Welcome to the substances disorders news page. Here you will be able to find research and news from 2011 and recent years on such topics as addiction science (street drug pharmacology, the neuroscience of addiction, the medical consequences of alcohol and other drug use, medication-assisted treatment), new directions in the treatment of substance use disorders and changes in epidemiological patterns of drug use. Our goal is to answer the question, "As a counselor, therapist or prevention professional, how can I use this information in my daily work?" In other words, how can you link research to practice? We can not always answer this question, but will endeavor to do so. If you have an idea for using a research finding in your prevention or treatment work, let us know so that we can share your suggestions with others. Click here to visit the "Contact us" page. Please visit this page often since it will be updated on a regular basis. If you have a question you would like to have answered or you would like to see a particular topic featured here, click here. Thank you for visiting the substance use disorders news page!
December 20, 2011
MDMA ("ecstasy") Use May Result in Brain Damage
A recent paper in the Archives of General Psychiatry has provided updated information on a controversial topic: whether MDMA use results in persistent changes in brain structure or function. The study indicates that at some level and dosage of MDMA, persistent damage to the serotonin neurotransmitter system (specifically, serotonin-2A receptor density) may occur. This damage did not disappear with abstinence, suggesting that it may be permanent.
The research described in the paper involved an experimental group of 14 female MDMA users and 10 female matched controls who had not used the drug*. Within the experimental group, a hair analysis showed that no other drugs had been used for at least 90 days. Neither specific dosages of MDMA nor frequency of us were cited. Thus, neither the amount of MDMA nor usage pattern can be linked to the neurotoxity associated with its use. However, the authors suggest that multple doses of the drug and/or concurrent activities (such as dancing) that result in hyperthermia may be important factors in the brain damage.
The authors caution readers that this is a retrospective study with little knowledge of the subjects' prior drug use or pre-existing psychiatric conditions. In addition the "N" (number of subjects) was limited. The specific behavioral or cognitive effect of the serotonin system damage could not be identified, but impairment in memory functions is a likely outcome. However, these results raise a red flag and should be taken seriously by both clinicians and clients. Further, future research that uses MDMA as a therapeutic drug may not be safely conducted until more research regarding the particular pattern of use associated with disruption within the brain's serotonin system is identified.
* Females were recuited for this study since men and women megtabolize MDMA differently, and so te results cannot be generalized to both genders.
Source: Di Iorio, CR, Watkins, TJ, Dietrich, MS, Cao, A, Blackford, JU, et. al. (2011). Evidence for Chronically Altered Serotonin Function in the Cerebral Cortex of Female 3,4-Methylenedioxymethamphetamine Polydrug Users. Archives of General Psychiatry, published on-line only December 5, 2011. Full text retrieved December 21, 2011 from http://archpsyc.ama-assn.org/cgi/content/abstract/archgenpsychiatry.2011.156v1?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=MDMA&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT.
December 16, 2011
Multiple Medications Pose Serious Problems for U.S. Troops
As the conflict in Iraq winds down, substance dependency programs are likely to see more veterans. It is important to screen these men and women not only for psychiatric disorders and persistent pain, but also for the medications used to treat such conditions. According to a story in the New York Times, U.S. Troops stationed in Iraq and Afghanistan may be at high risk of medical consequences as the result of being prescribed multiple prescriptions for anxiety, depression, post-traumatic stress disorder and chronic pain.
Source: For Some Troops, Powerful Drug Cocktails Have Deadly Results . New York Times, February 11, 2011
November 2, 2011
Prescription Pain-Killers Cause More Overdose Deaths than Heroin and Cocaine Combined
The non-medical use of prescription analgesics (pain-killers) has risen significantly in the past decade. In 2010, enough prescription painkillers (opioid substances such as hydrocodone/Vicodin and oxycodone/OxyContin, Percodan) were prescribed to medicate every American adult around-the-clock for a month, and 12 million Americans (age 12 or older) reported nonmedical use of these substances. Today The U.S. Centers on Disease Control and Prevention announced that prescription analgesics are responsible for more fatal overdoses than heroin and cocaine combined.
The CDC also reports that:
Certain groups are more likely to abuse or overdose on prescription painkillers.
The supply of prescription painkillers is larger than ever.
Some states have a bigger problem with prescription painkillers than others.
For more information on this topic, and to see what recommendations the CDC makes for government agencies, individuals, health care insurers and health care professionals, click here.
Source: CDC "Vital Signs, November 2011
October 21, 2011
"Bath Salts Placed in Schedule I by the Drug Enforcement Administration
The federal Drug Enforcement Administration's emergency scheduling authority allows them to classify previously legal substances as controlled substances without cprior authority. This week the DEA placed three drugs that are sold under names such as "bath salts", "plant food" and "glass cleaner" into Schedule I of the Controlled Substance Act. The three drugs, Mephedrone , 3,4 methylenedioxypyrovalerone (MDPV) and Methylone, will remain in Schedule I for one year, after which time the DEA will decide whether to keep them in Schedule I or to classify them elsewhere. Since there is no controlled human research on these substances in the scientific lierature, and since it would be difficult to complete such studies within a year, it is likely that the three drugs will remain in Schedule I for a longer period of time if not forever.
Mephedrone , 3,4 methylenedioxypyrovalerone (MDPV) and Methylone are sold under a variety of brand names, including Vanilla Sky, Aromatherpy and White Blizzard.
Read the DEA announcement here
October 15, 2011
Herbal Incense: New research, New Concerns
While information from controlled human trials involving synthetic cannabinoids is still lacking, a variety of new reports have provided important knowledge concerning the acute and chronic effects of smoking “herbal incense” products.
Withdrawal: The irritability and sleep problems associated with cessation of heavy cannabis use are well known effects. Now research conducted in Germany has provided important information regarding withdrawal symptoms that may occur following daily use of “Spice Gold” and other herbal incense brands. These symptoms include:
These symptoms may come as a surprise by some in the substance disorders field, since they resemble opiate or alcohol withdrawal signs more than they do the cannabis withdrawal syndrome. However, the synthetic cannabinoids have different chemical structures than THC, and so can be expected to produce dissimilar action within the brain.
Psychosis: Transient psychotic episodes induced by “herbal incense” use has been anecdotally reported by reliable sources as well as documented in the scientific literature. One paper describes psychiatric “relapse” among a population with pre-existing psychotic illnesses, but others describe cannabinoid-induced psychotic states in those with no apparent psychopathology. Although cannabis itself has been implicated in the development of psychosis, it also contains cannabidiol, which has been shown to have anti-psychotic properties. Most synthetic cannabinoids, however, do not contain cannabidiol, and so may be more likely to induce symptoms of mental illness.
Anxiety: Generalized anxiety and panic attacks are commonly reported not just in the scientific literature, but by a good number of herbal incense users (see http://www.erowid.org/experiences/subs/exp_JWH018.shtml#Bad_Trips). In some cases, these symptoms have persisted for months after cessation of use.
These studies demonstrate how small changes in the chemical structure of psychoactive substances can have far-reaching implications. They also show the dangers associated with unregulated, poorly understood drugs. Readers are advised to keep up-to-date on new street drugs, and to include information regarding these substances in client education.
Sources:
D’Souza, D.C., Perry, E., MacDougall, L., Ammerman, Y., Cooper, T., Wu, Y.T., Braley, G., Gueorguieva, R., Krystal, J.H. (2004). The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis. Neuropsychopharmacology 29: 1558–1572.
Every-Palmer, S. (2011). Synthetic cannabinoid JWH-018 and psychosis: An explorative study. Drug and Alcohol Dependence, 117: 152-157.
Matthew Large, M., Sharma, S. Compton, M.T., Slade, T. & Nielssen, O. (2011). Cannabis use and earlier onset of psychosis: A Systematic Meta-analysis. Archivesof General Psychiatry, 68: 555 - 561.
Leweke, F.M., Koethe, D., Pahlisch, F., Schreiber, D., Gerth, C.W., Nolden, B.M., Klosterkötter, J., Hellmich, M., Piomelli, D. (2009). S39-02 Antipsychotic effects of cannabidiol. European Psychiatry 24, S207.
Müller, H., Sperling, W., Köhrmann, M., Huttner, H.B., Kornhuber, J., Maler, J.M. (2010). The synthetic cannabinoid Spice as a trigger for an acute exacerbation of cannabis induced recurrent psychotic episodes. Schizophrenia Research, 118, 309–310.
Zimmermann U. S.,Winkelmann P. R., Pilhatsch M., Nees J. A., Spanagel R., Schulz K. (2009). Withdrawal phenomena and dependence syndrome after the consumption of ‘Spice Gold’. Dtsh Artzebl Int (English version) 2009; 106: 464–67.
Zuardi, A.W., Crippa, J.A., Hallak, J.E., Moreira, F.A., Guimarães, F.S. (2006). Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Brazilian Journal of Medical and Biological Research, 39: 421–429.
September 11, 2011
"Bath salts" Substances to be Placed in Schedule I of the CSA
On September 7, 2011, the federal Drug Enforcement Administration (DEA) served notice that within the next 30 days, it will use its emergency scheduling powers to move three substances (Mephedrone , [3,4] methylenedioxypyrovalerone {MDPV} and Methylone) into Schedule I of the Controlled Sustances Act *. One or more of these substances can be found in products known as "bath salts", "Vanilla Sky", "Ivory Wave", "Ocean" (and as many as a dozen other brand names) currently sold legally **.
This action will make possessing and selling these chemicals or the products that contain them illegal in the U.S. for at least one year while the DEA and the United States Department of Health and Human Services (DHHS) further study whether these chemicals should be permanently controlled.
View the DEA press release: http://www.justice.gov/dea/pubs/pressrel/pr090711.html
View the DEA Background Briefing Here
* http://en.wikipedia.org/wiki/Controlled_Substances_Act
** For more information on these substances, click "Emerging Drugs" in the control panel to the left (this section will be available on or before the week of November 30, 2011).
