NCADD ESGPV Blog

The opioid epidemic has taken an especially heavy toll on U.S. veterans, Reuters reports.

Veterans are twice as likely as non-veterans to die from accidental overdoses of opioid painkillers.

Veterans of the wars in Iraq and Afghanistan are at the highest risk of opioid addiction, federal data indicates.

Senator John McCain has sponsored the Veterans Overmedication Prevention Act, which would fund research to help Veterans Administration (VA) doctors rely less on opioids in treating chronic pain. The bill is stalled in Congress, the article notes. “The Veterans Administration needs to understand whether overmedication of drugs, such as opioid painkillers, is a contributing factor in suicide-related deaths,” said McCain, a Vietnam veteran.

The VA system has treated 68,000 veterans for opioid addiction since March, according to a department spokesman. The Louis Stokes VA Center in Cleveland has started testing alternative treatments, including acupuncture and yoga, to reduce use of and dependency on opioids, the VA said.

The Food and Drug Administration (FDA) advised consumers to avoid using the herb kratom, citing 36 known deaths associated with products containing the substance.

Kratom comes from a plant in Southeast Asia. It is used to treat pain, anxiety, depression, and symptoms of opioid withdrawal, The Washington Post reports.

It is also used recreationally, because it produces symptoms such as euphoria, the article notes.

“There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder,” FDA Commissioner Scott Gottlieb said in a statement. “Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product’s dangers, potential side effects or interactions with other drugs.”

The FDA noted that there have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage and withdrawal symptoms.

A new study finds a long-acting medication and a short-term drug that must be taken daily are equally effective in treating opioid addiction.

Researchers at NYU Langone Health found extended-release naltrexone (Vivitrol) was as safe and effective as more commonly prescribed buprenorphine-naloxone (Suboxone) in curtailing opioid use, relapse, treatment drop-out, and overdose.

The study, which was sponsored by the National Institute on Drug Abuse, was published in The Lancet.

The study is the first major head-to-head comparison of the treatments, according to The Washington Post. Researchers found each treatment had disadvantages. Short-acting medicines must be taken daily for years or even a lifetime. Naltrexone, which is given as a monthly injection, cannot be started until a person is fully detoxified from opioids—which more than 25 percent of the study subjects failed to do.

More than half of the study subjects relapsed at least once, regardless of which treatment they received.

The Drug Enforcement Administration (DEA) will classify illicit versions of fentanyl at the same level as heroin, Reuters reports.

The action will make it easier for federal prosecutors and agents to prosecute traffickers of all forms of fentanyl-related substances, the agency said.

Legally prescribed fentanyl is classified as a Schedule II drug, which means it is highly addictive but has a medical purpose.

The new DEA order classifies illicit fentanyl as a Schedule I drug, along with heroin. Schedule I drugs are considered addictive, with no medicinal purpose.

The DEA order will last up to two years, with a possibility of a one-year extension if certain conditions are met. In a statement, Attorney General Jeff Sessions said, “By scheduling all fentanyls, we empower our law enforcement officers and prosecutors to take swift and necessary action against those spreading these deadly poisons. I also urge the many members of Congress who clearly share our concern and alarm over fentanyl’s role in our opioid overdose epidemic to do their part by permanently scheduling these lethal substances.”

Teens who are dependent on marijuana and alcohol struggle to achieve hallmarks of adult success, such as graduating from college, getting married, having a full-time job and earning a good salary, a new study finds.

Researchers at the University of Connecticut tracked 1,165 study participants, starting at age 12.

They checked in on them at two-year intervals, until they were between 25 and 34 years old, HealthDay reports. Most of the participants had a grandparent, parent, aunt or uncle with an alcohol problem. Marijuana and alcohol dependence appeared to have a more severe effect on young men.

“Parents should try to delay their children’s onset of use as much as possible,” said researcher Victor Hesselbrock. “If you can push regular use back well into adolescence, the kids do a lot better.”

The study was presented at the annual meeting of the American Public Health Association.

The anti-drug ad campaign advocated by President Trump’s opioid commission will need millions of dollars in funding, advocates tell The Hill.

It is not clear how such a campaign would be funded, the article notes.

New Jersey Governor Chris Christie, who chaired the commission, said the campaign should be paid for by the federal government, with private sector partners. The report, released recently, included 56 recommendations, including an aggressive multimedia campaign to fight the opioid epidemic.

An ad campaign must be part of a more comprehensive approach that includes strengthening treatment and changing opioid prescribing patterns, advocates say.

In order to be effective, a campaign must be based on evaluations of what has been effective in the past, and must frequently test the ad’s message with the target audience, they note. “We’ve learned a lot about how to communicate about these issues in the past three decades or so. There’s a lot of really good science on this right now,” said Marcia Lee Taylor, Chief Policy Officer of the Partnership for Drug-Free Kids.

A study of patients who went to the emergency room suffering from acute pain found those given a combination of ibuprofen and acetaminophen reported as much pain relief as those who were given opioids.

The 416 patients in the study had acute pain in their shoulders, arms, hips or legs, the Los Angeles Times reports.

About 20 percent of the patients had a bone fracture, the researchers wrote in the Journal of the American Medical Association. Other patients had injuries such as a sprained ankle or dislocated shoulder.

Patients were assigned to one of four groups. One group received a combination ibuprofen/acetaminophen tablet (containing the medications found in Advil and Tylenol. The other groups received a drug containing a prescription opioid, such as Percocet (a combination of oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen) or Tylenol No. 3 (codeine and acetaminophen).

Patients were asked to rate their pain when they arrived at the hospital and two hours after they received their medication. Those who took the acetaminophen/ibuprofen tablet reported pain relief similar to those who received an opioid.

 Drug overdose deaths increased more than 17 percent between 2015 and 2016, according to a new report by the Centers for Disease Control and Prevention (CDC).

The overdose death rate rose to almost 20 people per 100,000, up from 16.3 per 100,000 the previous year, The New York Times reports.

Drug overdoses are now the leading cause of death for Americans under age 50, the CDC found.

Recently, these deaths have been driven by overdoses of fentanyl and other synthetic opioids, according to Dr. Robert Anderson, Chief of the CDC mortality statistics branch. “The main message is the drug rate went up a lot again, and of course we’re worried about it,” he said.

Hospitals are struggling to deal with an overwhelming number of cases of diseases that result from intravenous opioid use, including hepatitis C, endocarditis and the antibiotic-resistant infection MRSA.

Hepatitis C is the most common infectious disease that affects people with opioid use disorder, USA Today reports.

Reported cases of the disease almost tripled between 2010 and 2015.

Endocarditis—a condition in which the heart’s inner lining is inflamed—is a side effect of opioid addiction. Hospitalizations for endocarditis rose almost 50 percent from 2002 to 2012, at an average cost of $50,000 per patient.

MRSA is the second most common co-occurring condition with opioid use disorder, the article notes. The cost of treating the infection is about $60,000 per patient.

School officials report a growing number of teens are bringing a new e-cigarette device called a Juul vaporizer to school.

The device looks like a USB flash drive, and charges when plugged into a laptop, USA Today reports.

Juul is small enough to fit inside an enclosed hand. It comes with pods of e-liquid in sweet flavors such as mango, fruit medley and crème brulee. The devices and flavored pods can be ordered online.

U.S. Senator Chuck Schumer of New York wrote a letter to the Food and Drug Administration (FDA), asking it to reverse a recent decision to delay the regulation of e-cigarettes popular among teens, such as Juul.

“To know that New York kids are much more likely to be using these new-age e-cig devices, like Juul, is not only concerning, but it could be dangerous,” Schumer said in a statement. “Up until now, the FDA was on track to reign in e-cigs and regulate them like any other tobacco product, but this recent delay, coupled with the new numbers showing a rise in the use of gadgets like Juul, which can fool teachers and be brought to school, demands the FDA smoke out dangerous e-cigs and their mystery chemicals before more New York kids get hooked.”

Among the 67% of U.S. men who drink alcohol, those aged 50 and older are more likely than those under 50 to say they have imbibed within the last 24 hours, which suggests older men drink more frequently than younger men. However, younger men likely drink more than older men on the occasions when they do consume alcohol.

Men in all age groups drink more often than women do.

U.S. men aged 50 and older report they consumed an average of 5.3 alcoholic drinks over the past seven days, while men aged 18 to 49 had an average of 6.2 drinks. Both older and younger women report drinking fewer than three alcoholic beverages in the last week.

These data come from aggregated results of Gallup's Consumption Habits Survey from 2001-2017, totaling interviews with 11,544 U.S. adults who drink alcohol.

The type of drinks that men and women prefer may at least partly explain the difference in the number of alcoholic beverages they report having. In 2017, men are far more likely to say beer is their alcoholic beverage of choice (62%) than either wine (11%) or liquor (24%). In contrast, women favor wine (50%) over beer (19%) or liquor (28%). Even when accounting for gender and age, individuals who consume beer report drinking more alcoholic beverages than those who prefer wine, underscoring the relationship between one's beverage of choice and total consumption.

