The Drug Enforcement Administration says that when they survey law enforcement and ask them about the biggest drug problem in their area, prescription drug abuse tops the list. The numbers are high especially among adolescents, as one in five teenagers reports abuse of prescription drugs to gain a quick high, and one in seven reports using prescription drugs in the past year.

Acting U.S. Attorney, Ann Scheel, says teenagers begin by using prescriptions but then realize they can’t afford them so they delve into illicit drugs once they are hooked. The Obama administration is focusing on targeting the seller and not the consumer and says for the government the problem is the transfer and distribution of the drugs, not the possession of them. The Administration points out that there isn’t a difference between the heroin dealer and the doctor from a legal perspective, if they are both violating the law. Both would be charged with the same crime as if they were a street dealer pushing heroin.

Last year the DEA arrested a doctor in California who was accused of running a prescription mill in his office. The government seized over $3 million and a 1999 Bentley, all allegedly due to proceeds from trafficking pain medications.

DEA Says Prescription Drug Abuse Hit Epidemic Proportions is a post from: Drug Addiction Treatment

Drugs from the opiod family can be extremely addictive and difficult to quit. Similar to other drugs, they also produce a “high,” which is one of the reasons they are often abused. In fact, OxyContin in said to be the legal prescription version of the street drug heroin. Like street drugs, athletes can build up a tolerance, leaving them wanting more to produce the desired effect.

Opiod pain medications work by binding opioid receptors in the nervous system and GI tract. Essentially they interfere with the body’s ability to read and perceive pain. Those in the professional sports industry start taking opiods because of sports related injuries and years of physical impact. These medications also allow players to continue playing through pain as the pain signals are blocked from ever reaching the brain. Among the most commonly prescribed opiod painkillers are Oxycodone (branded as OxyContin), Vicodin, codeine and morphine.

Not surprisingly former NFL players are among some of the highest users of opiod pain medications. In fact, a study conducted by Washington University School of Medicine in St. Louis, Missouri reports that these individuals are four times as likely to use opiod painkillers as everyone else. Once the game is over, these athletes are left to deal with the repercussions of playing through sustained injuries. Approximately 70 percent of those surveyed said they used the drugs to cope with moderate to severe pain.

Researchers surveyed 667 former NFL players about their current and past use of prescription drugs for pain management. What they found was that over 50 percent of retirees used the drugs while on the field, and 71 percent admitted to abusing them. About fifteen percent of those who misused the drugs while playing continued to abuse them after retirement.

Perhaps most telling is the fact that most of the players reported getting the drugs from someone other than a doctor. While 37 percent of those surveyed received their medications solely from a physician, 67 percent claimed they got them from someone else. This surprising statistic helps explain why the medications are misused.

Linda Cottler, lead researcher on the study, says that when it comes to pain management and addiction, players are being left to fend for themselves. She advocates finding other ways of helping players cope with pain other than prescription drug use. Other experts recommend that the NFL start aggressive drug testing. NFL players and retirees say that, instead of prescription drug use, the NFL has traditionally focused on drugs that enhance performance such as steroids.

The study also found that significant pain, undiagnosed concussions and excessive drinking were directly related to the abuse of painkillers. Cottler says that NFL players need to be more closely monitored throughout their career and beyond to assist with prevention and maintenance. For the sake of our beloved athletes, other alternatives to pain management need to be explored so that they aren’t left struggling with addictions long after the game is over.

Pain, Injuries leave NFL Retirees Battling OxyContin and Other Painkiller Addictions is a post from: Drug Addiction Treatment

After meeting on Thursday, September 16, the FDA’s Advisory Committee agreed with Alkerme’s sNDA and its research that was first introduced at the 2010 American Psychiatric Association (APA) Annual Meeting in May, where four clinical studies demonstrated naltrexone’s ability to suppress both alcohol and opioid cravings and withdrawals. The FDA will consider the recommendation of the Advisory Committee and formally announce its final decision on October 12, 2010. The FDA is not obligated to agree with the recommendations of its Advisory Committee—a panel of outside experts—although the U.S. administration historically tends to follow suit.