August 6, 2011
The Use of Buprenorphine with Opiate-Dependent Clients in the Criminal Justice System
Although there has been research involving the use of methadone and buprenorphine as an adjunct to treatment in men who are transitioning from incarerartion to community-based treatment, no such research has been conducted with females.
In this study, opiate-dependent women in correctional facilities were started on a buprenorphine regimen prior to transferring from correctional facilities to community-based treatment, they had more opiate-positive urine drops during the 12-week study than similar women not treated with this medication.
Drug-dependent individuals within prisons and jails are often released with a referral to treatment but little else. However, this paper provides evidence that when opiate substitution therapy is initiated prior to women re-entering the general population, their risk of relapse to their drug of choice can be reduced, at least in the short run.
Source: Cropsey, K.L., Lanea, P.S., Halea, J.H., Jackson, D.O., Clark, C.B., et. al. (2011). Results of a pilot randomized controlled trial of buprenorphine for opioid dependent women in the criminal justice system. Drug and Alcohol Dependence (corrected edition, in press): doi:10.1016/j.drugalcdep.2011.06.021
July 15, 2011
New Research Helps to Explain the Reason for Alcohol-Related "Blackouts"
An alcohol-related blackout is the inability to recall events that took place during a period of intoxication. In technical terms, a blackout refers to antegrade amnesia (i.e., the impairment of long term memory creation) associated with heavy alcohol use.
A recent paper in the Journal of Neuroscience sheds light on why blackouts occur. The ingestion of relatively high amounts of alcohol appears to intefere with the production of 5-alpha-reductase, an enzyme critical to the synthesis of allopregnanolone, which is a metabolite of the hormone progesterone. Allopregnanolone aids in neurogenesis (the creation of new neurons/brain cells) and has been found to be helpful in treating Alzheimer’s disease, a key symptom of which is memory impairment.
How can this information help counselors and therapists in the treatment of alcohol use disorders? It further reinforces the fact that heavy or frequent alcohol consumption can result in both short- and long-term changes to the brain, some of which may not be reversible. It also helps family members and other significant others to understand that alcoholism is a brain disorder, one possible symptom of which is the occurances of blackouts.
Source: Tokuda, T.; Izumi, Y. and Zorumski. C. (2011). Ethanol Enhances Neurosteroidogenesis In Hippocampal Pyramidal Neurons by Paradoxical NMDA Receptor Activation. Journal of Neuroscience, 31(27): 9905-9909
March 28, 2011
"Lazy Cakes"
A "Lazy Cake" is a brownie that contains melatonin (N-acetyl-5-methoxytryptamine), a chemical found naturally in humans and other animals, plants and microbes. In animals, the level of melatonin rises and falls during the day and night, and regulates circadian rhythms (the 24 hour cycle that is primarily driven by relative amounts of light and darkness).
Although "Lazy Cakes" have been described recently as a dangerous product, the dose of melatonin in them (7-8 mg) is roughly equivalent to the amount in 2-3 tablet of the over-the-counter (non-prescription) melatonin tablets sold in pharmacies as well as grocery and health food/supplement stories. Further, a toxic dose of melatonin has been estimated as 100-200 milligrams (mg) in rats, the human equivalent of 4400-8800 mg. In fact, melatoin has been found to be a powerful antioxidant, reducing the risk of cancer and certain cardiovascular disorders. It has been found to increase longevity in rats by 20%, and there is good reason that it may also do so in humans.
The most common use of melatonin is to help induce sleep, but opinions within the scientific community regarding the ability of melatonin to do this vary considerably.
Sources:
Hardeland R (July 2005). "Antioxidative protection by melatonin: multiplicity of mechanisms from radical detoxification to radical avoidance". Endocrine, 27 (2): 119–30.
March 9, 2011
"Chronic Candy"
Reports of cannabis-treated candy have been received from several areas around the country. This candy is known by different names, but "Chronic Candy"* is the term that has been used the most.
The existence of psychoactive/intoxicating cannabis-treated candy has never been confirmed. Websites that advertise "cannabis" lollipops and other sweets state that their products taste like cannabis, and imply that there is more to enjoy than the flavor. Since selling any product containing THC is blatantly illegal regardless of its formulation, it is doubtful that any business has entered that market. However, the association of the term "Chronic" (a common slang name for marijuana) with lollipops or other candies could serve to trivialize marijuana use among among children and adolescents.
February 21, 2011
NIDA Advisory on "Bath Salts"
An advisory regarding "bath salts" (written by Director Nora Volkow. M.D., Ph.D) was recently issued by the National Institute on Drug Abuse.
February 7, 2011
The Association of Cannabis (marijuana, hashish) Use with Earlier Onset of Psychosis
A recent study published in the Archives of General Psychiatry provides further data to suggest that cannabis (marijuana, hashish) use may be associated with an earlier onset of psychosis. A meta-analysis (analysis of a wide range of previous studies) yielded evidence that of patients with psychotic symptoms (most commonly those with schizophrenia), those who had used cannabis heavily developed their symptoms between 2 and 2.7 years earlier than those who were non-users.
Dependence and Withdrawal Associated with "Herbal Incense"
Few well-documented clinical reports exist related to the use of synthetic cannabinoids (in the form of "herbal incense" smoking products). However, a paper in the German language journal Deutsches Ӓrzteblat provides insight into the potential of one of these products ("Spice Gold") for dependence and physical withdrawal.
A 20 year-old man was brought to a hospital by a youth worker who had been seeing the individual as a client. The patient began consuming Spice Gold (which contains the synthetic cannabinoids JWH-018 and CP 47497) daily for eight months. After developing tolerance to the drug, he increased the daily dose to three grams/day. Although this amount of the drug resulted in cognitive impairment and neglect of his professional duties, he felt a continuous desire for the drug and kept on using it. A few months prior to his admission to the hospital, he had faced a short period of abstinence owing to his inability to obtain the drugs. During this time, he began experiencing heavy sweating during the day and more profusely at night. He also manifested anxiety, tremor, heart palpitation, insomnia, headache, diarrhea, nausea, and vomiting. During this period he also experienced a powerful craving for Spice Gold and felt depressed and desperate. These symptoms persisted for two days disappeared upon resumption of use. Following this experience, he abandoned any thought of discontinuing his use. In the preceding month, he lost approximately 11 pounds in weight and could sleep for only five hours a night. In response to the latter, the man's primary physician prescribed zopiclone*.
The patient indicated that he had felt "internal unrest" and nervousness since childhood, and that only cannabis and Spice Gold relieved this condition. He also smoked ten cigarettes a day. When admitted to the hospital, a breath test for alcohol and urine tests for cannabinoids (i.e., THC), benzodiazepines, amphetamines, cocaine and opiates were negative. On day one of abstinence is the hospital, he showed no remarkable symptoms, but on the evening of day two, he began complaining of anxiety. Zopiclone, 3.75 mg, was administered, but discontinued after the first dose. On the evening of day three, he first began to sweat profusely. Beginning on day four, the patient began to complain of internal unrest, craving for Spice, nightmares, nausea, tremor, and headaches. 7.5 mg of zopicone did not quell these symptoms. He also stated that he had "stood beside himself" and later developed intermittent sensations of electrical shocks and "twitches" around the shoulder, followed by a feeling of numbness in the right arm that, radiating into the fingers and lasted approximately one minute. His blood pressure and pulse rose to an unusually high level, but were brought back into the normal range by non-psychoactive medications. However, his other symptoms continued unabated. Over the next 18 days, the patient's symptoms decreased in severity except for his insomnia, which was treated successfully with the anti-Parkinson's Disease medication pramipexole. In fact, after administration of this drug, the patient reported that he had not slept so soundly since before his use of Spice began.
On day 21, the patient was released from the hospital and began an intensive outpatient program (four sessions per week) of cognitive behavioral group therapy, but discontinued this treatment very shortly. Four months after his release, he returned to the hospital and indicated that he felt well and was no longer consuming Spice or other herbal incense products. He had used cannabis about four times since his release, but stated that he had discontinued pramipexole after approximately one month, and could now sleep well enough without either that drug or zopiclone.
This report describes a case of "Spice" dependence as confirmed by the five DSM-IV-TR criteria of:
- Tolerance
- Withdrawal
- Persistent desire or unsuccessful efforts to cut down or control substance use**
- Important social, occupational, or recreational activities are given up or reduced because of substance use
- The substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
In addition, the specific symptoms of anxiety, nervousness and "internal unrest" have been self-reported by a number of "herbal incense" users. In one case, the individual experienced continued and persistent (more than four weeks) anxiety after discontinuing use of these substances. In another, the person also reported severe headaches that could not be relieved by a variety of physician-initiated interventions.
A confounding factor in the case of both scientifically observed and anecdotally reported symptoms of herbal incense use and discontinuation is the inconsistence of ingredients within these products. Various synthetic cannabinoids are routinely detected, but these may vary both from one brand (e.g., "Spice", "K2") to another and from from one batch of a specific brand and to another. A further complication is that five of the synthetic cannabinoids (see the following article) are now controlled (illicit) substances, and new canabinoids and perhaps other ingredients are not appearing in "second generation" herbal incense products such as "K3" and "Splice." Continued observation and scientific study is needed in order to gain a clearer understanding of the "herbal incense" use phenomenon.
* (Zopiclone is not available in the United States, but its stereoisomer (mirror image), eszopiclone is sold as a prescription substance under the brand name Lunestra.
** The patient wished to discontinue his Spice use, but was fearful of the withdrawal that he had previously experienced
Source: Zimmermann, U.S.; Winkelmann, P.R.; Pilhatsch, M.; Spanagel, R. & Schulz, K. (2009). Deutsch Arztebl International, 106(27): 464–467. Translated from the original German by Rodney A. Yeates, M.A., Ph.D, and retrieved February 2, 2011 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719097/.
January 6, 2011
New "Herbal Incense" Products
On November 24, 2010, the federal Drug Enforcement Administration used its emergency scheduling power to ban JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol; synthetic cannabinoids used to make such "herbal incense" products as K2, Spice and Black Mamba. This ban took effect on December 24, 2010 and will last for at least one year. During this time, the DEA and the federal Department of Health and Human Services will investigate the properties of these cannabinoids and make a final ruling regarding their status at the end of that period.