Many drug dealers use their customers to test the strength of the synthetic opioids they sell, the Associated Press reports.

They want the drugs to be strong enough to keep their customers coming back, but not strong enough to kill them.

Local dealers take fentanyl made in Chinese labs and use powders such as baby formula to increase its volume and street value.

“It is sick and awful that dealers are treating people this way,” said Bradley Ray, Director of the Center for Criminal Justice Research at Indiana University-Purdue University in Indianapolis, who studies overdose prevention. “It is sad that things have come to this. (Testers’) addictions will push them to take that; they’re not thinking clearly.”

A new study suggests hospitals are missing opportunities to help opioid overdose survivors avoid future overdoses.

The researchers looked at claims data before and after overdoses among Medicaid patients who overdosed on heroin in Pennsylvania from 2008 to 2013, NPR reports.

The filling of opioid prescriptions fell by only 3.5 percent, while medication-assisted treatment rose by only 3.6 percent. Medication-assisted treatment—buprenorphine, naltrexone or methadone—is considered the gold standard treatment for opioid addiction, the article notes.

“This is a time when people are vulnerable, potentially frightened by this event that’s just occurred and amenable to advice, referral and treatment recommendations,” said study senior author Julie Donohue of the University of Pittsburgh. “It’s safe to characterize it as a missed opportunity for the health system to respond.”

Although President Trump announced in August that he was declaring the opioid epidemic a national emergency, he has not yet taken formal steps to do so, CBS News reports.

If he does officially declare the opioid epidemic a national emergency, then FEMA can make money available to states, the article notes.

States could also request aid, and public health workers could be redeployed to fight the epidemic.

Dr. Cece McNamara Spitznas, who works in the White House Office of National Drug Control Policy, said, “What the powers are related to a national emergency and trying to determine how would that apply in this situation — it requires a lot of specialist eyes to take a look. And a lot of people to sit around and sort of go through exactly what we can do legally, and across all the different parts. I think we’re in that phase of looking at [it] and leaving no stone unturned on what is it that we can possibly do.”

Half of the increase in deaths involving heroin after 2013 can be attributed to heroin mixed with fentanyl, according to a new study by the Centers for Disease Control and Prevention (CDC).

About 33,000 people died of an opioid overdose in the United States in 2015, HealthDay reports.

Opioid overdoses accounted for 63 percent of drug overdose deaths in the United States that year. Between 2010 and 2015, heroin overdose deaths quadrupled, from 3,036 to 12,989.

A second study by the CDC found about 90 percent of overdose deaths in Ohio early this year involved fentanyl or a chemically related substance. Only 6 percent involved heroin.

Young Men and Women’s Brains DO Not Function the Same after Heavy Alcohol Use

A new study presented at the European College of Neuropsychopharmacology conference finds that chronic alcohol use affects the brain cells of young men and women differently.

Participants of the preliminary study did not have alcohol use disorder, but were classified as heavy drinkers. All participants were also in their 20s, suggesting that alcohol-related brain changes may not take very long to develop.

The participants included 11 men and 16 women between the ages of 23 and 28 years, who all reported "heavy" drinking patterns over the previous 10 years.

People who reported little or no alcohol use served as controls.

Interestingly, the researchers found differences in the activity of receptors for the neurotransmitter GABA – which plays an important function in regulating anxiety and is thought to play a role in depression.
"Generally, our work showed that alcohol causes more pronounced changes in both electrical and chemical neurotransmission in men than women," said study author Outi Kaarre in a news article. "There are two types of GABA receptors, A and B. Long-term alcohol use affects neurotransmission through both types in males, but only one type, GABA-A, is affected in females.

Many people who need treatment for substance use disorders are not receiving it.

Though there are many physicians with waivers to provide buprenorphine for medication-assisted treatment, they tend to be clustered in and around urban centers,leaving many rural counties without access to treatment.

In fact, 60.1 percent of rural counties in the United States lack a physician with a DATA 2000 waiver to prescribe buprenorphine.

To widen the availability of medication-assisted treatment using buprenorphine, the 2016 Comprehensive Addiction and Recovery Act authorized SAMHSA to allow nurse practitioners (NPs) and physician assistants (PAs) to apply for waivers to prescribe buprenorphine to treat opioid addiction.

To receive the DATA 2000 waiver, NPs and PAs must complete 24 hours of training (triple the 8 hours required of physicians). To make training more accessible to NPs and PAs, including those in remote areas, SAMHSA offers the training free through the Providers' Clinical Support System for Medication-Assisted Treatment.

The drinking culture in America is changing…for the worse.

A research study published in JAMA Psychiatry compared two large studies where American adults self-reported their drinking behaviors. The first study was conducted from 2001 to 2002 and compared to a recent study from 2012 to 2013.

Overall, Americans who reported they drank at least once in a year-long period increased by 11 percent. High-risk drinking, meaning drinking four or more beverages per day at least once a week for women and five or more for men, increased by 30 percent. One of the most concerning finds – alcohol use disorders, more commonly referred to as alcoholism, increased by almost 50 percent.

Honing in on gender demographics, women had some of the greatest increases. High-risk consumption increased by 60 percent among them and alcohol use disorder rose 84 percent. In a news article, 2017 National Leadership Forum speaker George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, said: “The gap between women and men drinking has decreased. It used to be quite large.” From a cultural standpoint, Koob says he isn’t concerned about the increase in women’s alcohol consumption. However, women are particularly vulnerable to the physiological effects of alcohol, due to biological make-up.

In terms of age, researchers found that adults ages 65 years and older have seen a larger increase in alcohol consumption, with high-risk drinking rising by 65 percent and alcohol use disorders soaring to nearly 107 percent.

A new study found that 3.5 percent of all emergency department visits in the United States were avoidable and for non-life-threatening conditions.

The study, published in the International Journal for Quality in Health Care, found the top three discharge diagnoses for hospital emergency departments in the United States were alcohol abuse, dental disorders and mood disorders like anxiety or depression.

Researchers defined avoidable visits as those where there was no requirement of diagnostic or screening services, procedures or medications, with patients being discharged home.
Researchers analyzed data from 424 million emergency department visits by patients age 18 to 64 from 2005 to 2011 and found 6.8 percent of all avoidable visits were due to alcohol abuse or mood disorders.

Roughly 3.9 percent of avoidable visits were due to dental disorders of the teeth and jaw. The study found that 16.9 percent of all mood disorder visits were avoidable, 10.4 percent of all alcohol-related visits were avoidable and 4.9 percent of all dental visits were avoidable.

Of all the avoidable visits to the emergency department during the study period, 14 percent were made by ambulance

The Substance Abuse and Mental Health Services Administration (SAMHSA), within the U.S. Department of Health and Human Services (HHS), is sponsoring the 23rd National Recovery Month (Recovery Month).

This long-standing, national observance promotes the societal benefits of prevention, treatment, and recovery for substance use and mental disorders, celebrates people in recovery, lauds the contributions of treatment and service providers, and promotes the message that recovery in all its forms is possible.

The goal is to educate Americans that addiction treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life. Recovery Month spreads the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.

Each September, thousands of prevention, treatment, and recovery programs and services around the country celebrate their successes and share them with their neighbors, friends, and colleagues in an effort to educate the public about recovery, how it works, for whom, and why. There are millions of Americans whose lives have been transformed through recovery.

These successes often go unnoticed by the broader population; therefore, Recovery Month provides a vehicle to celebrate these accomplishments.

Despite the fact that recent federal reports found that drug-overdose deaths increased in 2015 among U.S. adolescents aged 15–19, a new primary care pediatric practice model designed to treat teens with substance-use disorder is showing promise.

The nation’s health system is struggling to cope with the toll of substance-use disorder as there are too few pediatric or adolescent medicine physicians specializing in addiction medicine and too few inpatient treatment beds, according to Sharon Levy, MD. She is director of the Adolescent Substance Abuse Program at Boston Children’s Hospital and represents the American Academy of Pediatrics (AAP) membership on the AMA Opioid Task Force.

One solution that is starting to gain momentum is integrating treatment programs into pediatric primary care, Dr. Levy said in an interview with AMA Wire® and, previously, in an essay she co-wrote for The Lancet.

“Addressing the opioid crisis will require innovative strategies, including some that should prompt dramatic rethinking of the role and training of pediatric generalists,” Dr. Levy and her colleagues wrote. “With its neurobiological, molecular and genetic aspects, addiction is a disorder that falls squarely into the set of common conditions in which pediatric providers should have competency. It is incumbent on providers who care for young people to do their part to address the opioid crisis before more young lives are lost.”

A major component of Dr. Levy’s primary care strategy includes medication-assisted treatment (MAT) and having prescribers in a practice undergo the eight-hour training course that is required by the Drug Enforcement Administration (DEA) before a health professional can prescribe or dispense buprenorphine. (Find education resources at the AMA Opioid Task Force website.)

