and economic costs because of this misuse of alcohol.

It’s tough to pick up the newspaper or turn on the news and not see stories about people being arrested for their third, fourth, fifth, sixth and even 13th drunk driving offense.

We’re so used to these kinds of stories that we think this behavior is normal. It’s not.

Wisconsin has the absolute worst rate of binge and chronic heavy drinkers in the nation. We have the worst rate of underage drinking in the country. We’re also worst in the country for fatal car crashes caused by alcohol.

In Dane County, more than 40% of the fatal car crashes last year involved alcohol. Three times as many people are killed in alcohol-related traffic crashes than are murdered in Dane County each year. Three thousand people are booked on drunk-driving charges in this county each year.

Alcohol is a major factor in many other crimes too, like sexual assault. Nearly 40% of offenders and almost two-thirds of victims are under the influence at the time of a sexual assault. Alcohol is a factor in nearly one in three of the physical assaults in our state.

UW-Madison police issued more than 1,000 underage drinking tickets in 2006. That figure doesn’t include the tickets written by other law enforcement agencies downtown. Campus police report finding students unresponsive in their own beds and in bathroom stalls lying in their own vomit. Students have fallen off their bikes, down flights of stairs and even worse. All while drunk.

Do we want our deputies and police officers spending their shifts hauling drunks to detox instead of patrolling our neighborhoods?

As taxpayers, we spend about $60 million each year to run the county jail. Nearly half of the sentenced inmates are in jail for alcohol-related offenses. We spend an additional $8 million in hard-earned county tax dollars on court programs to help those addicted to alcohol and drugs.

That’s a major commitment, and we’ve seen great results. Treating the consequences of alcohol abuse and treating those who suffer from it is important work that we should do as efficiently and humanely as we can. But the real question remains: Can’t we do more to prevent this problem?

Alcohol misuse is the third leading cause of preventable diseases. Seventeen thousand people were so impaired in this state last year they had to be hospitalized.

Our state has the highest number of women of child-bearing age who binge drink. One in three women ages 19-44 report drinking alcohol during their pregnancies. That increases dangerous risk factors jeopardizing the well-being of the baby.

It’s estimated nearly 25,000 Dane County kids go home to parents who are intoxicated, either passed out on the couch or, worse yet, verbally and physically abusive. This is real human misery.

With all the greatness of our community, why do we put up with this?

We can be different. We all need to look inside ourselves and think twice about what we’re willing to accept as appropriate. Whether it’s looking in the mirror or talking with a co-worker, friend or family member, we all can be part of the solution.

We need to do more for our young people who right now grow up in a culture thinking the only things to do on Thursday, Friday or Saturday nights involve a bottle-opener, can or keg.

That’s why I’ve spent the past several months studying, reading, listening and reviewing the options for how we can best move forward to address our problem with alcohol. This fall, I’ll produce a set of steps I think we need to take.

This isn’t about stopping drinking to celebrate. It’s about stopping the celebration of drinking.
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source: Isthmus, http://www.thedailypage.com

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Topics: Alcohol, Alcohol Addiction | No Comments »

Are Americans in Denial about the Widespread Abuse of Prescription Drugs?

By admin | August 15, 2008

CASA’s just-released National Survey of American Attitudes on Substance Abuse, has found that those who fail to monitor their children’s school night activities, safeguard their prescription drugs, address the problem of drugs in their children’s schools, and set good examples increase the risk that their 12-17 year old children will smoke, drink, and use illegal and prescription drugs.

As youth drug use continues to decline nationwide, we very concerned about the increasing rates of prescription drug abuse among teens. Many Americans benefit from the appropriate use of prescription pain killers, but, when abused, they can be as addictive and dangerous as illegal drugs.

USA Today reports:

Drugs such as Vicodin — a commonly prescribed pain pill that causes a drunk-like feeling — can be detrimental to the still-developing teenage brain and can impair judgment in people who already are prone to mistakes in judgment. The drugs increase “the risk for accidents, sexual activities (and) more drugs,” Lopez says.

The survey comes at a time when teen use of illegal drugs is actually down, says Tom Riley, spokesman for the Office of National Drug Control Policy.

“While teen use of illegal drugs has gone down in recent years, the one category that has gone up is teen abuse of prescription drugs,” Riley says. “Americans are in denial about how widespread this problem is.”

Many recommend locking up drugs. But the best way to prevent drug abuse is good old-fashioned parenting, Planet and others say.

“We know from our research that parental engagement — being involved in your kids’ lives, monitoring what they’re up to — is a very key component in teen substance risk.”

The telephone survey reached 1,002 teens and 312 parents this past spring. The margin of error is 3.1 percentage points.
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source: Pushing Back, http://pushingback.com

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Topics: Drug Addiction, Prescription Drugs, society, teenagers | No Comments »

Teens Cite Ease of Access To Drugs

By admin | August 14, 2008

A growing number of teenagers say it’s easier to illegally obtain prescription drugs than to buy beer, according to a survey published today.