To fill the void left by this ban, new herbal incense products have been created and are being sold at various locations around the country, including several locations in the Chicago area. These products have been presumably treated with one or more of the many synthetic cannabinoids that remain legal. Some of the brand names for new herbal incense products are "Destiny" (manufactured by the same company that created and sold "K2" products), "Cloud Ten" and "Apocalypse"*. The effects of these substances are to be seen since no human research has ever been conducted on any of the synthetic cannabinoids.
Additional information concerning "herbal incense" will appear here as it becomes available.
* Apocalypse appears to be distributed globally by a company with the website, http://www.alibaba.com in cooperation with a variety of suppliers, including Bonsai, Inc., a company based in Naperville, Illinois. The product information provided by alibaba.com indicates, "Herbal incense for retail sale. Made with the most pure crysteline (sic) JWH (99.85%). "
December 16, 2010
Employee Drug Tests Indicate Changes in Drug Consumption Patterns
Newly released information has provided support to the idea that patterns of psychoactive drug use consumption are rapidly changing in the United States. In 2009, Quest Diagnostics (http://www.questdiagnostics.com) analyzed more than 5.5 million urine drug tests collected from workers across the country. Of the 3.6% of drug tests that were positive for an illicit drug, cannabis* was the most commonly encountered, with 43.7% of tests indicating use of that substance. However, this represents a decline from the 62.2% of tests positive for cannabis in 1999. In addition, positive cocaine tests decreased from 16.2% to 7.3% during the same period. In contrast, positive sedative tests rose from 6.5% to 11.2% and tests indicating the use of amphetamines and opiates from 4.5% to 13.1% and 7.5% to 20.1% respectively.
Over the past century, periods of heavy stimulant use (e.g., cocaine and illicit methamphetamine) have typically been followed by phases of depressant use (e.g., opiates and sedative-hypnotic drugs). The escalating use of amphetamines does not seem to fit this pattern, but in this case, pharmaceutically made amphetamine (such as Adderall) is perceived as "safer" than illicit methamphetamine and is consistent with the currently occurring shift from illicit drugs to pharmaceutical substances.
What can alcohol and other drug counselors do in response to these epidemiological changes? First, know your enemy. Clinicians who are used to treating cannabis- and cocaine-dependent clients may not understand the role that physical dependence plays in recovery from drugs such as opiates and sedatives. Secondly, know your friends. Medications such as methadone, buprenorphine and naltrexone can be a helpful and important part of treatment for opiates dependent clients. Finally, educate your clients, especially those who may not understand that the use of pharmaceutical substances carry many of the same risks and produce the same effects as illicitly-produced substances. This knowledge may serve to overcome the sense among those dependent on prescription drugs that they are "different" from street drug "addicts".
* Actually cannabis metabolites
Sources:
CESAR FAX, Vol. 19, Issue 46, November 29, 2010. Retrieved 12/3/10 from http://www.cesar.umd.edu/cesar/cesarfax/vol19/19-46.pdf
Webber, Randall & White, William L. (2003). The Future of Substance Abuse. Counselor, 4(4): 18-21.
White, William L. & Webber, Randall. (2003). Substance Use Trends: History and Principles. Counselor, 4(3): 18-20.
These beverages present a public health concern
The U.S. Food and Drug Administration today warned four companies that the caffeine added to their malt alcoholic beverages is an “unsafe food additive” and said that further action, including seizure of their products, is possible under federal law.
The companies receiving Warning Letters and their products are:
• Charge Beverages Corp.: Core High Gravity HG, Core High Gravity HG Orange, and Lemon Lime Core Spiked
• New Century Brewing Co., LLC: Moonshot
• Phusion Projects, LLC (doing business as Drink Four Brewing Co.): Four Loko
• United Brands Company Inc.: Joose and Max
FDA’s action follows a scientific review by the Agency. FDA examined the published peer-reviewed literature on the co-consumption of caffeine and alcohol, consulted with experts in the fields of toxicology, neuropharmacology, emergency medicine, and epidemiology, and reviewed information provided by product manufacturers. FDA also performed its own independent laboratory analysis of these products.
“FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is ‘generally recognized as safe,’ which is the legal standard,” said Dr. Joshua M. Sharfstein, Principal Deputy Commissioner. “To the contrary, there is evidence that the combinations of caffeine and alcohol in these products pose a public health concern.”
Experts have raised concerns that caffeine can mask some of the sensory cues individuals might normally rely on to determine their level of intoxication. The FDA said peer-reviewed studies suggest that the consumption of beverages containing added caffeine and alcohol is associated with risky behaviors that may lead to hazardous and life-threatening situations.
The agency said the products named in the Warning Letters are being marketed in violation of the Federal Food, Drug, and Cosmetic Act (the FFDCA). Each Warning Letter requests that the recipient inform the FDA in writing within 15 days of the specific steps that will be taken to remedy the violation and prevent its recurrence. If a company does not believe its products are in violation of the FFDCA, it may present its reasoning and any supporting information as well.
If the FDA believes that the violation continues to exist, the agency may pursue an enforcement action that could include seizure of the products or an injunction to prevent the firm from continuing to produce the product until the violation has been corrected.
FDA’s action today follows a November 2009 request to manufacturers to provide information on the safety of adding caffeine to their products.
FDA is aware that on November 16, Phusion Projects, LLC, the maker of Four Loko, announced its intention to remove caffeine and other stimulants from its drinks. FDA views this announcement as a positive step. FDA has not yet heard officially from the company about this announcement, including how quickly it will remove present product from circulation and how quickly it will reformulate its product. FDA intends to work with Phusion Projects, LLC and the other manufacturers to assure their products meet safety standards.
Retrieved 11/17/2010 from http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm234109.htm
August 18, 2010
Why are men more susceptible to alcoholism?
Past research has shown that the incidence of alcohol use disorders is twice as high in men as it is in women. A recent study sheds light on why this may be so.
Male and female college students were screened for alcohol use and dependency. Those who did not meet the diagnostic criteria for these disorders were included as subjects in the present research study. On 2 separate days, a control group was give a mixture of water and a trace amount of alcohol. The experimental group was given water mixed with alcohol at 0.75 mg/kb of body water weight (0.34 mg/pound). Immediately following this self-administration, a specialized type of positron emission tomography (PET) was used to determine the level of the neurotransmitter dopamine in the ventral striatum, an important structure in the "reward pathway", a section of the brain known to reinforce sex, eating and the use of alcohol and other drugs. The members of the control group showed no appreciable change in dopamine levels, while the experimental group did. More importantly, male subjects showed a significantly higher increase in dopamine levels than females that correlated with an increase in the subjective positive effects of alcohol intoxication. Further, the heighten levels of dopamine required more alcohol to achieve on the second day of administration.
The study researchers concluded that the enhanced response to alcohol among males explains, at least in part, the higher incidence of alcohol use disorders in men versus women. In addition, the increased amounts of alcohol necessary to raise these enhanced dopamine levels leads to tolerance and the development of more severe types of alcohol dependence.
Clients in substance use disorder treatment should be made aware of these findings in order for them to achieve a better understanding of alcohol abuse and dependence. In addition, alcoholic parents may wish to pass this information along to their children so that the children better understand the risk factors that may contribute to the their own development of alcohol use problems.
Source: Urban, N.B.L., Kegeles, L.S., Slifstein, M., Xu, X., Martinez, D. et. al. (2010). Sex Differences in Striatal Dopamine Release in Young Adults After Oral Alcohol Challenge: A Positron Emission Tomography Imaging Study With [11C]Raclopride. Biological Psychiatry, 68(8): 689-696
July 1, 2010
Do alcohol dependency and sugar intake problems have similar causes?
For years, both researchers and treatment professionals have speculated that alcohol and other drug use problems may be related to "process addictions" such as gambling and eating disorders. Now research has shown that there may be both neurochemical and genetic similarities between alcohol use disorders and "sugar addiction". Dr. Jeffrey L. Fortuna found that the consumption of food or drinks with a high sugar content primes the release of both endorphins and dopamine within the nucleus accumbens (an important structure in the human "reward circuit"). Many psychoactive drugs produce their reinforcing effects in the same manner, and sugar-related craving, tolerance, withdrawal and sensitization have been documented in both human and animal studies. According to Dr. Fortuna, it has also been observed that the biological children of alcoholic parents, particularly alcoholic fathers, are at greater risk to have a strong preference for sugar-rich foods and drinks. Further, scientific studies have shown that specific genes may be associated with a "sweet preference" in alcohol- and drug-dependent individuals, as well as in biological children of paternal alcoholics. Finally, Dr. Fortuna notes that there may be common genetic markers associated between alcohol dependence, bulimia, and obesity, such as the A1 allele gene and the dopamine 2 receptor gene. Are our substance dependency treatment programs prepared to meet the needs of individuals with both psychoactive drug problems and eating disorders or anomalies? Are "process addictions" in fact similar enough to substance use disorders that they an be treated with similar methods? What is the eating equivalent of "abstinence"? How do third-party payors view eating disorders, pathological gambling and other impulse control problems? These are all questions that remain to be answered.
Source: Fortuna, J.L. (2010). Sweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes. Journal of Psychoactive Drugs, 42(2).
June 15, 2010
Journal of Substance Abuse Treatment: Top Articles 2005-2010
Periodically the Journal of Substance Abuse Treatment (JSAT) lists the top 10 most often cited papers over the last several years. Below are the titles of these paper and the issue in which they were published. Visitors to the JSAT website (http://www.sciencedirect.com/science/journal/07405472) can read abstracts on-line and request full copies of the papers by emailing the corresponding author.