Very brief mindfulness training could help heavy drinkers to start cutting back. So concludes a new study that found that as little as 11 minutes of mindfulness training helped heavy drinkers to reduce their alcohol intake in the following week.

An article in Medical News Today announced that researchers from University College London (UCL) in the United Kingdom ran an experiment that compared the effect of "ultra-brief" mindfulness training against relaxation training (the controls).

Lead author Dr. Sunjeev Kamboj, deputy director of the Clinical Psychopharmacology Unit at UCL, says, "We found that a very brief, simple exercise in mindfulness can help drinkers cut back, and the benefits can be seen quite quickly."

Writing in the International Journal of Neuropsychopharmacology, he and his colleagues explain that in recent years, there has been much interest in incorporating mindfulness training into psychological treatments for addiction.

Mindfulness training teaches people to heighten their "moment-to-moment awareness" of what is going on in the mind without judging it. Thus, when a craving arises, mindfulness training teaches you how to just observe the sensations, thoughts, and feelings of that moment without evaluating or analyzing them.

“It all comes down to your choices,” said a man in his fifties as he completed treatment following a brief return to drinking lots of alcohol.

In the company of supportive peers and an empathic treatment team, this man had immersed himself for three weeks in mindfulness practices structured by Acceptance and Commitment Therapy (ACT). He also maintained connections with his sponsor and Alcoholics Anonymous.

The man recounted how an offer of alcohol—made amid physical, interpersonal, and financial stressors—precipitated his most recent drinking episode. Similar situations had instigated previous binges.

In the future, he plans to minimize exposure to stressors and drinking opportunities. When stressors or alcohol are unavoidable, he anticipates choosing to notice them without reacting in ways that conflict with his values. “Personal responsibility” for “choices” protects his paramount value, sobriety.

Such clarity is too rare. Many others with addiction—and people around them—would do well to adopt this perspective. Choices represent the way out of active addiction, much as they represent the way in.

A NIDA-funded randomized clinical trial found that primary care patients with opioid and alcohol use disorders (OAUD) who were offered a collaborative care intervention were more likely to receive evidence-based treatment and refrain from using opioids and alcohol six months later, compared to patients receiving usual care.

The collaborative care intervention increased both the proportion of patients receiving evidence-based treatment for OAUD (39.0% vs. 16.8%) and the number refraining from opioids or alcohol use at six months. (32.8% vs. 22.3%).

Collaborative care was designed to increase the delivery of either a six-session brief psychotherapy treatment, and/or medication-assisted treatment, with either buprenorphine/naloxone for opioid use disorders or long-acting injectable naltrexone for alcohol use disorders. Usual care participants were given a number for appointment scheduling and a list of community referrals for OAUD treatment.

The authors suggest the findings indicate that treatment for OAUDs can be integrated into primary care settings effectively.

For a copy of the paper go to — "Collaborative Care for Opioid and Alcohol Use Disorders in Primary Care: The SUMMIT Randomized Clinical Trial"— published in JAMA Internal Medicine.

Beverly Haberle has, for thirty-two years, been the Executive Director of The Council of Southeast Pennsylvania, Inc. (formerly Bucks County Council on Alcoholism and Drug Dependence, Inc.), a non-profit education advocacy association.

And for the past twelve years, Ms. Haberle has been the Project Director for the Pennsylvania Recovery Organization/Achieving Community Together (PRO-ACT), a grass roots organization mobilizing the recovering community family members and other interested advocates.

Ms. Haberle holds a Master’s degree in Human Services, is a Licensed Professional Counselor, and a Certified Addictions Counselor. Ms. Haberle has been a past member of the Board of Directors for the National Council on Alcoholism and Drug Dependence, Inc. and currently sits on a number of Boards and state-wide drug and alcohol coalitions and committees. In addition, Ms. Haberle has been a part time faculty member at Penn State University since 1991. 2011 Elected National Board Member Faces and Voices of Recovery.

As Beverly Haberle is nearing the time to retire from her role as Executive Director of The Council of Southeast Pennsylvania, Inc, is embarking on a comprehensive leadership transition.

AMA Source recently published an article noting that patients with substance use disorders may experience stigma that can interfere with treatment options.

But when substance use disorders are recognized and treated as a chronic disease, that stigma can be reduced.

The article goes on to note that treating patients with substance use disorders in a family medicine setting can be a unique situation because physicians are often treating other members of the patient’s family as well. At first, patients may be reluctant to discuss substance use but once the condition is out in the open, having the family involved can be beneficial.

And since many primary care physicians (especially those in family medicine) know many of their patients very well and have established a long-term relationship. That can be advantageous when a patient begins to show signs of a substance use disorder.

Once the physician and patient have had a conversation about substance use and have determined that it would be best to seek treatment, the primary care setting can be a great place for that treatment to occur. Some patients feel more comfortable when their substance use disorder is treated in the same way as any other medical condition, which can also reduce the stigma.

There is a clear body of research assessing sex and gender differences in risk behaviors among people who inject drugs, however little or no research has investigated sex differences in hepatitis C (HCV) susceptibility.

A newly published analysis examining data from more than 1800 people suggests that women who inject drugs have a 38% higher risk of contracting HCV than their male counterparts.

Interestingly, while sharing of syringes and other injection equipment is a significant risk factor for HCV, differences in these behaviors did not account for the higher risk among women.

The research was funded by the National Institute on Drug Abuse (NIDA), part of the National institutes of Health.

The analysis used data from the International Collaboration of Incident HIV and HCV in Injecting Cohorts, a project of pooled biological and behavioral data from ten prospective cohorts of people who inject drugs, including the United States, Australia, Canada and the Netherlands. This study includes data from seven of the 10 cohorts.

The stimulant methamphetamine, also popularly known as 'speed,' 'ice' and 'meth,' is linked to a heightened risk of stroke among young people, reveals a review of the available evidence, published online in the Journal of Neurology Neurosurgery & Psychiatry.

According to a recent article in Medical News Today, a stroke caused by a bleed into the brain (haemorrhagic) rather than a clot (ischaemic) is the most common type associated with taking this drug, with men twice as likely to succumb as women, the findings show.

Given the often disabling or fatal consequences of a stroke, and the increasing use of methamphetamine among young people, particularly in countries around the Pacific rim, the findings are a cause for concern, warn the researchers.

They base their findings on a comprehensive trawl of research looking at a potential link between methamphetamine use and associated stroke risk in young people (under the age of 45), and published up to February 2017. They found 77 relevant pieces of research out of 370, including epidemiological studies and case report series.

Methamphetamine can be swallowed, inhaled, or injected. Haemorrhagic strokes were equally associated with swallowing the drug and injecting it while inhalation was the most common method of getting high associated with ischaemic stroke.

The risk of death from hypertension is three times greater in adults who use marijuana, compared with nonusers, based on data from a retrospective study of 1,213 adults.

According to an article in Cardiology News, the recent changes in the legalization of marijuana may promote increased recreational use, but data on the long-term effects of marijuana use on cardiovascular and cerebrovascular mortality are limited, wrote Barbara A. Yankey, PhD, of Georgia State University, Atlanta, and her colleagues.

The researchers collected data from the National Health and Nutrition Examination Survey from adults aged 20 years and older who were asked between 2005 and 2006 whether they had ever used marijuana, and those who answered “yes” were defined as users. Data on 686 users and 527 nonusers were combined with the 2011 mortality data from the National Center for Health Statistics.

Overall, marijuana users had a 3.42 times greater risk of death from hypertension than did nonusers (95% confidence interval, 1.20-9.79), and the risk increased by 1.04 for each year of use (95% CI, 1.00-1.07). The average duration of marijuana use was 11.5 years. At the time of study entry, the average age of the participants was 38 years, and the average body mass index was 29 kg/m2; 23% of marijuana users and 21% of nonusers had a prior diagnosis of hypertension.

Of the study participants, 20% used marijuana and smoked cigarettes, 16% used marijuana and were past smokers, 5% were past smokers, and 4% only smoked cigarettes. “In our study, increase in risk for hypertension, [heart disease], or cerebrovascular disease mortality associated with cigarette use was not significant,” the researchers wrote. They attributed this factor to the small sample size and noted that the dangers of cigarette smoking to the cardiovascular system are well established.

Opioid misuse and overdose deaths in the United States have been rising for two decades. Between 2000 and 2013, the opioid overdose rate—among all ages, races, genders, and ethnicities—nearly quadrupled, increasing from 0.7 to 2.7 deaths per 100,000 individuals. Drug overdose is now the single greatest cause of unintentional deaths in America.

Suffolk County, in downstate New York, has been hit particularly hard. With 337 heroin-related deaths between 2009 and 2013, Suffolk County reported more such deaths than any other county in New York State. And in 2014, the age-adjusted opioid-related death rate in Suffolk County was 12.6 per 100,000, compared to the New York State average of 7.2 per 100,000. This article explores why Suffolk County residents are at greater risk for overdose deaths and, more important, how they are now protecting themselves.