The Advisory Committee voted 12 to 1 in favor of naltrexone’s use in the treatment of opioid dependency and found the sNDA to be particularly favorable since the clinical trials of the drug showed no apparent serious side effects. Although the clinical trials did show positive results among sample populations of alcoholics or opioid addicts compared to placebo-administered control groups, the Advisory Committee was concerned about the efficacy of a single research study that was held outside the U.S.

“Efficacy and Safety of Extended-Release Injectable Naltrexone (XR-NTX) for the Treatment of Opioid Dependence,” conducted by lead investigator Dr. Evgeny Krupitsky of St. Petersburg Regional Center of Addictions in Russia found that naltrexone injections successfully reduced drug cravings among opioid-dependent individuals. In a 24-week investigation involving 250 opioid-dependent participants who had opioid addiction for 10 years, the group administered naltrexone injections showed significant reductions in their cravings, physiologic dependence, and self-reported opioid use, and had better retention compared to the placebo group. These participants were more capable of suppressing their cravings, preventing relapse and sustaining abstinence.

Due to the disruption of normal neurotransmission in the brain’s reward system caused by opioid use, opioid abusers become physiologically vulnerable to their cravings and often relapse even after undergoing treatment. The experts from the clinical trials as well as the FDA Advisory Committee caution that naltrexone may not be an absolute cure-all to alcoholism or opiate addiction, but the benefits of this new injectable does give the field of addiction medicine more options when it comes to treating opioid addiction, which as of yet has no other pharmacological form of treatment.

Source: MedScape Today, Emma Hitt, FDA Panel Recommends Naltrexone Extended-Release Injectable Suspension for Opioid Addiction, September 17, 2010

FDA Committee Recommends Naltrexone for Opioid Addiction Treatment is a post from: Drug Addiction Treatment

The Drug Abuse Warning Network (DAWN) provides monitoring of drug-related emergency department visits in the United States. In 2008, nonmedical use of pain relievers was a leading form of drug abuse in the United States among persons aged 12 years or older, second only to the use of marijuana.

Narcotics, or opioids, are pain relievers that are chemically derived from opium. DAWN reports use of the drug when it is being taken differently than prescribed by a doctor.

In 2008, the rate of admissions for the nonmedical use of narcotics pain relievers rose 111 percent, from 144,644 to 305,885. Both male and female patients doubled, as did cases of patients younger than 21 and those 21 and older.

There was also an increase of particular types of narcotics used for nonmedical purposes, including oxycodone products, hydrcodone products, methadone, morphine products, fentanyl products and hydromorphone products.

Emergency department visits related to oxycodone products increased by 152 percent. Hydrocodone products were increasingly used by 123 percent and methadone was increased by 73 percent. Hydromorphone showed the largest increase at 259 percent, but the number of visits related to hydromorphone was minor relatively compared to the other types of narcotics used.

The results reported by DAWN show that between 2004 and 2008 there was a significant difference in the number of medical emergencies that were related to nonmedical use of narcotics. Visits related to certain types of narcotic pain relievers, such as hydromorphone, increased dramatically over the course of the study.

Over the five year period of DAWN monitoring, it is clear that nonmedical use of narcotic pain relievers is a growing problem. Six major types of narcotic pain relievers showed significant increases, indicating that narcotics are widely misused.

The findings of the study show that there is a need for increased education about the misuse of narcotic pain relievers. Individuals prescribed the narcotic need to be cautioned about the risk of dependence and signs of an increased tolerance level to the drugs.

In addition, medical personnel need to be educated on how to watch for signs that a person may be misusing their narcotic pain reliever. Careful monitoring is needed for patients on narcotics to prevent the misuse or overdose of opioids.
 

Emergency Department Treatment of Nonmedical Narcotic Use is a post from: Drug Addiction Treatment

Medscape Today reports that The National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study found that those who tapered off the medication using buprenorphine during a 9-month period, whether initially or after a period of improvement, almost universally relapsed.