SPECIAL ALERT May 11, 2010
Sibutramine found in "herbal supplements" and "diet aids"
The federal Drug Enforcement Administration (http://www.justice.gov/dea/index.htm) and various media sources have reported that the appetite suppressant sibutramine has been found in “herbal supplements” and “diet aids” sold through the Internet. Sibutramine is a schedule IV substance that is related to the amphetamines and manufactured by Abbott Laboratories under the brand name Merida. The products sold through the Internet are not manufactured by Abbott and contain illicit sibutramine in varying and unpredictable amounts that could pose significant risk to consumers. A partial list of the substances in question can be found at http://llnw.image.cbslocal.com/27/2010/05/11/original/DietPills.jpg?cach.... Although sibutramine is a controlled substance, it does not appear to have a significant addiction potential, if any at all. This may be because it does not affect brain levels of the neurotransmitter dopamine, known to be an important element in the rewarding effects of many dependency-producing substances. However, certain serious side effects may rarely occur when sibutramine is used according to medical instructions, and more commonly when illicit forms of the drug are taken. These side effects include: * fast or pounding heartbeat * chest pain * shortness of breath * nausea * stomach pain * vomiting * extreme excitement * restlessness * anxiety * depression * dizziness * lightheadedness * fainting * confusion * uncoordinated or abnormal movement * muscle stiffness * shaking hands that you cannot control * seizures * shivering * excessive sweating * fever * sore throat * large pupils (black area in center of eyes) * change in vision * eye pain * hives * skin rash * itching * difficulty speaking, breathing, or swallowing * hoarseness * swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs * unusual bleeding or bruising
Sources: Arfken, CL, Schuster, CR & Johanson, C-E (2003 ). Postmarketing surveillance of abuse liability of Sibutramine. Drug and Alcohol Dependence, 69(2): 169-173 "Sibutramine". Retrieved May 11, 2010 from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601110.html. Schuh, LM, Schuster, CR, Hopper, JA & Mendel, CM (2000). Abuse liability assessment of sibutramine, a novel weight control agent. Psychopharmacology, 147(4): 339-346.
April 10, 2010
K What?
An enduring problem associated with street drugs is that users (and many dealers) often do not know the actual composition of the substance that they purchase or sell. In at least one case (heroin) this fact is acknowledged by virtually everyone whose life is touched by this drug: substance users (whether dependent or not), dealers, law enforcement officers, members of the scientific community and substance disorder prevention and treatment professionals. Although the purity of street heroin (“junk”, “smack”, etc.) has increased radically over the past two decades, a portion (often the majority) of all “junk” is not heroin, but rather adulterants and fillers, some of which are toxic, some not. With regard to other substances, the alleged content of street drugs are also something more-or other than- the dealers and their customers believe. This state of uncertainty exists in part because the same street name may refer to more than one substance or to the same substance adulterated with different “cuts” (adulterants). With the above in mind, we report this month on the drug “K2”, which is also known as “spice” and “red dragon”. Recent reports from the law enforcement, medical and drug-using communities have confirmed that this relatively new substance has appeared on the street in cities throughout Europe and the U.S. It takes the form of a dried herb, but the plant material varies from one product to another. In any case, the herb is only a carrier for the actual psychoactive drug, which leads us back to the general problem of street drug adulteration, misrepresentation and naming. What is K2 supposed to be, and what is it in actuality? Because K2 is (or was, depending on the location) a legal substance, it is often manufactured and packaged uniformly (see photos 1-3 below). Thus, if the composition of one sample can be identified, it is reasonable to assume that all products with similar branding are the same. Still, this leaves one with the question, “What drug is it that K2 contains?” This could have been an unanswered question but not for the intervention of two German entities, the Institute of Forensic Medicine at the University Medical Center Freiburg (specifically, Professor Volker Auwärter’s laboratory) and the Bundeskriminalamt (BKA), Germany’s federal criminal police office. At that time (or rather the psychoactive ingredient[s]) was legal in Germany, and so some of Professor Auwärter’s colleagues decided to obtain several of the products sold as “herbal incense” (what is known as K2 in the United States) and experiment with them. After smoking what they considered to be a low dose (about 1/3 of a gram), they experienced an intoxication similar to that produced by cannabis (marijuana), that lasted 5-6 hours. However, chemical analysis detected neither THC (the psychoactive chemical in cannabis) nor any known mood altering chemicals present. However, when the team explored the Internet, they found rumors that herbal products had been treated with synthetic cannabinoid substances that could not be detected by common drug (urine) tests. However, chemical analysis detected neither THC (the psychoactive chemical in cannabis) nor any known mood altering chemicals present. However, when the team explored the Internet, they found rumors that herbal products had been treated with synthetic cannabinoid substances that could not be detected by common drug (urine) tests. Eventually, a pharmaceutical company in Germany announced that it had identified JBW-018, one of several cannabinoids synthesized at Clemson University, in samples of herbal incense. In the United States, HU-210 (another synthetic cannabinoid) has been identified in several brands of “herbal incense”, and JBW-018 is rumored to be present in “red dragon” as well as Spice" and "K2". Both of these cannabinoids (and others not mentioned here) bind (attach) to the brain’s naturally-occurring cannabinoid receptors (the C1 and C2), just as the THC in marijuana does. However, the synthetic cannabinoids have a higher affinity (attraction) to the C1 receptor than THC does, resulting in a higher level of potency for the synthetics. Individuals who are used to smoking a certain amount of marijuana (e.g., a joint or four small pipefuls) will find themselves considerably more intoxicated if they smoke a product such as K2. According to Internet sites frequented by drug users (including one that asks visitors to refer to themselves as “swim” in order to avoid self-incrimination) the various herbal products have cannabis-like effects, but appear to be a more risky drug. Symptoms reported by users include hallucinations, nausea, vomiting, agitation, irritability, increased heartbeat and feelings of paranoia and anxiety. Furthermore, “swimmers” and other users have indicated that this substance has both abuse and dependence potential, and describe withdrawal symptoms including insomnia, reduced appetite, sweating, chills, and irritability; the precise signs exhibited by some marijuana users who discontinue the drug abruptly. In Illinois (the home of the ABH Newsletter), medical, law enforcement and school officials in suburban Chicago and St. Louis have noted cases of young people displaying these effects. Further, like most street drugs, K2 may be adulterated with unknown substances. An analysis of seven “Spice” samples in Germany detected high levels of a chemical solvent in one batch. Although the availability and use of this substance appears to be minimal at this time, that situation may be changing. K2 is not a controlled substance, and so possession and/or sale is not illegal. In addition, standard urine tests do not detect it. However, it is a “banned” substance in more than a dozen countries, primarily in Europe, but extending to South Korea. Via the Internet, it is available from a variety of sources (e.g., http://jwh018supplier.com/buy-jwh-018-online/?gclid=CK2PpuWToKACFRLxDAod...) at prices that range from $30 to $45 per gram. Only the highest quality of marijuana fetches a price that high.
Perhaps a good way to close this article would be with a cautionary tale. In her excellent article in the journal Analytic Chemistry author Christine Piggee states: "Reporters for German television probably thought that they were doing society a favor when they broadcast a news story about herbal incense that produced a marijuana-like high but couldn’t be detected by common drug screens. But after the August 2008 broadcast, the popularity of the incense soared in Germany. Young people began to show up at emergency rooms across the country with psychosis-like panic attacks and heart and circulatory problems; these patients admitted to smoking or ingesting products marketed as “herbal incense”. Despite all signs pointing to marijuana overdose, no delta-9-tetrahydrocannabinol (THC) or any of its metabolites were detected in clinical samples from the patients". How do we guard against the use of psychoactive substances within high-risk populations without fueling an epidemic? This is an important public policy question that has yet to be answered. Perhaps it is time to begin the conversation.
Sources: Auwärter, K., Dresen, S., Weinmann, W., Müller, M., Pütz, M. & Ferreirósn. (2009). “Spice” and other herbal blends: harmless incense or cannabinoid designer drugs? Journal of Mass Spectrometry, 44:5, 832-837. Piggee, Christine (2009). Investigating a not-so-natural high: Researchers identify synthetic cannabinoids in herbal incense. Analytical Chemistry, 81 (9), pp 3205–3207
March 21, 2010
Prenatal Exposure to Methamphetamine May Produce Cognitive Problems in Children and Adolescents
Is well documented that prenatal exposure to alcohol can result in the negative outcomes generally known as Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Exposure (FAE). It has also been demonstrated that prenatal methamphetamine exposure can produce changes in certain brain regions, and that such changes are related to poor performance on tasks that require attention and verbal memory. Now research conducted at the University of California at Los Angeles (UCLA) has indicated that children and adolescents who are prenatally exposed to both methamphetamine and alcohol have more severe brain damage than those exposed to methamphetamine or alcohol alone. Dr. Elizabeth Sowell and her colleagues examined 61 children (aged 5-15 years old) who had experienced prenatally exposure to 1) methamphetamine and alcohol (MAA), 2) alcohol only (alc) or 3) no exposure to either drug. Both “exposure” groups had brain abnormalities, but the group with exposure to both drugs exhibited worse abnormalities than those exposed to alcohol alone. The damage was in a structure known as the striatum which plays a major role in cognitive function (thinking, memory, attention, reading and writing). These findings should not come as a surprise. Since prenatal exposure to either alcohol or methamphetamine along can produce changes in the structure and function of the brain, it makes sense that the combination of both would result in even more serious abnormalities. It should be noted that Dr. Sowell’s study (as she herself notes) examined a small number of children. In terms of research findings, this reduces the strength of the study results. However, future research will involve larger numbers of subjects, and may very well replicate (confirm) Dr. Sowell’s findings. It is critical to provide information to clients in substance disorder treatment regarding possible drug-related damage to the fetus. This provides an opportunity for women who are not pregnant to make changes in their drug use behavior that can protect against such damage. This information should also be provided to female clients’ partners, so that they can support the behavioral changes that the women have chosen to make. For women who have already exposed their fetuses to alcohol and/or other drugs, the message can be that it is never too late to stop using, and that each day of abstinence makes it more likely that she will have a healthy baby. At the same time, treatment staff should gently prepare these female clients for the possibility that their baby will face challenges.