The Community

Suffolk County occupies the easternmost two-thirds of Long Island. Its population size of 1.5 million is larger than that of several individual states (Vermont, Rhode Island, Delaware, North & South Dakota, Montana, Wyoming, and Alaska). Compared to the rest of New York State, Suffolk County residents are generally more prosperous (inflation-adjusted median annual household income $85,886 in 2014; third highest of New York’s 62 counties) and less diverse. The income gap between the county’s upper and lower socioeconomic classes is smaller than the state average. In 2015, 68.6 percent of Suffolk County identified as “non-Hispanic white,” compared to 56.0 percent for New York State.

Suffolk and Opioids

The high percentage of Caucasians in Suffolk County may help to explain that county’s high rate of opioid deaths. The following graph of national statistics from a Centers for Disease Control and Prevention (CDC) publication shows that, between 2000 and 2013, the most dramatic jump in heroin-related overdoses was in non-Hispanic white persons aged 18 to 44. New York State statistics are similar—in 2014, the heroin-related mortality rate for all residents of New York State was 6.5 per 100,000, whereas the rate for only non-Hispanic whites was significantly higher (9 per 100,000).

“Drug-Poisoning Deaths Involving Heroin: United States, 2000-2013.” Holly Hedegaard, Li-Hui Chen, & Margaret Warner. NCHS Data Brief #190, March 2015. http://www.cdc.gov/nchs/data/databriefs/db190.htm

The following information is available in a report titled “Facing Addiction in America: The Surgeon General's Report on Alcohol, Drug Abuse and Health. A New Agenda to Turn Back the Drug Epidemic.”

Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health was published in November 2016. Four months later, in March 2017, IBH held a meeting of 25 leaders in addiction treatment, health care, insurance, government and research to discuss the scope and implications of this historic document.

The Institute for Behavior and Health, Inc. (IBH) is a 501(c)3 non-profit substance use policy and research organization that was founded in 1978. Non-partisan and non-political, IBH develops new ideas and serves as a force for change.

The former US Surgeon General, Vivek H. Murthy, MD, was an active participant in the meeting. The significance of this new Surgeon General’s Report is analogous to the historic 1964 Surgeon General’s report, Smoking and Health, a document that inspired an extraordinarily successful public health response in the United States that has reduced the rates of cigarette smoking by over 64% and continues its impact even today, more than 50 years following its release.

The two primary objectives of the US Surgeon General’s Report of 2016 are first to provide scientific evidence that shows that in addition to nicotine, other substance misuse and addiction issues (e.g., alcohol, opioids, marijuana, etc.) also are best understood and addressed as public health problems; and second to encourage the inclusion of addiction – its prevention, early recognition and intervention, treatment and active long-term recovery management – into the mainstream of American health care.

A Celebration of Possibility, Hope and Promise

The Long Island Council on Alcoholism and Drug Dependence (LICADD) celebrated the 30th Annual Angel Ball.

Over 330 LICADD supporters and friends came together to note a year of milestones in the addiction and recovery arena. The filled to capacity crowd, raised over $300,000 enabling LICADD to continue its important and vital work of service, support, prevention education and advocacy.

At the height of an opioid crisis on Long Island, this successful event was a positive stride in the fight to support those individuals and their families who struggle with substance abuse.

The Angel Ball paid a heart-felt tribute to the late Adele C. Smithers. A good friend and advocate for LICADD, she has been dubbed the "Mother" of research, education, prevention Adele Smithersand recovery in the field of alcohol abuse and drug dependence. Her guidance, leadership and generosity will remain guiding principles for LICADD, as the agency furthers its 61-year mission for years to come.

Family members can be active participants in responding to the overdose epidemic by rescuing loved ones with the opioid overdose antidote naloxone, a new study finds.

Boston University researchers studied almost 41,000 people who underwent naloxone training, and found family members used the antidote in about 20 percent of 4,373 rescue attempts.

Almost all the attempts were successful, HealthDay reports.

“Families are willing participants in this fight against overdose deaths, and more should be done to involve them as allies,” lead researcher Sarah Bagley said.
The study appears in Drug and Alcohol Review.

A police officer in Ohio accidentally overdosed on fentanyl while on the job, NBC News reports.

He was recovering, but reportedly “still miserable” several days later.

Patrolman Chris Green was at the police station after having searched the car of two suspected drug dealers. A colleague pointed out some white powder on Green’s shirt. Green brushed it off with his bare hand. About an hour later, he passed out. It took four doses of the opioid overdose antidote naloxone (Narcan) to revive him, the article notes.

According to East Liverpool Police Chief John Lane, Green had used gloves and a mask to search the car, but had taken them off before he brushed the powder off. “He did this without thinking,” Lane said. “I’m not sure he even realized this was drugs.”

Two senators have introduced a bill that would protect the Office of National Drug Control Policy (ONDCP) from sweeping budget cuts proposed by the Trump Administration, according to the Associated Press.

The White House is proposing a cut of 94 percent to ONDCP’s budget, an e-mail to agency employees by Acting Director Richard Baum revealed. He asked employees not to share the information, but the e-mail was quickly leaked. The proposed budget fully eliminates several programs involved in fighting the opioid epidemic.

New Hampshire U.S. Senators Jeanne Shaheen and Maggie Hassan introduced a bill that would reauthorize the office, increase funding for programs, and streamline ONDCP to ensure efficient use of resources.

“The Trump Administration’s proposal to effectively eliminate the ONDCP is not fiscally responsible, it’s dangerous and would significantly roll back our efforts to stem the tide of this crisis,” Hassan said in a news release.

Nearly 32 million adults in the United States (13 percent of the U.S. population aged 18 and older) consumed more than twice the number of drinks considered binge drinking on at least one occasion, according to a 2013 survey that asked about past-year drinking. This higher level of drinking is associated with increased health and safety risks.

A report of the findings is online in the American Journal of Preventive Medicine. The study was conducted by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health.

Binge drinking, defined as having four or more drinks on an occasion for women, or five or more drinks on an occasion for men, can produce blood alcohol levels greater than 0.08 percent, which is the legal limit for driving in the United States. Reaching this level is well known to increase the risk of harms to the drinker and others. However, evidence suggests that many people drink far beyond four or five drinks per occasion, defined as extreme binge drinking. The current study analyzed three levels of past-year binge drinking - Levels I, II, and III. These levels were defined as four to seven drinks, eight to 11 drinks, and 12 or more drinks on a single occasion for women; and five to nine drinks, 10-14 drinks, and 15 or more drinks on a single occasion for men.

The researchers found that in the 2012–2013 survey, 39 percent of adult males and 27 percent of adult females reported Level I binge drinking during the previous year. Eleven percent of males reported Level II binge drinking (two times the binge drinking threshold for adult males) at least once in the past year, and 7 percent reported Level III binge drinking (three times the binge threshold) at least once in the past year. Five percent of females reported Level II binge drinking (two times the binge drinking threshold for adult females) at least once in the past year, and 3 percent reported Level III binge drinking (three times the binge threshold) at least once in the past year.

After controlling for age, race, sex, marital status, education, drug use, and smoking, compared to people who did not binge drink, people who drank at the various binge levels were much more likely to experience an alcohol-related emergency department visit; have an alcohol use disorder; be injured because of drinking; be arrested or have legal problems resulting from alcohol use; or be the driver in an alcohol-related traffic crash. Compared to non-binge-drinkers, Level I binge drinkers were 13 times more likely, Level II binge drinkers were 70 times more likely, and Level III binge drinkers were 93 times more likely, to have an alcohol-related emergency department visit.

The White House is proposing a cut of 94 percent to the budget of the Office of National Drug Control Policy (ONDCP), according to an e-mail to agency employees by Acting Director Richard Baum.

He asked employees not to share the information, but the e-mail was quickly leaked, NPR reports.

The proposed budget fully eliminates several programs involved in fighting the opioid epidemic, the article notes.

Senator Rob Portman of Ohio, who co-sponsored the Comprehensive Addiction and Recovery Act, which was signed by President Obama last year, sent a letter to Office of Management & Budget Director Mick Mulvaney urging the Trump Administration to reconsider cuts to the ONDCP. “We have a heroin and prescription drug crisis in this country, and we should be supporting efforts to reverse this tide, not proposing drastic cuts to those who serve on the front lines of this epidemic,” he said in a statement.

Colleges are addressing the opioid crisis by distributing the opioid overdose antidote naloxone and adding on-campus recovery programs, The Wall Street Journal reports.

Students have died from opioid overdoses at many campuses, including Queens University of Charlotte in North Carolina; Washington State University and Columbus State Community College in Ohio.

Adapt Pharma announced last month it would offer 40,000 free doses of its brand of naloxone, called Narcan, to colleges nationwide.

So far 60 schools have contacted the company about their offer.

The University of Texas at Austin stocks naloxone at the front desk of residence halls, and Idaho State University and Indiana University of Pennsylvania recently offered naloxone training. Campus Police at the State University of New York at Geneseo have been carrying naloxone since 2014.