The National Center on Addiction and Substance Abuse at Columbia University asked: “Which is easiest for someone your age to buy: cigarettes, beer, marijuana, or prescription drugs such as OxyContin, Percocet, Vicodin or Ritalin, without a prescription?” Nineteen percent of teenagers found it easier to purchase prescription drugs than cigarettes, beer or marijuana, compared with 13 percent a year ago. A quarter of the teens said it is easiest to buy marijuana, with 43 percent of 17-year-olds saying they could buy the drug in less than an hour.

The study also found that a large group of parents do not know where their children are in the evening and identified a group of “problem parents” whose actions increased the abuse of illegal and prescription drugs among 12-to-17-year-olds.

Joseph Califano, chairman and president of the center, said there are basic steps parents could take to avoid being “passive pushers.” The statistics showed that 34 percent of teenagers abusing prescription drugs, like OxyContin and Vicodin, obtained them at home or from their parents. “Fifty years ago, people would lock up the liquor,” he said in a telephone interview. “Maybe there should be a lock on the medicine cabinet now.”

Elizabeth Planet, the center’s director of special projects, who coordinated the study of 1,002 12-to-17-year-olds from April to June, highlighted the difference in behavior reported by parents and their children. “Half of the teenagers were saying they were out on school nights, but only 14 percent of the parents knew that they were out,” she said. “There are lots of factors at play here. Parents are not paying attention. There are parents who are out in the evening themselves. There are parents out at work.”

The correlation between allowing teens out late on school nights and the likelihood that people in their presence would be smoking and drinking was dramatic. Half of all teenagers allowed out after 10 p.m. said that they spent time with people smoking and using drugs, while 29 percent of those who returned home between 8 p.m. and 10 p.m. reported the same behavior.

Califano recommended family dinners as a simple way of decreasing the chances of drug abuse, noting that 23 percent of teens who ate fewer than three dinners a week with their family had used marijuana, compared with 10 percent when the family ate together five or more times a week.

Stephen Pasierb, the president of Partnership for a Drug-Free America, cited a lack of understanding between the generations, with parents not understanding the risks surrounding prescription drugs, in particular. “This is a very different generation of children,” he said. “Prescription drugs are entrenched, and they have not moved for five years, and this generation of parents simply do not understand the problem.”

Nora Volkow, the director of the National Institute on Drug Abuse, said that drug abuse has declined over the last six years, but the abuse of prescription medicine is a serious concern.

“Kids think that because these are medicines that are prescribed, they are safe,” she said. “The problem is that there is very little difference between the amount they take for a high and the amount that causes an overdose.”
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source: The Washington Post

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Topics: Drug Addiction, society, teenagers | 2 Comments »

After combat, citizen soldiers turning to alcohol

By admin | August 13, 2008

National Guard and Reserve combat troops in Iraq and Afghanistan are more likely to develop drinking problems than active-duty soldiers, a new military study suggests.

The authors speculate that inadequate preparation for the stress of combat and reduced access to support services at home might be to blame.

The study, appearing in today’s Journal of the American Medical Association, is the first to compare Iraq and Afghanistan veterans’ alcohol problems before and after deployment.

It should help guide planning for future prevention and treatment programs, said study co-author Dr. Edward Boyko, who works for the Veterans Affairs Puget Sound Health Care System.

The research is one of the first major studies to emerge from the Pentagon’s landmark “Millennium” study, launched in 2001 because of concerns about possible health effects from the first Gulf War. It includes tens of thousands of military personnel and is designed to evaluate the long-term health effects of military service.

In the alcohol study, researchers analyzed data from nearly 80,000 military personnel, including more than 11,000 who were sent to Iraq and Afghanistan. They looked at whether deployment and combat exposure were linked with new alcohol problems such as binge drinking.

They found that more than 600 combat troops who reported no binge drinking at the start of the study developed the problem after deployment and combat exposure. That accounted for about 26 percent of the estimated 2,400 military personnel exposed to combat who did not report binge drinking at the start of the study.

New patterns of regular heavy drinking and alcohol problems, such as missing work because of drinking, occurred more often in guard and reserve troops who experienced combat. Their risk of developing new drinking problems, compared to guardsmen and reservists who weren’t deployed, was about 60 percent higher.

Alcohol abuse, post-traumatic stress disorder and depression make up an “unholy trinity” that haunts some combat soldiers, said psychologist William Schlenger of the consulting firm Abt Associates Inc. in Durham, N.C. He was a principal investigator of the influential National Vietnam Veterans’ Readjustment Study but was not involved in the new research.
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source: Journal Gazette, http://www.journalgazette.net

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Topics: Alcohol, Alcohol Addiction, Mental Health | 1 Comment »

Is Compulsive Shopping A Mental Disorder?

By admin | August 12, 2008

There is little doubt that compulsive shopping can cause severe impairment and distress, two key criteria for formal recognition as a mental disorder.

But the rest remains up for grabs: Is compulsive shopping a biologically driven disease of the brain, a learned habit run amok, an addiction in its own right or a symptom of the other dysfunctions — most notab