Sources: Chang L, Smith LM, LoPresti C, Yonekura ML, Kuo J, Walot I, Ernst T, (2004) Smaller subcortical volumes and cognitive deficits in children with prenatal methamphetamine exposure. Psychiatry Research 132:95–106. Chang L, Cloak C, Jiang CS, Farnham S, Tokeshi B, et. al. (2009) Altered neurometabolites and motor integration. in children exposed to methamphetamine in utero. Neuroimage, 48:391–397. Smith LM, Chang L, Yonekura ML, Grob C, Osborn D, Ernst T (2001) Brain proton magnetic resonance spectroscopy in children exposed to methamphetamine in utero. Neurology 57:255–260. Sowell, ER, Leow, AD, Bookheimer, SY, Smith, LM, O'Connor, MJ, et al. (2010). Differentiating Prenatal Exposure to Methamphetamine and Alcohol versus Alcohol and Not Methamphetamine using Tensor-Based Brain Morphometry and Discriminant Analysis. The Journal of Neuroscience, 30(11): 3876-3885.
February 5, 2010
The Use of a Cocaine "Vaccine" in Treating Cocaine Dependency
Although there are effective pharmacological agents that can be used to support the treatment of alcohol and opiate dependence, no such medications are currently available to assist in the treatment of stimulant dependent clients. However, new research has indicated that the use of a "cocaine vaccine" can substantially reduce the use of that drug among clients in treatment. Dr. Bridget A. Martell and her colleagues at Yale University worked in partnership with scientists from Baylor University and from the U.S. Department of Veteran's Affairs to test the ability of succinylnorcocaine to reduce cocaine use in a population of clients at a methadone maintenance program.* Succinylnorcocaine creates antibodies that attach itself to cocaine molecules and prevent them from passing through the "blood brain barrier" and entering the brain. In a group of 115 clients, half were randomly assigned to receive injections of the vaccine, and half injections of a placebo (inactive) substance over a 12-week treatment period, after which there was a 12-week follow-up period. During this time, both groups also participated in weekly relapse prevention therapy sessions, had their blood tested for antibodies to cocaine, and were subject to urine testing three times a week for the presence of opioids (e.g., heroin) and cocaine. Roughly 38% of the individuals in the cocaine vaccine group developed a high enough level of antibodies to effectively block the effects of cocaine. These individuals had significantly more cocaine-free urines than those with low levels of the antibody or those who received placebo injections. The study's authors concluded that in combination with a relapse prevention program, a vaccine could be useful in assisting clients to remain cocaine free. However, less than half of the clients receiving succinylnorcocaine injections developed an antibody level sufficient to block the reinforcing effects of cocaine. Also, the relatively short study period was insufficient to demonstrate positive long-term outcomes. Thus, additional research will need to be conducted. Regardless of the drug on which a person may be dependent, medications are seldom sufficient in and of themselves to produce long-term abstinence and reduce relapse rates. While the testing of the "cocaine vaccine" appears to show positive results, the importance of compiling pharmacological approaches with individual and/or group counseling (such as the relapse prevention group used in the study) can not be overemphasized. * A methadone program was selected as a site for recruiting research subjects because client retention in treatment is substantially higher in methadone programs than in primary cocaine treatment programs.
Source: Martell, B.A.; Orson, F.M.; Poling, J.; Mitchell, E.; Rossen, R.D.; Gardner, T. and Kosten, T.R. (2009). Cocaine Vaccine for the Treatment of Cocaine Dependence in Methadone-Maintained Patients: A Randomized, Double-blind, Placebo-Controlled Efficacy Trial. Archives of General Psychiatry, 66(10):1116-1123
January 4, 2010
Treatment Outcomes Using Oral Versus Implantable Naltrexone
Naltrexone hydrochloride (referred to from here on simply as naltrexone) is an opiate antagonist; a substance that enters the brain and blocks opiate agonists (e.g., heroin, hydrocodone/Vicodin) from producing their effects. Currently, naltrexone is used to treat both alcohol and opiate dependency. In this report, the focus will be on heroin dependency. Because naltrexone is an opiate antagonist, clients must be detoxified from opiates before it can be used. Once a person with a history of opiate dependence has been detoxified, the oral use of naltrexone can reduce relapse rates by ensuring that the individual can not “get high” on any opiate. Dr. Gary Hulse and his colleagues at the University of Western Australia studied the outcome of using orally administered naltrexone versus a depot form of this drug. The depot form is implanted under the skin, and provides a consistent blood level of naltrexone over a 28-day period. Because naltrexone therapy relies heavily on client compliance (i.e., the client has to take the medication willingly), a reasonable hypothesis would be that the depot version would reduce relapse to heroin use. Over a period of six months, clients receiving the depot form of naltrexone had higher blood levels of the medication and a significantly lower return to heroin use rate. In addition, fewer of the depot-treated clients dropped out of the study. Previous studies (e.g., Krupitsky, 2008) have confirmed Dr. Hulse's findings. Naltrexone has been shown to be a valuable adjunct to substance dependency treatment, and the depot form appears to be a more effective means of delivering this drug to clients with a recent history of heroin dependency.
Sources: Gary K. Hulse, G.K., Morris, N, Arnold-Reed, D. and Tait, R.J. (2009). Improving Clinical Outcomes in Treating Heroin Dependence: Randomized, Controlled Trial of Oral or Implant Naltrexone. Archives of General Psychiatry, 66(10):1108-1115. Krupitsky, E.M. (2008). Double-Blind, Placebo-Controlled Trial of Effectiveness of Implantable Naltrexone (Prodetoxone) for Treatment of Heroin Addiction. Paper presented at the 21st European College of Neuropsychopharmacology Congress, Barcelona, Spain, 2008.
SPECIAL ALERT December 15, 2009
Toxic Anti-Parasite Drug Found in Cocaine Samples: A Risk Factor for Cocaine Users?
The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued a public health alert indicating that a significant amount of illicit cocaine may be adulterated with levamisole, an anti-parasitic drug used by veterinarians. Its use with humans in the U.S. as a colon cancer treatment medication has been limited since 2005 due to the occurrence of serious side effects in some patients, including rare instances of agranulocytosis, a disorder that leaves individuals vulnerable to rapidly developing, life-threatening infections. Despite the alert from SAMHSA, which suggests a link between adulterated cocaine and agranulocytosis, there is little if any support in the medical literature for this link. Nonetheless, it is advisable to notify clients in substance disorder treatment as well as individuals targeted for selective and indicated prevention initiatives of the possibility of serious medical complications associated with levamisole-tainted cocaine.
Sources: University of Maryland, College Park-Center for Substance Abuse Research (2009). Study Finds 45% of Cocaine Positive Specimens from D.C. Arrestees Also Contain Potentially Fatal Drug Levamisole. CESAR FAX, 18(19), December 14, 2009. Online at http://www.cesar.umd.edu/cesar/cesarfax/vol18/18-49.pdf Substance Abuse and Mental Health Services Administration (SAMHSA), Nationwide Public Health Alert Issued Concerning Life-Threatening Risk Posed by Cocaine Laced with Veterinary Anti-Parasite Drug,” SAMHSA News Release, 9/21/09 (online at http://www.samhsa.gov/newsroom/advisories/090921vet5101.aspx).
November 15, 2009
AMA Calls for More Research into Medical Use of Marijuana
The federal government should consider moving marijuana out of Schedule I of the Controlled Substances Act in order to facilitate clinical research and development of cannabinoid-based medications, the American Medical Association (AMA) said in a new policy statement. In adopting the policy on Nov. 10th (2009), the AMA’s House of Delegates backed away from the group’s long-standing opinion that marijuana should remain in Schedule I as a drug with no accepted medical uses, with a report from the group’s Council on Science and Public Health stating that smoked cannabis has been shown in short-term controlled trials to be effective in reducing neuropathic pain and improving appetite, and may also alleviate symptoms among patients with multiple sclerosis. In February 2008, the American College of Physicians similarly called for an “evidence-based review of marijuana’s status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule.”
Read the AMA Policy Statement at http://www.ama-assn.org/assets/meeting/mm/i-09-ref-comm-k.pdf
November 2, 2009
Naltrexone blocks the rewarding effects of amphetamines
It has been known for some time that the opiate antagonist* naltrexone is capable under certain conditions in reducing the rewarding effects of amphetamines. This is a remarkable discovery, because the amphetamines do not look or act like opiates. However, it has also been shown that naltrexone can block the rewarding effects of alcohol and reduce relapse rates in individuals treated for alcohol dependency. Thus, the opiate receptors (docking sites) found in the brain influence the effects of a wide range of psychoactive drugs. A recent paper in the journal Addiction Biology compared two different forms of naltrexone, a short-acting type that must be administered daily with an injectable, long-acting formulation that is effective for up to 28 days. The acute (daily) form did not reduce the reinforcing effects of amphetamine any more than did placebo. Among the animals treated with the extended release type of naltrexone, however, there was a significant reduction in amphetamine self-administration for up to 21 days. As the field's knowledge of naltrexone has increased, it has become more and more apparent that this substance is useful in treating a wide range of drug dependencies, including opiate, alcohol and amphetamine. Used as an adjunct to counseling or therapy, this substance has the potential for improving treatment outcomes, yet does not produce dependency itself. * An opiate antagonists is a substance that blocks or reverses the effects of opiates such as heroin, oxycodone ("OxyContin, Percodan) and hydrocodone (Vicodin).