Alcohol is part of our society. People use it to celebrate, socialize, relax, and enhance the enjoyment of meals. Nearly 90 percent of adults in the United States report that they drank alcohol at some point in their lifetime, and more than half report drinking in the last month. Although most people drink in moderation, nearly 40 percent of U.S. adults drink in excess of the low-risk guidelines established by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Alcohol misuse has wide-ranging adverse consequences. In the United States, nearly 88,000 people per year die from alcohol-related causes globally, alcohol accounts for 3.3 million deaths—5.9 percent of all deaths—each year. Alcohol misuse also contributes to poor performance at school and work; family problems; unprotected sex and sexually transmitted diseases; violence; memory blackouts; unintentional injuries, accidents, and overdoses; and organ damage and disease. It can lead to alcohol use disorder (AUD), a serious chronic condition that affects nearly 16 million people in the United States. The Centers for Disease Control and Prevention estimates that alcohol misuse, including AUD, costs the United States $249 billion per year due to health care expenses, lost workplace productivity, crime, property damage, and other outcomes.

NIAAA, a component of the National Institutes of Health (NIH), is the largest funder of alcohol research in the world. For nearly five decades, NIAAA’s extramural research program has supported a diverse portfolio of innovative investigator-initiated research to elucidate the effects of alcohol on health and reduce the burden of alcohol misuse for individuals at all stages of life. This work is complemented by a robust intramural research program that leverages the state-of-the-art resources available at NIH to advance high-risk, high-reward studies in key areas of alcohol science. In addition, through the Collaborative Research on Addiction at NIH (CRAN) initiative, NIAAA is partnering with the National Institute on Drug Abuse and the National Cancer Institute to integrate resources and expertise across NIH to develop a comprehensive, well integrated understanding of substance use, misuse, and addiction that considers the common and distinctive features of addictive substances and substance use disorders (SUDs).

Research supported by NIAAA has spurred tremendous progress in identifying the factors that contribute to alcohol-related problems and the fundamental biological and behavioral mechanisms by which they develop, and it has paved the way for innovative preventive and treatment interventions. Once viewed as a moral failing or character flaw, AUD is now widely regarded as a chronic but treatable brain disease that develops through complex, dynamic interactions among biological, environmental, and developmental factors. This shift in perspective, bolstered by decades of research on the neurobiology of addiction, has helped reduce the stigma associated with AUD and has underscored the need for a multipronged approach to preventing and treating alcohol-related problems, with interventions designed for individuals, families, communities, and society at large.
This strategic plan serves as a roadmap for catalyzing continued progress across the spectrum of alcohol research and translating these advances for the benefit of the public. It highlights NIAAA’s research goals in five key areas:

Along with the goals outlined above, NIAAA has identified several cross-cutting research themes, which are woven throughout this strategic plan.

Children who are bullied in fifth grade are more likely to become depressed and experiment with drugs and alcohol during their teen years than their peers who weren’t victimized by other kids, a U.S. study suggests.

Researchers followed almost 4,300 students starting in fifth grade, when they were around 11 years old. By tenth grade, 24 percent of the teens drank alcohol, 15 percent smoked marijuana and 12 percent used tobacco.

More frequent episodes of physical and emotional bullying in fifth grade were associated with higher odds of depression by seventh grade, which was in turn linked to greater likelihood of substance use later in adolescence, the study found.

"We drew on the self-medication hypothesis when trying to understand why peer victimization may lead to substance use over time," said lead study author Valerie Earnshaw, a human development and family studies researcher at the University of Delaware in Newark.

"This suggests that people use substances to try to relieve painful feelings or control their emotions," Earnshaw said by email. "So, youth who are bullied feel bad, or experience depressive symptoms, and then may use substances to try to feel better."

The U.S. Drug Enforcement Administration and more than 4,200 of its law enforcement and community partners collected more unused prescription drugs than at any of the 12 previous National Prescription Drug Take Back Day events.

On Saturday, April 29, the event brought in 900,386 pounds (450 tons) at close to 5,500 sites across the nation. Marking the 13th National Prescription Take Back Day since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.

The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue. According to the 2015 National Survey on Drug Use and Health, 6.4 million Americans abused controlled prescription drugs. The study shows that a majority of abused prescription drugs were obtained from family and friends, often from the home medicine cabinet. The DEA’s Take Back Day events provide an opportunity for Americans to prevent drug addiction and overdose deaths.

"Too often, unused prescription drugs find their way into the wrong hands. That's dangerous and often tragic,” said Acting DEA Administrator Chuck Rosenberg. “That's why it was great to see thousands of folks from across the country clean out their medicine cabinets and turn in - safely and anonymously - a record amount of prescription drugs."

DEA’s next National Prescription Take Back Day is Saturday, October 28.

The Long Island Council on Alcoholism and Drug Dependence, Inc. (LICADD), Long Island's premier provider of substance abuse services and prevention programs, is pleased to announce the installation of a beautiful hand-crafted Legacy Tree at LICADD headquarters in Westbury, NY. LICADD is also a NCADD Affiliate.

A magnificent hand-crafted Living Legacy Tree now adorns the LICADD Executive Offices in Westbury, N.Y. The tree was a brainchild of LICADD staff to honor and memorialize those lost and pay tribute to those dedicated to the field of substance abuse and recovery. Championed by LICADD Board Member, Father Philip Eichner of Kellenberg Memorial High School (KMHS), the tree was designed and created by artisan, Frederick H. Weber of Weber Woods with assistance from the KMHS carpentry department.

The striking Living Legacy Tree was crafted using over fifteen varieties of wood from the United States, Africa and South America, including Cherry, White Oak, Padouk and Purpleheart. The result is a mosaic-like pattern and evokes the feeling of many coming together as one - those who have lost their battle and those who continue the work of recovery and support. The visual message is powerful.

The Living Legacy Tree will feature the tribute: "In special recognition of those who have been touched by addiction." Donors' names or the name of a loved one, friend or relative, will be engraved and placed on the Tree. LICADD is committed to recognizing every contributor of $1,000 or more on the tree. The generosity of donors to the Legacy Tree will go toward funding both Chemical Dependency Interventions for families in the throes of addiction and the Student Assistance Program (SAP) that provides needed prevention education for students in grades K-12. 100% of the proceeds will go directly to LICADD programming to help those challenged with the ravages of addiction and their families. Donors who have made donations of less than $1,000 are invited to consider increasing their gift to participate in this special program.

Over sixty years ago, LICADD founder, R. Brinkley Smithers, surrounded himself with advocates in the medical and spiritual community as well as generous supporters to begin a national movement towards recovery. Today, LICADD is helping more families than ever before. A donation in memory of, in honor of or a tribute to someone is a thoughtful way to recognize a special person in your life. Tax-deductible donations will help others who are suffering while supporting LICADD's mission to provide help and hope for individuals and families consumed by the disease of alcoholism and drug dependence.

The nation’s opioid epidemic is causing some medical examiners to skip some autopsies because of a lack of staff, The Wall Street Journal reports.

The shortage of medical examiners is greatest in areas including New England and the Rust Belt, where overdose deaths from heroin and fentanyl have dramatically increased. “It’s a problem for every area of our office, from transporting bodies to doing autopsies to toxicology testing,” said James Gill, Chief Medical Examiner in Connecticut.

The National Association of Medical Examiners recommends autopsies for all overdoses. The group advises pathologists to perform no more than 250 autopsies annually, to avoid exhaustion and mistakes. In many areas hard-hit by the opioid epidemic, pathologists perform an average of 325 autopsies a year.

On April 25th BRiDGES, the Madison County Council on Alcoholism & Substance Abuse, Inc., and a NCADD Affiliate celebrated its 30th Anniversary with current and former Board Members, current and former staff (some pictured above), and a crowd of other community partners.

While attendees were talking together, sharing stories and updates, a slide show highlighting current programs and ones from the past played on a screen. The slide show was illustrative of how in thirty years some things have changed significantly while some issues have remained constant- like the struggle of addiction and the promise of recovery.

The keynote speaker, Christine Fix, was engaging and spirited in her message. Ms. Fix has spent her professional career in both the political world and the world of human services. Among other things, she talked about how the stigma attached to HIV/AIDS back in the early 90’s when she was traveling the counties providing education was similar to the stigma with addiction and mental health issues.

Ms. Fix stressed the importance of being clear and honest in our communication with young people, in particular, and how compassion and empathy are critical to being true helpers. Her message was delivered with humor and wisdom.

BRiDGES has remained true to its original mission of providing alcohol, tobacco and other drug prevention and education while expanding to include problem gambling and suicide prevention. The focus includes assisting the individual as well as looking at how a community’s norms, laws and regulations affect public health.

The Drug Enforcement Administration (DEA) is reporting a strain of fentanyl, resistant to the opioid overdose antidote naloxone, has caused several overdose deaths in Western Pennsylvania.