Roger D. Weiss, MD, professor of psychiatry at Harvard Medical School in Boston, and chief of the Division of Alcohol and Drug Abuse, McLean Hospital in Belmont, Massachusetts, said: "There has been virtually no research on the treatment of persons dependent on prescription opioids, in spite of the major increase in prescription opioid abuse and in the numbers of persons entering treatment for addiction to prescription opioids.”

"The trial was designed to help the physician manage patients who are dependent on opioids and want off the drugs but refuse treatment in a drug abuse treatment program," Dr. Weiss said.

The study enrolled 653 people with prescription opioid dependency and offered them standard medical management, which included buprenorphine, an initial one-hour visit, and weekly 20-minute sessions with a physician who counseled the patients and monitored for adverse drug effects. Half the group remained in this standard medical management group and half received enhanced medical management, which included twice-weekly 60-minute individualized drug counseling focusing on interpersonal issues, coping with triggers and high-risk situations, homework, and more.

Patients were evaluated after periods of individualized buprenorphine tapering and maintenance and were assessed for abstinence from opioids at various times.

Several patients reported current chronic pain (42%), and some were taking opioids for this condition. Many patients reported a lifetime history of heroin use (23%), alcohol abuse (60%) or dependence (27%), cannabis abuse (47%) or dependence (15%), and cocaine abuse (32%) or dependence (18%).

Opioids used within 30 days included sustained-release oxycodone (35%), hydrocodone (32%), immediate-release oxycodone (19%), methadone (6%), and others (8%).

Thirty percent of subjects had received some previous treatment for opioid dependency, primarily self-help (59%), inpatient/residential treatment (42%), outpatient counseling (40%), and methadone maintenance (31%). But Dr. Weiss noted that the trial was the first treatment for most subjects.

Treatment success was defined as four or fewer days of opioid use per month, no positive urine screens for opioids for two consecutive weeks, no other formal substance abuse treatment, and no injection of opioids.

In the standard medical management group, only 7% met the criteria for success, as did just 6% of the enhanced medical management group. "Nearly all patients relapsed after a four-week taper," Dr. Weiss said.

Patients who relapsed were asked to enter phase 2, at which time 360 patients were randomly assigned to standard medical management or enhanced medical management and received 3 months of buprenorphine stabilization, then had treatment tapered for one month, with a two-month follow-up.

At the end of the stabilization (at week 12), substantial improvement was noted for 52% of the enhanced medical management group and 47% of the standard medical management group, though there was no additional benefit to enhanced management.

Substantial improvement was defined as abstinence for three or more of the final four weeks of buprenorphine stabilization.

However, by the end of the stabilization period, many patients had relapsed again, Dr. Weiss reported.

"We went from an average success rate of 49% to 26% at week 16,"he said. At week 24, only 9% of patients remained successfully treated.

"At the end of the study, we were back into phase 1 territory," he said. "Seven of eight patients doing well on buprenorphine maintenance had relapsed."

The study also found that the presence of chronic pain did not influence outcomes. Patients with chronic pain were equally likely to enter phase 2 (indicating early treatment failure) and were equally likely to be substantially improved at week 12 of phase 2 (53% vs. 47% for those without chronic pain).

"Interestingly, we found that in many cases the patient’s pain got better," he added, explaining that one cannot assume that buprenorphine itself improved the pain, as there was no control group, but he noted that it is an interesting possibility.

Study Examines Treatment for Prescription Opioid Dependence is a post from: Drug Addiction Treatment

Opiate withdrawal can be a miserable experience, with symptoms including agitation, muscle aches, vomiting, and extreme discomfort. The symptoms usually subside after about a week, but for some they could persist for several months. Individuals may also experience craving for the drug for years after withdrawal.

Two medications are approved for use with opioid addiction. Methadone and buprenorphine are commonly offered to offset the effects of opioid withdrawal. Only 8 percent of all substance abuse treatment facilities offer this kind of treatment.

In order to offer methadone or buprenorphine to combat opioid withdrawal symptoms, the facility must be a certified Opioid Treatment Program (OTP). Individual physicians may also enroll in specialized training to prescribe buprenorphine addiction products in their practices.