Sources: Chiu CT, Ma T, Ho IK (2005) Attenuation of methamphetamine-induced behavioral sensitization in mice by systemic administration of naltrexone. Brain Research Bulletin, 67:100–109. Haggkvist Journal, Lindholm S, Franck Journal (2009) The opioid receptor antagonist naltrexone attenuates reinstatement of amphetamine drug-seeking in the rat. Behavioral Brain Research, 197:219–224. Jayaram-Lindstrom N, Konstenius M, Eksborg S, Beck O, Hammarberg A, Franck Journal (2008) Naltrexone attenuates the subjective effects of amphetamine in patients with amphetamine dependence. Neuropsychopharmacology, 33:1856–1863. Jayaram-Lindstrom N,Wennberg P, Beck O, Franck Journal (2005) An open clinical trial of naltrexone for amphetamine dependence: compliance and tolerability. Nordic Journal of Psychiatry, 59:167–171 Jayaram-Lindstrom N, Wennberg P, Hurd YL, Franck Journal (2004). Effects of naltrexone on the subjective response to amphetamine in healthy volunteers. Journal of Clinical Psychopharmacology, 24:665–669. Jones DN, Holtzman SG (1992) Interaction between opioid antagonists and amphetamine: evidence for mediation by central delta opioid receptors. Journal Pharmacology and Experimental Therapeutics, 262: 638–645. Todtenkopf, M.S.; O’Neill, K.S.; Kriksciukaite, K.; Turncliff, R.Z.; Dean, R.L., et. al. (2009). Route of administration affects the ability of naltrexone to reduce amphetamine-potentiated brain stimulation reward in rats. Addiction Biology, 14, 408–418 Winslow JT, Miczek KA (1988) Naltrexone blocks amphetamine-induced hyperactivity, but not disruption of social and agonistic behavior in mice and squirrel monkeys. Psychopharmacology, 96:493–499.
October 19, 2009
Memo from the U.S. Attorney General on the Prosecution of Individuals Who Sell Medical Marijuana
The United States Department of Justice today issued guidelines that instruct federal attorneys to shift their priorities away from prosecuting individuals who are in compliance with state laws regarding the sale of medical marijuana. Instead, they have been directed to focus on enterprises that unlawfully market and sell marijuana for profit. The Department of Justice memo can be viewed at http://blogs.usdoj.gov/blog/archives/192 What do you think? What effect will this action have on preventing substance dependence problems? Let us know click here.
October 5, 2009
This week, we are featuring two important studies reported in the Archives of General Psychiatry on October 4. Both of these studies address the issue of making drug use less rewarding for substance dependent individuals.
Cocaine Vaccine for the Treatment of Cocaine Dependence in Methadone-Maintained Patients: A Randomized, Double-blind, Placebo-Controlled Efficacy Trial
At this time, no medications for the treatment of cocaine dependency have been approved by the US Food and Drug Administration. However, it appears that one medication, succinylnorcocaine*, is capable of reducing the rewarding properties of cocaine. Recent research has indicated that treatment with this vaccine may be helpful in assisting those who use cocaine in reducing or eliminating their use of this substance. Previous studies with both animal and human subjects have indicated that the administration of the vaccine can produce antibodies that block cocaine from entering the brain. This eliminates any psychoactive effect, most importantly the rewarding effects of the drug. At the same time, the vaccine does not interfere with the therapeutic action of other medications such as methadone. 115 methadone-maintained clients were assigned in a random manner to receive either the vaccine or a placebo substance. All 115 individuals received injections of the vaccine or of placebo 5 times during the study. 94 participants completed the trial, and most of these individuals also smoked crack cocaine, and a smaller number used marijuana and alcohol. The study ran for 24 weeks and follow-up was conducted to 12 months. The blood level of vaccine was regularly assessed since previous research has shown that a specific level must be reached in order for it to be effective in blocking the cocaine high. The research staff also knew that peak blood levels of the antibody are not reached until approximately week 9, so they predicted that the cocaine use of the vaccinated subjects who reached the necessary blood levels would fall at about that time. They further knew that antibody levels typically go down between weeks 16 and 20, and so they hypothesized that any beneficial effect would decline at that time. All of the study participants reduced their cocaine use during the first 8 weeks of the trial. The research staff suggest that this is because they began methadone maintenance and received cognitive behavioral therapy, an evidence-based strategy that probably resulted in cocaine use reduction during the early part of the study. Beyond this point, the study produced mixed results. Only 38% of the vaccinated participants reached the necessary antibody blood level, these levels were not reached before week 8, and they declined between weeks 16 and 24. Nonetheless, of the 38% who reached the necessary antibody level, more than half showed significantly less cocaine use than the subjects who did not attain this level. In addition, there was less cocaine use even among those vaccinated subjects who did not attain the minimum antibody blood level compared to those who received placebo. This study holds great promise that the succinylnorcocaine vaccine can reduce cocaine use among substance dependent individuals. If so, this pharmacological approach could strengthen the already existing clinical strategies now being used to treat persons with substance dependence problems. * More precisely, this study used succinylnorcocaine that was linked to a recombinant cholera toxin B-subunit protein. We will refer to it henceforth as "vaccine" or "the vaccine". Source: Martell, B.A.; Orson, F.M.; Poling, J.; Mitchell, E. Rossen, R.D.; Gardner, T. & Kosten, T.R. (2009). Cocaine Vaccine for the Treatment of Cocaine Dependence in Methadone-Maintained Patients: A Randomized, Double-blind, Placebo-Controlled Efficacy Trial. Archives of General Psychiatry, 66(10):1116-1123.
Improving Clinical Outcomes in Treating Heroin Dependence: Randomized, Controlled Trial of Oral or Implant Naltrexone
Naltrexone hydrochloride (referred to from here on simply as naltrexone) is an opiate antagonist; a substance that enters the brain and blocks opiate agonists (e.g., heroin, hydrocodone/Vicodin) from producing their effects. Currently, naltrexone is used to treat both alcohol and opiate dependency. In this report, the focus will be on opiate dependency. Because naltrexone is an opiate antagonist, clients must be detoxified from opiates before it can be used. Once a person with a history of opiate dependence has been detoxified, the oral use of naltrexone can reduce relapse rates by ensuring that the individual can not “get high” on any opiate. One problem with naltrexone therapy is that its usefulness relies on patient compliance. In other words, it only works if the client takes the medication. A person who plans a relapse can stop taking naltrexone at any point, and within a day (or slightly longer if the dose of naltrexone is higher) be able to get high on opiates again. In order to address this problem, a form of sustained-release naltrexone was developed. This form of the drug is implanted in a “depot” manner; placed under the skin so that it releases naltrexone regularly over a period of 30 days. The purpose of this study was to compare the safety and efficacy of sustained release naltrexone with one-daily oral delivery. 70 individuals with a history of opiate dependency were included in this study. Half of these received 50 mg of oral naltrexone daily (plus a placebo implant) and half were given 2.3 grams of naltrexone as an implant (plus placebo tablets). The purpose of the placebo medication was to ensure that the participants did not know whether they were in the oral naltrexone or implant group, since such knowledge could affect their reaction to the medication. The factors that were measured in this study were: 1) maintenance of naltrexone levels above 2 nanograms* per milliliter of blood; 2) return to regular heroin use (at least four days per week); 3) Any other heroin use as well as abstinence; 4) the use of any illicit non-opiate drug; 5) the number of opiate overdoses requiring hospitalization; 6) unexpected or adverse physical reactions due to naltrexone treatment; and 7) blood naltrexone levels among participants who had received naltrexone implants. After two months, it was found that 1) naltrexone blood levels were lower among those in the oral medication group that those in the implant group; 2) return to heroin use within six months was significantly lower among those in the implant group; 3) of those who relapsed to heroin use, such use is not as frequent (measured by days per week of use) in the implant group; 4) ten adverse events occurred (including six cases of diarrhea and one case related to the surgical implantation of the naltrexone, not to the drug itself); 5) although the majority of participants in both groups used non-opiate drugs (with cannabis and stimulants being the most common substances), there were more of these in the implant group (eleven cannabis and four stimulants) than in the oral medication group (seven cases of cannabis use and one of stimulants). What do these results mean in terms of clinical practice? First, blood levels of naltrexone tend to be consistently higher (at least for the first two months) in the depot group. Secondly, although opiate relapse is inevitable for some clients, the depot version of naltrexone may significantly reduce both the time to first use and the frequency of such outcomes. Third, except for a limited number of clients who may experience diarrhea, side effects related to the use of naltrexone are minimal. Little can be said regarding the use of non-opiate drugs, except that 1) this is not an issue for most clients on naltrexone, and 2) depot naltrexone does not seem to have an advantage over the oral version. Overall, clinicians may find that they have more time (particularly during the first 2 months of treatment when recovery are most fragile and relapse more likely than in later time periods) to help depot-treated opiate-dependent clients develop relapse prevention skills. This seems to be due to the longer period of time before first use and the less frequent level of use among those who in fact did relapse. Thus, if depot naltrexone is not available to clients in programs that use this drug therapeutically, clinical staff may want to ask their medical director of consultant if it can be made available. * A nanogram (ng) is 1/1,000,000,000 of a gram (approximately 1/28 billionth of an ounce). Source: Hulse, G.K., Morris, N., Arnold-Reed, D. & Tait, R.J. (2009). Improving Clinical Outcomes in Treating Heroin Dependence: Randomized, Controlled Trial of Oral or Implant Naltrexone. Archives of General Psychiatry, 66(10):1108-1115.
August 31, 2009
Perinatal Drug Abuse and Neonatal Drug Withdrawal
It is widely acknowledged that the use of psychoactive drugs during pregnancy can produce neonatal anomalies, up to and including physical dependency, birth defects and neonatal mortality. A recent on-line article on the emedicaine.com website provides a summary of perinatal effects of the mother's alcohol and other drug use. •Nonopiate drug withdrawal: Withdrawal syndromes that are related to individual nonopiate drugs have been difficult to study. The high prevalence of polydrug use prevents clinicians from witnessing the effects of isolated medications. At this time, little data supports a description of a cocaine-abstinence syndrome.
•Alcohol withdrawal: Signs of alcohol withdrawal may include hyperactivity, crying, irritability, poor sucking, tremors, seizures, poor sleeping patterns, hyperphagia, and diaphoresis. Signs usually appear at birth and may continue until age 18 months. Withdrawal typically appears within 3-12 hours after delivery.
•Barbiturate withdrawal: Signs may include irritability, severe tremors, hyperacusis, excessive crying, vasomotor instability, diarrhea, restlessness, increased tone, hyperphagia, vomiting, and disturbed sleep.
•Marijuana withdrawal: For marijuana, a mild opiate-like withdrawal syndrome has been observed. Signs may include fine tremors, hyperacusis, and a prominent Moro reflex; however, these symptoms rarely require treatment. •Nicotine withdrawal: Mild signs are observed, including fine tremors and variations in tone; however, no comprehensive syndrome that typically requires treatment is recognized.