The strain of fentanyl resistant to naloxone is called acryl fentanyl, KDKA reports. “If acryl fentanyl is introduced into the population, it can have devastating effects,” said DEA

Special Agent in Charge, David Battiste. The DEA said acryl fentanyl is being manufactured overseas, smuggled into the United States, and sold mainly on the dark web. It comes in powder form, and looks similar to fentanyl.

“These are dangerous drugs. They’re cut by these dealers who don’t care about anything other than making a profit. It can be cut with anything,” Battiste said.

Opioid abuse has decreased among Medicare recipients in states that require doctors to check patients’ drug history in a prescription drug monitoring database, according to a new study.

While all states have databases to track opioid prescriptions, not all states require healthcare providers to check the databases before writing prescriptions for patients, UPI reports.

The new study found states that required doctors to check the database had a decrease in the number of Medicare recipients who received more than a seven-month supply of opioids in a six-month period.

These states also had a decrease in patients who filled a prescription before the previous one had finished. “Doctor-shopping” in these states decreased by 8 percent in Medicare patients who used opioids.

The states with the largest reductions in rates of opioid abuse had the strictest laws. For example, New York requires doctors to check a patient’s opioid history at each visit, the researchers note in the National Bureau of Economic Research.

A Colorado children’s hospital reports visits by teens to its emergency department and satellite urgent care centers more than quadrupled after the state legalized marijuana, a new study finds.

Researchers examined the hospital’s records for 13- to 21-year-olds between 2005 and 2015.

Colorado legalized medical marijuana in 2010 and recreational marijuana in 2014.

The annual number of visits related to marijuana or involving a positive marijuana urine drug screen more than quadrupled, from 146 in 2005 to 639 in 2014, the researchers found.

They will present their research at the 2017 Pediatric Academic Societies Meeting in San Francisco.

A new combination of opioids, known as “Gray Death,” is being blamed for deaths in Alabama, Georgia and Ohio, the Associated Press reports.

The combination includes heroin, fentanyl, carfentanil and a synthetic opioid called U-47700.

“Gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis,” said Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation. Kilcrease said people using the drug are not aware of its ingredients or their concentrations. Simply touching the powder can put a person at risk, she added.

Gray death looks like concrete mix. It varies in consistency from a hard, chunky material to a fine powder, the article notes. It is much more potent than heroin, according to the Gulf Coast High Intensity Drug Trafficking Area. People use the drug by injecting, swallowing, smoking or snorting it.

The opioid epidemic has led to the deadliest drug crisis in US history – even deadlier than the crack epidemic of the 1980s and 1990s. Drug overdoses now cause more deaths than gun violence and car crashes. They even caused more deaths in 2015 than HIV/AIDS did at the height of the epidemic in 1995.

A new study suggests that we may be underestimating the death toll of the opioid epidemic and current drug crisis. The study, conducted by researchers at the Centers for Disease Control and Prevention (CDC), looked at 1,676 deaths in Minnesota’s Unexplained Death surveillance system (UNEX) from 2006 – 2015. The system is meant to refer cases with no clear cause of death to further testing and analysis. In total, 59 of the UNEX deaths, or about 3.5 percent, were linked to opioids. But more than half of these opioid-linked deaths didn’t show up in Minnesota’s official total for opioid related deaths.

It is unclear how widespread of a problem this is in other death surveillance systems and other states, but the study’s findings suggest that the numbers we have so far for opioid deaths are at best a minimum.

Typically, deaths are marked by local coroners or medical examiners through a system; if the medical examiner marks a death as immediately caused by an opioid overdose, the death is eventually added to the US’s total for opioid overdose deaths. But there is no national standard for what counts as an opioid overdose, so it’s left to local medical officials to decide whether a death was caused by an overdose or not. This can get surprisingly tricky – particularly in cases involving multiple conditions or for cases in which someone’s death seemed to be immediately caused by one condition, but that condition had a separate underlying medical issue behind it.

For example, opioids are believed to increase the risk of pneumonia. But if a medical examiner sees that a person died of pneumonia, they might mark the death as caused by pneumonia, even if the opioids were the underlying cause for the death.

The McShin Foundation hosted its 13th Annual Spring Awards Banquet at the Virginia War Memorial to celebrate the past year of success. John Adams, Republican nominee for Attorney General of Virginia, was the keynote speaker.

As an affiliate of The National Council on Alcoholism and Drug Dependence, Chesterfield County Sheriff Karl Leonard was presented with the Bronze Key Award for his determination to combat the heroin epidemic and his success with the Heroin Addiction Recovery Program (HARP).

In addition to the Bronze Key Award, community awards were given as well. The awardees are as follows:

Main story image features Sheriff Karl Leonard and McShin President John Shinholser. Pictured above are McShin President John Shinholser, McShin CEO Honesty Liller, Henrico Commonwealth Attorney Shannon Taylor, Congressman Dave BratIn addition to Sheriff Karl Leonard and John Adams, other event attendees included Virginia House of Delegates members Dave Brat and Betsy Carr, Caroline County Commonwealth Attorney John Mahoney, Henrico Commonwealth Attorney Shannon Taylor and Chesterfield County Captain James Pritchett.

The McShin Foundation was founded in 2004 and is Virginia’s leading non-profit, full-service Recovery Community Organization (RCO), committed to serving individuals and families in their fight against Substance Use Disorders.

Several years ago, a colleague asked me what I thought about his “four months and done” buprenorphine treatment program. He believed that virtually all people with opioid use disorders could “learn” how to stay drug-free in that time.

All his patients were titrated to an effective dose in the first weeks, maintained for the first two months, and tapered off over the next two months. He offered anecdotal evidence of the success of his approach, but it became clear that most of those he tapered simply disappeared. He had no meaningful data, even in the short term. I asked him whether he took a trauma history when his patients initially presented, and he had no idea what I was talking about.

I am an individual in recovery as well as a treatment professional, and I have treated tens of thousands of patients with addiction. Most of those patients, when questioned, had a history of serious early-life trauma, or such significant neglect that it was the equivalent of trauma.

Yet, as little training as I received in medical school and residency about substance use disorders, even less was provided on the role of trauma. This was true in my addiction fellowship as well.

I have reviewed scores of intake forms for treatment programs, and only in the last several years have I seen questions about traumatic experiences routinely asked.   I was involved in an audit of an internal medicine practice that was concerned about the overprescribing of opioids and benzodiazepines by “outlier” physicians. They had an excellent electronic medical record with a section on early-life trauma. Out of hundreds of charts reviewed, however, this section was not completed for even one patient.

Most healthcare professionals promote the well-being of one individual at a time. Those who work in public health, however, promote the well-being of groups of individuals. The U.S. Public Health Service and the rest of the U.S. Department of Health and Human Services (HHS) promote the well-being of overlapping groups that taken altogether represent the entire population of the United States.

Individuals do not always collaborate with healthcare providers. For example, only about 50 percent of patients with chronic diseases take their medications as prescribed. It remains to be seen whether the population of the United States will collaborate with HHS’s current initiative to protect the well-being of the Nation.

In November 2016, HHS released FACING ADDICTION IN AMERICA: The Surgeon General’s Report on Alcohol, Drugs, and Health. Reports from the Surgeon General are not routine government publications. They address serious threats to the health of the population (e.g., HIV/AIDS) to raise awareness, provide scientific background, and generate interventions to reduce the danger. The reduction in American adults who smoke from 42 percent in 1960 to 18 percent in 2012 is due in part to a series of Surgeon General’s reports on smoking and health that began in 1964.

FACING ADDICTION IN AMERICA conveys authoritative information in accessible language and lists abundant references for readers who desire more detail. The report presents persuasive statistics for anyone who may doubt that alcohol and drugs put our health at risk. For example, “In 2015, 66.7 million people in the United States reported binge drinking in the past month and 27.1 million people were current users of illicit drugs or misused prescription drugs.” (p 1-1) And, “Substance misuse and substance use disorders… [cost] more than $400 billion annually in crime, health, and lost productivity.” (p 1-2)

 Scientific background in this report encompasses not only a neurobiological explanation of why substance-using behaviors are so difficult to change, but also research that shows which prevention and treatment methods are most likely to succeed. Health services research supports the integration of substance use prevention and treatment with general healthcare services, which is in keeping with Surgeon General Vivek Murthy’s call for “a cultural shift in how we think about addiction…addiction is not a character flaw—it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.” (Preface)

Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterized by inattention, disorganization, and/or hyperactivity-impulsivity that consistently disrupt a person’s activities and relationships. According to DSM-5 (p 32), “Inattention and disorganization entail inabil­ity to stay on task, seeming not to listen, and losing materials, at levels that are inconsistent with age or developmental level. Hyperactivity-impulsivity entails overactivity, fidgeting, in­ability to stay seated, intruding into other people's activities, and inability to wait—symptoms that are excessive for age or developmental level.”