According to a recent survey by the National Survey of Substance Abuse Treatment Services, facilities that specialized only in opioid treatment are more likely than other types of treatment centers to be operated by a private for-profit organization (92.9 percent versus 83.3 percent).

Most OTPs are located in a metropolitan area, with 44.8 percent of those specializing only in opioid treatment located in a large central metropolitan area.

According to the survey, facilities that specialized only in opioid treatment were also more likely to focus specifically on substance abuse, instead of a mix of substance abuse and mental health treatment.

Counseling is an important component of recovering from an opioid addiction and getting past withdrawal symptoms to avoid a relapse. Almost all of OTPs (99.6 percent) specializing in opioid treatment provided individual counseling to their clients. The most used types of therapy were substance abuse counseling and relapse prevention.

Facilities offer a variety of options for payment. Almost all OTPs accept cash or self payment, but those specializing specifically in OTP are less likely to accept other types of payment or have sliding fee scales or free treatments for those who cannot pay.

It is clear from the information gathered in the survey that facilities specializing only in OTPs may be limited in the facets of treatment they can offer clients who struggle in more than one area of substance abuse or mental disorders.

It is very helpful for healthcare providers and counselors to have the information from the survey so that they are informed about the many types of care available. With this information, referrals can be made to ensure the best possible fit for those undergoing the uncomfortable process of opioid withdrawal.

Opiate Withdrawal is a post from: Drug Addiction Treatment

To better understand the role glial cells play in morphine’s effects in the brain, researchers funded by the National Institute on Drug Abuse (NIDA) gave rats either twice-daily doses of a drug called ibudilast, which inhibits the activity of glial cells, or a control injection. On the third day, the rats began receiving morphine in increasing doses.

After 5 days of morphine exposure, the rats received a dose of the opioid inhibitor naloxone to induce withdrawal. In contrast to control rats that showed dramatic increases in levels of the chemical dopamine in the nucleus accumbens (NAc) region of the brain in response to morphine injection, rats who had received the ibudilast showed smaller increases.

Moreover, the rats who received ibudilast also showed significantly fewer physical signs of withdrawal after naloxone injection. They also noted that, after naloxone administration, as dopamine levels decreased so did the physical signs of withdrawal.

These results show that inhibiting glial cells with ibudilast can reduce dopamine levels in the NAc, which are considered indicators of morphine reward and may also be associated with withdrawal. Therefore, targeting glial cell activity with drug therapies such as ibudilast may be a promising approach for treating opioid addiction.

Suppressing Glial Cell Activity Reduces Effects of Morphine on Rats is a post from: Drug Addiction Treatment

Among the most commonly prescribed medications in Canada, opioids are often used for patients with chronic non-malignant pain. This study suggests that the increases in opioids prescriptions are a significant factor in accidental opioid-related deaths.

To complete this study, researchers examined data from 1991 to 2007 from IMS Health Canada and deaths attributed to opioids use from records of the Office of the Chief Coroner of Ontario between 1991 and 2004.

Opioid pain medication prescriptions increased by 29 percent, with codeine being the most frequently prescribed. Interestingly, the number of prescriptions for that drug declined during the study period. There was also a 850 percent increase in ocycodone prescriptions, which accounted for 32 percent of the almost 7.2 million prescriptions for opioids dispensed in 2006.

In the years between 1991 and 2004, 7,099 deaths with complete records were attributed to alcohol and/or drugs. In 3,406 of these deaths, or 61.9 percent, opioids were implicated as the cause of death.

"The rise in opioid-related deaths was due in large part to inadvertent toxicity," wrote Dr. Irfan Dhalla, of the University of Toronto and coauthors. "There was no significant increase in the number of deaths from suicide involving opioids over the study period."

Once the coroner’s data was linked to health care databases, the researchers included 3,066 deaths. As many as 66.4 percent of these patients have seen a physician at least one in the four weeks preceding their death and received a diagnosis of mental health problems and pain-related complaints were among the most common reasons for medical attention.