•Acute narcotic withdrawal: This withdrawal usually begins 24-48 hours after birth, depending on the time of last dose. However, signs may not appear in the infant until 3-4 days after birth.
•Methadone withdrawal: Symptoms typically appear within 48-72 hours but may not start until the infant is aged 3 weeks. This is particularly true for infants whose mothers took excessively higher doses. Conflicting data has emerged concerning withdrawal severity and higher in-utero methadone doses. Data has shown that co-exposure with nicotine increases the severity and duration of the neonatal withdrawal.
•Opiate withdrawal: Signs of neonatal abstinence syndrome (NAS) include hyperirritability, gastrointestinal dysfunction, respiratory distress, and vague autonomic symptoms (e.g., yawning, sneezing, mottling, and fever). Tremors and jittery movements, high-pitched cries, increased muscle tone, and irritability are common. Normal reflexes may be exaggerated. Loose stools are common, leading to possible electrolyte imbalances and diaper dermatitis. Long-term symptoms have been difficult to study, but evidence supports that these children show hyperphagia, increased oral drive, sweating, hyperacusis, irregular sleep patterns, poor tolerance to environmental changes, and continued loose stools. NAS appears to be less severe if the mother has used opiates longer than one week prior to delivery.
•Cocaine: Acute signs such as tremors, high-pitched cry, irritability, excess suck, hyperalertness, apnea, and tachycardia can be seen with the first 72 hours of life. However, because these signs can be seen before the typical half-life of a dose immediately prior to delivery, one can argue that these signs are more typical of intoxication, rather than withdrawal.
•Amphetamines: Whether amphetamine use during pregnancy affects neonatal outcome remains unclear. Increasing evidence suggests that it is associated with an increased risk of prematurity and intrauterine growth restriction and the risk of congenital anomalies does not appear to be increased. As well, although several reports of neonatal amphetamine withdrawal are documented, each case involved polydrug use during the pregnancies. •Phencyclidine: Because the number of known phencyclidine use during pregnancies is limited, little is known of the neonatal consequences. Some studies have reported neurobehavioral abnormalities in the immediate neonatal period, such as hypertonicity, irritability, sleep problems, and temperature instability. However, as in many other observational reports, these typically include patients with polydrug use during the pregnancy.
•Antidepressants: Perhaps no class of medications is more studied than the current generation of selective serotonin reuptake inhibitors (SSRI). Because of their widespread use, concern over possible fetal or infant effects have been well studied In general, no withdrawal syndrome has been associated with SSRIs. However, infants have been noted to show jitteriness, respiratory distress, and other neonatal complications. They are more commonly observed in newborns whose mothers were taking a short-acting SSRI such paroxetine (Paxil). Debate rises over whether these symptoms are actually withdrawal or, more likely, a drug intoxication effect. Of all SSRIs studied, intrapartum use of sertraline (Zoloft) has shown the safest neonatal clinical profile.
Source: http://emedicine.medscape.com/article/978492-overview
August 5, 2009
Adolescent Rats Self-Administer More Nicotine Than Adults
Within the past decade, new information regarding the adolescent brain has been made possible by advanced brain imaging techniques. It is now known that the human brain does not mature until approximately the age of 22. Further, the last areas of the brain to fully develop are those that are responsible for impulse control, decision-making and the ability of understand and focus on the future consequences of current behavior. This makes the use of alcohol and other drugs particularly risky for adolescents. A study recently highlighted by the National Institute on Drug Abuse (NIDA) used an animal model to examine the outcome of adolescent nicotine use. Edward Levin and his colleagues at the Duke University Medical Center allowed both adolescent and adult rats that had never been exposed to nicotine to self-administer the drug for a period of four weeks. Over the first two weeks of the study, the younger male rats administered more than three times as much nicotine as the adults. As the adolescent rates matured, their nicotine consumption decreased until it declined to adult like levels by the end of week 4* In a study conducted previously by Dr. Levin and his colleagues, it was found that adolescent female rats self-administered twice as much nicotine as adults. However, compared to the male rats in the current study, as the adolescent female rats matured, they continued to self-administer more nicotine than adults. What significance does research with rats have for humans? In many ways, rats are behaviorally more like humans than are other species (such as primates) that are closer in evolutionary status to us. Rodent research over many years has very often been proven to apply to human behavior. -This being the case, Dr. Levin's findings may indicate that (human) adolescent males are initially more sensitive than females to nicotine, but that females may experience a more persistent vulnerability. This conclusion is given substance by previous studies of human females which conclude that women may have more difficulty quitting the use of nicotine than men. Thus, substance abuse treatment services need to take into account the role of gender in smoking cessation programs, and adjust clinical approaches to address differences between men and women. Sources: Levin, E.D.; Lawrence, S.S.; Petro, A.; Horton, K.; Rezvani, A.H., Seidler, F.J. & Slotkin, T.A. (2007). Adolescent vs. adult-onset nicotine self-administration in male rats: Duration of effect and differential nicotinic receptor correlates. Neurotoxicology and Teratology, 29(4): 458-465. Anon. (2009). Adolescent Rats Self-Administer More Nicotine Than Adults. NIDA Notes, 22(3):3.
* It should be noted that while two to four weeks is an insignificant amount of time for a human, it represents a relatively longer period of time for rats, since their life span is only two to three years. For this reason, weeks of "rat time" are equal to years of "human time".
July 6, 2009
Diprivan
A drug that has mentioned as a possibly contributing factor in Michael Jackson's death is Diprivan. Because it is unclear which company makes Diprivan (the Internet lists at least two possible manufacturers), we will refer to it by its generic name*: propofol. Propofol is not a commonly used street drug. In fact, after more than 35 years of studying street drug pharmacology, this writer has not once encountered this substance. According to the U.S. Food and Drug Administration, propofol was approved in 1989 for use as an intravenous general anesthetic**, although in smaller doses, it can be used to produce conscious sedation***. This drug is never used by physicians outside of a hospital setting, and requires the presence of an anesthesiologist****. This person must have immediate access to devices that can assist in cardiopulmonary resuscitation***** There are several possible dangers associated with the administration of propofol: 1) The drug should not be administered too rapidly or too slowly. 2) If too much of the drug is administered, or if it is administered too quickly, cardiorespiratory depression (dangerous slowing of the heart and breathing rate, sometimes resulting in death) can occur. 3) It is dangerous to administer propofol to an individual who is also under the influence of opiates (analgesics or painkillers of the kind which Michael Jackson allegedly took in large quantities) due to the possible of cardiorespiratory depression. 4) 43% of patients to which propofol is administered suffer apnea (they stop breathing) for 30 seconds or more. 5) Failure to handle propofol properly can result in the patient suffering serious and possibly life-threatening infections. Clearly, this is a drug that under certain conditions poses sigificant hazards when not administered properly by a specially trained medical doctor. As of this date, the role (if any) of this substance in the death of Michael Jackson still remains to be seen. Source: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseacti.... Retrieved July 6, 2009 from http://www.fda.gov. - - - - - - - - - - - - - - - - -
* The generic name of a drug is its official, legal name, while the brand name is registered and can only be used by the company that owns it. For example, Advil, Motrin and Nuprin are all brand names for the drug that has the generic name ibuprofen.
** A drug administered by injection into a vein (intravenously) that produces general anesthesia. General anesthesia refers to a state of unconsciousness under which no pain or other sensation is felt by the patient.
*** A state of partial unconsciousness during which the patient is relaxed and pain-free, but also capable of responding to physical stimulation and verbal commands when necessary.
**** A physican who is specially trained to administer anesthesia and to monitor a patient's pulse, breathing, blood pressure, level of consiousness and other vital functions during a surgical procedures.
***** The restarting of the heart and breathing once they have stopped.
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June 22, 2009
Alcohol and Suicide
A study reported in the June 19 edition of the (Centers on Disease Control) Morbidity and Mortality Weekly Report indicates that suicide is linked to alcohol intoxication within a diverse group of ethnic groups and age categories. Approximately 24% of those who commit suide have blood alcohol levels at or above 0.08 g/dL (grams per deciliter), the legal limit for driving under the influence of alcohol. The highest rate among ethnic groups was 37% for American Indians/Alaska Natives (AI/AN) followed by Hispanics at 29%. The lowest rate was among non-Hispanic Black individuals at 7%. Within age groups, persons aged 29-40 years had the highest rate at 28%, and the lowest rate occurred among 10-19 year-olds, who, obviously, are below the legal age for consuming alcohol. Risk and protective factors, including alcohol use, substance misuse and social support, are commonly used to develop suicide prevention programs. However, usch programs have seldom focused on specific ethnic groups. However, one successful program, The Natural Helpers, has been implemented by AI/NA communities. This program is descibed in May, Hurt & DeBruyn (2005). Involvement of members of the community in which an intervention is implemented as well as mental illness prevention efforts are important components of suicide prevention programs. How might such programs be better designed for high risk ethinic populations.
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Sources: Centers for Disease Control (2009). Alcohol and Suicide Among Racial/Ethnic Populations --- 17 States, 2005--2006. Morbidity and Mortality Weekly Report (MMWR), 58:637-641. May PA, Serna P, Hurt L, DeBruyn LM (2005). Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. American Journal of Public Health, 95:1238-44.
June 15, 2009
Maintenance therapy and 3-year outcome of opioid-dependent prisoners: a prospective study in France:(2003–06)
The concept of providing opiate substitution therapy (e.g., methadone maintenance) to incarcerated individuals with histories of heroin dependency is not a new one. However, conflicting research regarding the efficacy of this approach has hampered any wide-spread implementation of this practice. In a 2008 paper, Kinlock and his colleagues found that providing methadone maintenance therapy to incarcerated individuals who had pre-incarceration histories of heroin dependency facilitated participation in post-release community treatment, decreased self-reported heroin use (but not heroin-postive urine samples), and decreased criminal recidivism (both self-reported crime and reincarceration) at three months post-release. Kinlock also cites additional studies that support the use of opiate substitution therapy in correctional facilities. A new paper, published this month in the journal Addiction, indicates that long-term outcomes for individuals who were provided with methadone maintenance prior to release from incarceration may not be as positive. Jean-Noel Marzo and colleagues found that reincarcerattion rates for these subjects was just under 50%; a less than ideal finding. The efficacy of providing opiate substitution therapy to incarcerated individuals in preparation for their release remains an issues open to debate.