This conception of ADHD is relatively new, although literature of the past 200 years depicts individuals who might meet current criteria for ADHD. In 1844, for example, German psychiatrist Heinrich Hoffman created a children’s story about Fidgety Phil (“Zappelphilipp”). In 1902, English pediatrician George Still described children with an “exaggeration of excitability” whose behavior was so disruptive that he considered them to have a defect of moral control. In 1937, Rhode Island physician Charles Bradley, while attempting to treat headaches that followed pneumoencephalograms, discovered that the stimulant benzedrine improved learning and behavior in hyperactive children. The modern understanding of ADHD began to emerge with descriptions of “minimal brain dysfunction” in the 1960s and 1970s. (Lange et al. 2010)

Estimates vary, but about 10 percent of children and 4 percent of adults may meet criteria for ADHD. ADHD in childhood is a risk factor for early substance use and adult substance use disorder. Up to 30 percent of adults with ADHD are estimated to have a substance use disorder. The common comorbidity of ADHD and addiction makes it important for clinicians who treat ADHD in adults to assess patients comprehensively—even though their patients don’t like to wait.

When assessing adults for ADHD, symptoms may be misleading and accurate diagnoses elusive. Family histories of ADHD, other mental illnesses, and addiction are relevant. So is evidence of when patients’ ADHD symptoms began, since rigorous diagnosis of adult ADHD requires that several symptoms were present before age 12. Old report cards help, or talking with individuals who were adults when they knew the patient as a child.

ADHD, bipolar disorder, and addiction mimic one another, yet any two—or all three—conditions may co-occur in one individual. Hyperactivity and impulsivity, for example, suggest both ADHD and bipolar disorder. (Bipolar disorder is favored when the behaviors are episodic and accompanied by elevated mood.) Inability to wait (“I want what I want when I want it”) can be a manifestation of any of the three conditions.

Once again, the holiday season is upon us.  The Addiction Medicine Update, Hope & Caution—for Happy Holidays,  originally published in November 2012, receives thousands of views, telling us that it strikes a chord in readers.  With that in mind, we are reprinting it this year.

 As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all.

 Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such as shopping, travel, cooking, social gatherings, and so forth—or the stress of not having any of those to keep up with. Strong feelings also arise from our past. And our past is more present at the holidays, especially past family life. Cherished holiday memories hurt when special people are no longer with us. Painful holiday memories hurt even more when the holidays arrive, whether the people involved are still with us or not.

As a general precaution, reduce holiday stress by talking about your feelings with an empathic person and by letting go of unrealistic expectations. Specific precautions against hazardous holiday substance use depend partly on whether a person is in recovery or not. Individuals in recovery want to abstain from all mood-changing substances. But an occasional drinker may simply wish to limit her or his alcohol consumption enough to avoid disinhibited behavior (at an office party, for instance) or driving under the influence.

Motor vehicle crashes caused by drunk or drugged-driving end too many lives and damage countless others. For that matter, even DUI offenses can have life-changing consequences. The statistics are hard to ignore.

Efforts to create electronic cigarettes date from the 1930s. The first commercially successful devices were produced in China in 2003. Electronic cigarettes were introduced to Europe in 2006 and America in 2007. In the United States, regulation of these and similar products became much more stringent in 2016.

The Family Smoking Prevention and Tobacco Control Act became law June 22, 2009, and gave the U. S. Food and Drug Administration (FDA) regulatory authority over the manufacture, distribution, and marketing of tobacco products. The FDA has deemed electronic nicotine delivery systems (ENDS) to be tobacco products and issued regulations that affect not only electronic cigarettes (e-cigarettes) but also other devices that produce an inhalable cloud containing atomized nicotine. Initial stipulations took effect August 8, 2016. Additional requirements are scheduled for 2018.

Some ENDS resemble conventional means for smoking tobacco, such as e-cigarettes, e-cigars, electronic pipes, and electronic waterpipes. There are also hand-held personal vaporizers that look like oversized pens or electronic boxes with high-tech tubes on one end. Usual components of these devices include a cartridge or reservoir (“tank”) to hold a solution containing nicotine, the solution itself (e-liquid or “juice”), a heating coil to vaporize the solution, a wicking mechanism to bring solution to the coil, a battery to power the coil, and a mechanism to turn the power on and off. The user briefly activates the unit and inhales nicotine-containing vapor as it is generated.

Most e-liquids contain nicotine extracted from tobacco. Synthetic nicotine is sometimes used, but it’s more expensive and unlikely to avoid FDA regulation despite not being a tobacco product. E-liquids listing no nicotine content are still subject to regulation.

E-liquids are manufactured with a range of nicotine concentrations to accommodate different consumer preferences and methods of use. A light-to-moderate strength e-liquid, for example, contains 6 milligrams of nicotine per milliliter of solution. The bulk of e-liquids (80 to 90 percent or more) are either propylene glycol (PG), vegetable glycerine (VG), or a blend of the two. The rest is nicotine, flavoring, and perhaps added distilled water. PG and VG are common food additives considered safe for humans to eat. Their safety when inhaled has not been established.

Imagine two stalwart fans of professional wrestling locked in debate. One holds that the wrestlers are athletes. The other argues that they are not athletes but entertainers, performing in a variety of theater. Both fans are thoughtful and persuasive. Notice that their disagreement is not about the physical attributes of professional wrestlers, or about what they do inside and outside the ring. Their disagreement is about how to name, or classify, the group of people who engage in professional wrestling.

Professional wrestlers are what they are and do what they do.  Naming and classifying, however, are conceptual, and therefore somewhat arbitrary.  This arbitrariness is no revelation.  As Shakespeare’s Juliet said: 

What's in a name? that which we call a rose
By any other name would smell as sweet

But when debates about classification heat up, people often think and act as if the issues are absolute rather than arbitrary, especially if debaters have a personal or professional stake in one point of view.  Or just like to debate.

Diseases are classifications. They designate groups of people with health problems whose problems are not identical but are so similar in their biological mechanisms and responses to treatments that, when individuals are accurately diagnosed with a disease, they can benefit from knowledge of causes and treatments drawn from research on others like them.

Healthcare providers are charged with helping individuals who come to them with physical, emotional, and behavioral problems.  As they prepare to help, providers usually follow a routine—they get to know the person and their problem(s), examine the person, and, frequently, obtain additional information such as blood tests or x-rays.  Prior to recommending specific treatment, providers “make a diagnosis,” which then guides providers and patients to treatment options relevant to the problem at hand.

    Diagnoses are commonly expressed in terms of the manifestations of a problem (hives, for example) or the cause of a problem (for example, penicillin allergy).  Clinicians sometimes make diagnoses quickly and confidently or, at other times, slowly and tentatively.  They may entertain several candidate diagnoses, “the differential diagnosis,” before settling on a provisional, or working, diagnosis.

    A biology professor periodically reminded his students, “Variation is the law of life!”  Clinicians can testify to this.  No two patients—or the problems they present—are identical, which means that when clinicians make the same diagnosis in two individuals, they are not saying the two people have exactly the same problem.  They are saying that the problems of the two patients have important characteristics in common, often at a cellular level, and that both patients are likely to respond to similar treatments.

    For example, the thick, scratched blotches on the neck of the woman under stress do not look precisely like the raised, itchy patches that appeared on the arm of the young man after a dose of penicillin.  But if clinicians diagnose hives in both cases, both patients will likely obtain relief if they accept treatment with an antihistamine.

The two people and two skin eruptions are not identical, but the underlying cellular processes and responses to medication are so much alike that both individuals, with different but similar problems, benefit from receiving the same diagnosis—and ensuing treatment guided by that diagnosis.

Crimes related to illegal drugs often make headlines—seizures of substances, arrests of drug lords and dealers, and laws broken to support habits. Crimes related to alcohol are also in the news, but we may have to turn to police logs to find them. Yet alcohol is implicated in 56.6 percent of incarcerations in America, which includes 57.7 percent of inmates who committed a violent crime such as murder, forcible rape, robbery, or aggravated assault. Alcohol has more links to crime than any other single drug. (Behind Bars II: Substance Abuse and America’s Prison Population).

Consumption of alcohol does not in itself cause crime. But alcohol impairs coordination and judgment, which makes driving dangerous, especially for young, inexperienced drinkers. Estimates vary, but some authorities report alcohol-impaired driving contributes to more than 50 percent of motor vehicle crashes and more than 50 percent of highway fatalities. Driving under the influence (DUI) of alcohol is against the law for good reason.

About one-third of individuals arrested or convicted of drunk driving are repeat offenders. Of course a calamity may occur the very first time someone drinks and drives, but over 80 percent of DUI offenders are estimated to be more than casual users of alcohol and/or other drugs. Screening, intervention, and treatment of offenders reduce future risks to them and to others on the road.

Again, alcohol consumption does not in itself cause crime. But alcohol is disinhibiting, which means individuals under the influence of alcohol are more likely to do things they would not otherwise do. Alcohol is also addictive, which means some individuals will do things they would not otherwise do—repeatedly.