"The societal burden of opioid-related mortality and morbidity in Canada is substantial," write the authors. "In our study, the annual incidence of opioid-related deaths in 2004 (27.2 million) falls between the incidence of death from HIV infection (12 per million) and sepsis (40 per million)."
 

Opioid-Related Deaths Continue to Rise in Canada is a post from: Drug Addiction Treatment

Tramadol is a synthetic opioid used to treat moderate to severe pain, and is available in both injectable and oral forms. It can produce euphoria in many users, and the high is similar to opioids like morphine and heroin, but not as intense. This can lead to physical and mental dependence and severe withdrawal symptoms. In addition, the possibility of convulsions at high doses makes recreational use of tramadol very dangerous.

An article in the Journal of the American Academy of Physician Assistants discusses the risks of tramadol abuse by reviewing two cases. In the first case, a 38-year-old male who used tramadol frequently was still in denial about his dependence after suffering a tramadol-induced seizure. After having a second seizure, he admitted his dependence and expressed a desire to seek treatment. At the peak of his addiction, he was taking 27 tablets of tramadol per day.

The patient, who was a physician, began using tramadol for daily headaches about four years earlier, and experienced euphoria and an increased energy level after taking the drug. He attempted to stop the medication several times but ran into difficulty when he experienced mood changes and rebound headaches. He had a history of drug use/abuse in his family, but did not use tobacco products or alcohol. Following completion of a 6-week inpatient detoxification and residential treatment program, he entered a voluntary 5-year monitoring program that included monthly visits with an addictionist, random urine drug screens, group counseling sessions, and documented participation in 12-step meetings.

Currently, the patient is under the care of an internist, neurologist, and addictionist. He has been abstinent from tramadol for 25 months, and his daily headaches are controlled with modifications to diet, exercise, and as-needed use of NSAIDs. He has maintained his employment and is active in the recovery process, which includes 12-step participation and frequent interaction with his sponsor.

In the second case, a 57-year-old female admitted to an addiction medicine physician that she had been using tramadol five to six times daily for the past three months. She expressed a desire to quit but couldn’t do so without assistance due to the withdrawal symptoms.

The patient had a 30-year history of substance abuse, including pentazocine, meperidine, hydrocodone, and oxycodone. She had completed multiple substance abuse treatment programs, including detoxification, inpatient/residential treatment, and intensive outpatient programs. She had experienced emotional, physical, and sexual abuse, and had a history of alcohol and drug abuse in her family. She also used tobacco products and consumed alcohol regularly.

The patient was prescribed trazodone at bedtime for sleep and a daily dose of Suboxone, a drug that virtually stops withdrawal symptoms from opiates and makes it impossible to get high on other opiates while taking it. She was referred to a counselor to address her history of abuse and was encouraged to participate in 12-step meetings.

The patient continues to struggle with her sobriety and intermittently tests positive for amphetamines, barbiturates, benzodiazepines, and opiates. She has chronic pain, headaches, and difficulty sleeping and controlling depressive symptoms, yet she continues to see the addiction medicine specialist and seems to have good family support.

The article notes that physical dependence and withdrawal have been associated with abuse of tramadol in several reports, and that caution should be used before prescribing tramadol to patients at high risk of dependence, such as those with previous personal or family histories of alcohol or drug abuse.

Because tramadol is an unscheduled medication, it can be obtained online, diverted from clinical settings, and purchased outside the US. Some case reports have documented the financial problems that can result when dependent patients purchase tramadol over the Internet; such monetary problems may be the first sign of drug dependence.

The clinical signs associated with abuse, dependence, and withdrawal are very similar to those of opiates. Intoxication is accompanied by euphoria, sedation or excitation, nausea, and miosis (constriction of the pupils), and behavioral withdrawal symptoms are associated with depression, craving, and drug-seeking. Atypical withdrawal symptoms have also been reported from tramadol dependence, including confusion, delusions, paranoia, peripheral numbness, and hallucinations.

The Dangers of Tramadol: Two Stories is a post from: Drug Addiction Treatment