If you have had experience with this approach, or have formed an opinion concerning the utility of this approach, I invite your comments via the "Contact us" link on the home page of this website.
Sources: Kinlock, TW; Gordon, MS; Schwartz, RP & O'Grady, KE (2008). A Study of Methadone Maintenance For Male Prisoners: 3-Month Postrelease Outcomes. 3-Month Postrelease Outcomes. Addiction, 103(8): 1333-1342. Marzo, J; Rotily, M; Meroueh, F; Varastet, M; Hunault, C; Obradovic, I & Zin, A (2009). Maintenance therapy and 3-year outcome of opioid-dependent prisoners: a prospective study in France: (2003–06). Addiction, 104(7): 1233-1240.
May 19, 2009
Classification of Inhalants
In an earlier edition of the Addiction Science section, we discussed research that shows that the prevalence of inhalant use is higher among adolescent males involved in the juvenile justice system that among their peers without such involvement. However, regardless of juvenile justice involvement, inhalant use has increased among several adolescent age groups. In addition, many youth see less risk in trying inhalants and indicate less disapproval of use among their peers. A significant problem has been that the "inhalants" category has traditionally included a wide range of substances, some which (e.g., nitrous oxide/"laughing gas") pose less risk to health than others, such as industrial solvents, paints and gasoline. Often there is no discrimination between these various categories, In the June 2009 edition of the journal Addiction, a group of scientists and behavioral health experts from the multi-national Inhalants Working Group suggests that the current system of classifying inhalants by form or product type is not useful for scientific purposes, and that a system of sub-classification should be developed. Both substance disorder preventionists and treatment professionals stand to benefit by such reclassification, which may be based in part on shared patterns of use and geographic distribution, by more precisely categorizing high risk youth and adolescents with substance use disorders. Sources: Balster, RL, Cruz, SL, Howard, MO, Dell, CA & Cottler, LB (2009). Classification of Abused Inhalants, Addiction, 104(6): 878-882. Johnston, LD., O'Malley, PM., Bachman, JG., & Schulenberg, JE. (2008). Various stimulant drugs show continuing gradual declines among teens in 2008, most illicit drugs hold steady. University of Michigan News Service: Ann Arbor, MI. Retrieved 05/30/09 from http://www.monitoringthefuture.org/
May 11, 2009
Non-Substance "Addictions"
Are behaviors such as pathological gambling, "eating disorders" (e.g., anorexia nervousa, bulimia) and compulsive shopping actually addictions in the same sense as substance dependency disorders? Although some research has found common physiological traits in both "process" and chemical addictions, this continues to be a matter of continuing debate within the scientific and clinical communities. In the current edition of the journal Addiction, Dr. Mark Potenza of the Yale University School of Medicine suggests that studying individuals such as compulsive gamblers could provide a unique perspective on the physiological processes that may underlie many behaviors that are or appear to be addictions. Dr. Potenza makes the point that the study of persons with dependency on such drugs as alcohol or cocaine must take into account the physical (particularly within the brain) that may be caused by excessive and/or long-term use of these substances. Compulsive gamblers (assuming they are not substance dependent-a perhaps uncommon situation) do not suffer from such neurological damage, and the study of such subjects may provide a unique window into the inherent predispositions that influence all addictions, both process and chemical. What has your experience been with regard to the interaction of substance and process addictions? Let us know so that we can share this information with others.
Source: Potenza, Marc N. (2009). Commentary: Non-Substance and Substance Addictions. Addiction, 104(6): 1016-1017.
May 4, 2009
Inhalant Abuse and Dependency Among Youth Involved in the juvenile justice system.
The use of inhalants (e.g., glues, nail polish remover, lighter fluid, spray paints, aerosols, cleaning fluids and industrial solvents) can produce serious medical consequences, up to and including death. Regular abuse of these substances can result in harm to vital organs including the brain, heart, kidneys, and liver. In some cases, damage to the brain can result in persistent learning and emotional problems. In a study of adolescent males involved in the juvenile justice system, Dr. Matthew Howard of the U of NC and Dr. Brian Perron U of Michigan found that 18.6% of these youth (average age: 15.5 years) met DSM-IV-TR diagnoses of inhalant abuse, and 28.3% inhalant dependency. Since a diagnosis of substance abuse or dependency requires that symptoms must have occurred within the preceding 12 months, these rates can be compared to the percentage of youth in the general population who indicated that they had used inhalants within the past year. According to the Monitoring the Future Study (the largest survey in the U.S. devoted to identifying the alcohol and other drug use patterns of adolescents and young adults) 8.7% of 8th graders and 5.4% of 10th graders said that they had used an inhalant substance at least once within the past year. Although there was no evidence per see that any of these students met criteria for inhalant abuse or dependence, use within the past year is the minimum frequency that could result in such diagnoses. Inhalant use is substantially more prevalent among males in the juvenile justice system than among the general adolescent population. Collaboration between adolescent substance use disorder treatment providers and the juvenile justice system could result in earlier detection of inhalant use, a patten of behavior that puts abusers at high risk for serious and potentially irreversible physical and psychological problems. Sources: Howard MO; Perron BE (2009). A survey of inhalant use disorders among delinquent youth: prevalence, clinical features, and latent structure of DSM-IV diagnostic criteria. BMC Psychiatry, 9:8 Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2008). Monitoring the Future: A national survey results on drug use, 1975–2007: Volume I, Secondary school students (NIH Publication No. 08-6418A). Bethesda, MD: National Institute on Drug Abuse. National Institute on Drug Abuse (2005). Research Report Series: Inhalant Abuse. (NIH Publication Number 05-3818). Retrieved May 7, 2009 from http://www.drugabuse.gov/ResearchReports/Inhalants/Inhalants.html
April 27, 2009
Drinking a Glass of Wine Daily Lowers the Risk for Barrett's Esophagus
The esophagus is the tube that carries food from the throat to the stomach). In recent years, the incidence of esophageal adenocarcinoma (cancer of the esophagus) has "skyrocketed". This type of cancer is very often linked to gastroesophageal reflux disorder (GERD), the irritation that occurs when stomach acid leaks and moves back up into the esophagus. The primary symptom of GERD is "heartburn". When the esophagus is damaged by frequent attacks of GERD, the resulting condition is known as Barrett’s esophagus. This disorder is serious, because it is a risk factor for esophageal cancer. A recent study found that drinking a one to two glasses of wine a day can lower the risk of developing Barrett’s esophagus by 56%. This effect did not occur when beer or spirits were consumed instead of wine. What if a person who suffers frequent GERD has an alcohol use disorder? There is an alternative. The study found that individuals who maintained a healthy body weight and who consumed at least 8 servings of fruits and vegetables daily also reduce their risk of Barrett’s esophagus. Consumption of wine (particularly red wine) has also been linked with a decreased risk of heart disease. It is clear that small amounts alcohol can sometimes be a good thing. On the other hand, there are individuals (including pregnant women) for whom no amount of alcohol has been shown to be safe.
Sources: 1) Wilson, J F. (2008). Gastroesophageal reflux disease. Annals of Internal Medicine, 149(3). 2) Kubo, A, Levin, T, Block, G, Rumore, G; Quesenberry, C (Jr); Buffler, P & Corley, D (2009). Alcohol Types and Sociodemographic Characteristics as Risk Factors for Barrett’ s Esophagus. Gastroenterology, 136(3): 806-815.
April 20, 2009
Comparsion of Cannabis and Tobacco Withdrawal: Severity and Contribution to Relapse
Many professionals in the substance use disorder treatment field are still unaware that discontinuation of heavy or daily use of cannabis (marijuana) may be associated with predictable withdrawal symptoms. In a 2008 paper, Dr. Alan Budney and his colleagues indicated that both users of tobacco and users of cannabis experienced similar withdrawal symptoms. Many clients who stop using marijuana can be expected to demonstrate withdrawal symptoms unpleasant enough to lead to relapse. These withdrawal symptoms (and their severity) should be Identified thorough interaction with each client, and a plan developed to respond to them. Typically symptoms include craving for marijuana, irritability, difficulty falling sleep or staying asleep, loss of appetite, and physical uneasiness. How should treatment staff respond to these symptoms? Let us know by contacting us.
Source: Budney, AJ; Vandrey, RG; Hughes, HR, Thostenson, JD & Bursac, Z (2008). Journal of Substance Abuse Treatment, 35(4): 362-368.
April 13, 2009
Daily Drinking vs. Binge Drinking as a Risk Factor for Alcohol-related Liver Disease
Long-term daily drinking, rather than weekly binge drinking, is by far the biggest risk factor in serious liver disease, according to a new report from researchers at the University of Southampton. Dr Nick Sheron and his colleagues compared daily drinkers with those whose alcohol consumption pattern was characterized by binge drinking. The authors found that 71 per cent of the subjects with ALD (Alcohol-related Liver Disease)* drank on a daily basis, while of those drinking moderately on four or more days each week (and so drinking heavily on three or less days), only 8 per cent had ALD. “If we are to turn the tide of liver deaths, then one of the important things we can do is find a way to identify those people who are most likely to develop alcohol-related illnesses at a much earlier stage, looking at the frequency of drinking occasions as often as we do to binge drinking. The transition from a late teenage and early 20’s binge drinking pattern to a more frequent pattern of increased intake may prove to be a useful point of intervention in the future, and the importance of three alcohol-free days each week should receive more prominence” Dr Sheron commented. Source: Hatton J, Burton A, Nash H, Munn E, Burgoyne L, Sheron N (2009). Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease. Addiction, 104: 587-592. * Including disorders such as cirrhosis (a chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells.)
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