Following incarceration for addiction-related crimes, recidivism to substance use and to crime is probable unless those released engage in addiction recovery. A study that found only eleven percent of inmates with substance use disorders received relevant treatment during incarceration also reported that each former inmate who remains sober, crime-free, and employed will save the nation $91,000 per year.

In the December, 2015, edition of this Science Update we responded to a recent article appearing in The Atlantic.1 Its author, Gabrielle Glaser, claimed that AA and its 12-step programs lack scientific foundation, asserting that “nothing about the 12-step approach draws on modern science …..” We presented the data supporting the opposite case, citing several published scientific reports that she did not mention. In the present installment, we review the basis on which she asserts her claim that the success rate of AA is only 5-8 percent. Relying on a single secondary source2 for this claim, Ms. Glaser writes, “That is just a rough estimate [of AA’s effectiveness], but it’s the most precise one I’ve been able to find.” Because flawed science can cause harm, we offer a critique of the scientific basis she cites for her claim.

At the outset, Ms. Glaser’s source presents neither new data nor any of the studies we have cited that report first-hand observations targeting AA’s effectiveness. Rather, her source itself refers only to data gathered by others, mostly for purposes other than judging AA’s effectiveness. This forms the basis for three separate, questionable, calculations that arrive at the 5-8% figure. In each calculation, all dropouts—counted after as few as one AA meeting—are treated as AA failures. By analogy, this seems to us like counting insulin for diabetes as a failed treatment after only one insulin injection. In our view, looking at outcome rates for active AA members offers a more accurate estimate of AA’s effectiveness. But let us examine the 5-8% figure.

In the first calculation, The Atlantic article’s source multiplies a 25% AA attendance figure by a 22% abstinence figure to arrive at a 5.5% estimate of AA’s effectiveness. Where do these figures come from? Another second-hand source3 that also cites the work of others: two publications from the Rand Corporation that examined, among other things, attempts at controlled drinking and offered little focus on AA’s effectiveness.  At 4-year follow-up the Rand group identified patients with at least one year abstinence who had been regular members of AA 18 months after the start of treatment: 42% of the regular AA members were abstinent, not the “calculated” 5.5% figure. The Rand Reports are public and both Ms. Glaser and The Atlantic editors could have read them rather than rely on a third-hand source.

The second calculation repeats the 25% AA attendance rate multiplying it by another “abstinence rate” of 21%. This rate is taken from an article by Harris and colleagues4 who surveyed 150 alcoholics entering a residential treatment program because they were not abstinent. Based on the reports of those entering, the study concluded that the sample did “not represent ‘typical’ AA recruits.” Despite this, the third-hand calculation method uses two percentages lifted out of context from the Harris study—16% who had reported ever taking at least one step of the 12-step program divided by 75% who had ever attended an AA meeting—and gives a figure of 21%. This calculation has no bearing on abstinence from alcohol, nor does it apply to AA participation over time. Ms. Glaser and her editors at The Atlantic might have looked into these available data in greater detail in the interest of accuracy.

The third calculation applies the 21% “abstinence” rate claimed above to an alleged 40% sustained abstinence rate noted in yet another report, a paper by Fiorentine (1999).5 Ms. Glaser’s source quotes Fiorentine as writing “’approximately 40 percent of individuals categorized as having continued active participation in AA maintained high rates of abstinence.’” Our reading of Fiorentine’s paper fails to find any such statement. Curiously, Fiorentine reports on a study of drug addicted individuals, only a portion of whom were identified as having an alcohol problem, to offer an estimate of the success of AA. That being said, the data Fiorentine presents is as follows: 77.7% of individuals who attended AA 12-step meetings at least weekly reported being free of drug use for 6 months prior to a 24-month follow-up, a finding corroborated by urinalysis at the time of the interview, and 74.8 % reported being free of alcohol use during the same time period. These figures suggest that a high observed abstinence rate is associated with regular participation in AA. Neither The Atlantic editors nor Ms. Glaser indicate an awareness of these factual discrepancies.

Alcoholics Anonymous is the most widely used treatment for alcoholism in the world, yet it continues to come under attack by popular media ignorant of the science behind its success. A recent high profile attack appeared in the April 2015 issue of The Atlantic, in the form of an article by Gabrielle Glaser titled, “The Irrationality of Alcoholics Anonymous.”   In this article, Ms. Glaser boldly states that 12-step programs lack a scientific foundation and that most professional treatment programs fail to provide scientifically supported treatment, largely because they are 12-step oriented. Ms. Glaser writes, “The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.”

Contrary to Ms. Glaser’s sweeping statements about the lack of science concerning AA, a significant body of research has been conducted on this organization and its impact on drinking and other variables. For example, three colleagues and one of the authors (CDE) published a meta-analysis of the scientific literature on Alcoholics Anonymous in 1993, incorporating a grand total of 107 data sets in the overall analysis. The findings of this meta-analysis were correlational due to the fact that most of the available data at that time were correlational in nature. These results showed positive correlations between AA membership and drinking outcome, as well as other outcome measures such as psychological health. Of course, correlation does not mean causation. Thus, the data at that time offered promising evidence for the effectiveness of AA but could not support the conclusion that involvement in AA causes better outcomes with respect to drinking and other variables.

But science moves on. A more recent publication (Vaillant 2012) offers yet another example of high-quality research on AA. Dr. George Vaillant of Harvard University reported his analysis of two male cohorts (Harvard undergraduates and inner-city Boston youth) who were studied in depth for 60 years (from the time they were 20 until they were 80)! Over the course of the study, 39 men in the college cohort and 101 men in the inner city cohort were identified as alcoholics. When the lives of these men were studied at age 80 (some of the men were deceased but information was obtained on the status of these individuals at the time of their death), 9 of the college cohort who became alcoholic had been abstinent an average of 15 years and 57 of the inner city cohort alcoholics had been abstinent for an average of 16 years. The remaining men in both cohorts had been abstinent an average of only 1 year over the course of their lives. It is important to note that the duration of active alcoholism did not differ between those who developed long-term abstinence and those who did not. Of relevance to the present article is that those who achieved long-term abstinence in the college cohort attended an average of 137 AA meetings compared to just 2 meetings among those with only short-term abstinence, while those in the inner-city cohort who maintained long-term abstinence attended 143 AA meetings, on average, compared to just 8 meetings among those who did not acquire long-term abstinence. In answer to the question, “is recovery through AA the exception or the rule?” Dr. Vaillant concludes, “In both cohorts, the men who were stably abstinent attended about twenty times as many AA meetings as the chronically alcoholic.” These data, while remarkable, are, as with the Emrick et al. findings, plagued with the issue of self-selection bias. It could be that individuals who go to AA are more motivated to stop drinking than those who don’t become AA involved, with the result that AA members have better drinking outcome, not because they are participating in AA, but rather because they were a more motivated group of alcoholics to begin with. The possibility of self-selection bias thus prevents Vaillant’s (as well as Emrick et al.’s) data from offering evidence that AA involvement causes better drinking outcome.

Fortunately, scientific investigations of AA have continued to advance. From 1993 to 2010, five randomized clinical trials were conducted in which AA Facilitation Interventions (AAFI) was one of the treatments studied. A general finding of these studies is that patients who received some form of AAFI had better drinking outcome than patients receiving alternative treatment(s), with the better outcome appearing to be mediated by AA involvement. Unfortunately, even with these and other clinical trials on AA, selection bias continues to be a thorny problem. That is, some patients assigned to AAFIs do not become involved in AA and patients assigned to alternative interventions become involved despite their being in treatment that does not encourage participation in AA. Given this situation (known as crossover) if AA participation in these studies is found to lead to better outcome than non-participation, we cannot be sure that involvement in AA per se is causing the better outcome. This is because the better outcome seen in AA members may be due, at least in part, to their having stronger motivation to recover from alcohol problems than do non-AA participants. Thus, selection bias is not fully eliminated even when using a randomized clinical trial research design.

In order to address this nagging issue pertaining to the aforementioned randomized clinical trials, Dr. Keith Humphreys, a professor at Stanford University, and colleagues employed an innovative statistical analytic method that controls for selection bias--a procedure called instrumental variables modelling. This analysis enabled the researchers to determine if increased AA involvement due to AAFIs made a difference in drinking outcomes when the role of the participants’ motivation to recover from alcoholism was taken out of the comparison between patients receiving AAFIs and those getting alternative treatments. The results of this study were published in the prestigious peer-reviewed journal, Alcoholism: Clinical and Experimental Research in November of 2014. Humphreys et al. used the number of days abstinent as the outcome measure. The main finding was that at both three and 15-month follow-ups, those who increased AA attendance due to the effects of AAFIs (not personal motivation) had significantly more days of abstinence than those getting alternative treatments who did not go to AA.   To clarify, involvement in AA was the variable that led to better drinking outcome, not receipt of AAFIs per se. The scientists conclude, “For most individuals seeking help for alcohol problems, increasing AA attendance leads to short- and long-term decreases in alcohol consumptions that cannot be attributed to self-selection.”