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Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012

July 15, 2014 Comments off

Decline in Drug Overdose Deaths After State Policy Changes — Florida, 2010–2012
Source: Morbidity and Mortality Weekly Report (CDC)

During 2003–2009, the number of deaths caused by drug overdose in Florida increased 61.0%, from 1,804 to 2,905, with especially large increases in deaths caused by the opioid pain reliever oxycodone and the benzodiazepine alprazolam (1). In response, Florida implemented various laws and enforcement actions as part of a comprehensive effort to reverse the trend. This report describes changes in overdose deaths for prescription and illicit drugs and changes in the prescribing of drugs frequently associated with these deaths in Florida after these policy changes. During 2010–2012, the number of drug overdose deaths decreased 16.7%, from 3,201 to 2,666, and the deaths per 100,000 persons decreased 17.7%, from 17.0 to 14.0. Death rates for prescription drugs overall decreased 23.2%, from 14.5 to 11.1 per 100,000 persons. The decline in the overdose deaths from oxycodone (52.1%) exceeded the decline for other opioid pain relievers, and the decline in deaths for alprazolam (35.6%) exceeded the decline for other benzodiazepines. Similar declines occurred in prescribing rates for these drugs during this period. The temporal association between the legislative and enforcement actions and the substantial declines in prescribing and overdose deaths, especially for drugs favored by pain clinics, suggests that the initiatives in Florida reduced prescription drug overdose fatalities.

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No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration Department of Veterans Affairs

July 13, 2014 Comments off

No Time to Waste: Evidence-Based Treatment for Drug Dependence at the United States Veterans Administration Department of Veterans Affairs
Source: Human Rights Watch

The 39-page report states that more than one million US veterans take prescription opioids for pain, and nearly half of them use the drugs “chronically,” or beyond 90 days. Alcohol and drug dependence is strongly associated with homelessness and mental health conditions including post-traumatic stress syndrome and depression, psychological conditions that affect 40 percent of Iraq and Afghanistan veterans in VA care. Drugs or alcohol are involved in 1 of 3 Army suicides, and the VA estimates that 22 veterans commit suicide each day.

Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012

July 3, 2014 Comments off

Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Overprescribing of opioid pain relievers (OPR) can result in multiple adverse health outcomes, including fatal overdoses. Interstate variation in rates of prescribing OPR and other prescription drugs prone to abuse, such as benzodiazepines, might indicate areas where prescribing patterns need further evaluation.

Methods:
CDC analyzed a commercial database (IMS Health) to assess the potential for improved prescribing of OPR and other drugs. CDC calculated state rates and measures of variation for OPR, long-acting/extended-release (LA/ER) OPR, high-dose OPR, and benzodiazepines.
Results: In 2012, prescribers wrote 82.5 OPR and 37.6 benzodiazepine prescriptions per 100 persons in the United States. State rates varied 2.7-fold for OPR and 3.7-fold for benzodiazepines. For both OPR and benzodiazepines, rates were higher in the South census region, and three Southern states were two or more standard deviations above the mean. Rates for LA/ER and high-dose OPR were highest in the Northeast. Rates varied 22-fold for one type of OPR, oxymorphone.

Conclusions:
Factors accounting for the regional variation are unknown. Such wide variations are unlikely to be attributable to underlying differences in the health status of the population. High rates indicate the need to identify prescribing practices that might not appropriately balance pain relief and patient safety.

Implications for Public Health:
State policy makers might reduce the harms associated with abuse of prescription drugs by implementing changes that will make the prescribing of these drugs more cautious and more consistent with clinical recommendations.

UN World Drug Report 2014

July 2, 2014 Comments off

World Drug Report 2014
Source: United Nations
From press release (PDF):

Drug use prevalence is stable around the world, according to the 2014 World Drug Report of the United Nations Office on Drugs and Crime (UNODC), with around 243 million individuals, or 5 per cent of the world’s population aged 15- 64 having used an illicit drug in 2012. Problem drug users meanwhile numbered about 27 million, roughly 0.6 per cent of the world’s adult population, or 1 in every 200 people.

Youth Risk Behavior Surveillance—United States, 2013

June 13, 2014 Comments off

Youth Risk Behavior Surveillance—United States, 2013 (PDF)
Source: Morbidity and Mortality Weekly Report (CDC)
From press release:

Cigarette smoking rates among high school students have dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, according to the 2013 results released today by the Centers for Disease Control and Prevention.

By achieving a teen smoking rate of 15.7 percent, the United States has met its national Healthy People 2020External Web Site Icon objective of reducing adolescent cigarette use to 16 percent or less.

Despite this progress, reducing overall tobacco use remains a significant challenge. For example, other national surveys show increases in hookah and e-cigarette use. In the YRBS, no change in smokeless tobacco use was observed among adolescents since 1999, and the decline in cigar use has slowed in recent years, with cigar use now at 23 percent among male high school seniors.

CRS — Prescription Drug Abuse

June 12, 2014 Comments off

Prescription Drug Abuse (PDF)
Source: Congressional Research Service (via National Association of Chain Drug Stores)

An estimated 6.8 million individuals currently abuse prescription drugs in the United States. Unlike policy on street drugs, federal policy on prescription drug abuse is complicated by the need to maintain access to prescription controlled substances (PCS) for legitimate medical use. The federal government has several roles in reducing prescription drug abuse.

European Drug Report 2014: Trends and developments

June 2, 2014 Comments off

European Drug Report 2014: Trends and developments
Source: European Monitoring Centre for Drugs and Drug Addiction

How many new drugs were detected in Europe over the last year? Is cannabis getting stronger? How many Europeans have ever used an illicit drug? What are the latest drug policy developments in the region? These are just some of the questions explored in the European Drug Report: Trends and developments. This report provides a top-level overview of the long-term drug-related trends and developments at European level, while homing in on emerging problems in specific countries. Such a perspective is valuable, as it allows differing national experiences to be understood within the broader European context.

Healthcare Inspection – VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy

May 29, 2014 Comments off

Healthcare Inspection – VA Patterns of Dispensing Take-Home Opioids and Monitoring Patients on Opioid Therapy
Source: U.S. Department of Veterans Affairs, Office of Inspector General

As requested by the Senate Committee on Veterans’ Affairs, the VA Office of Inspector General assessed the provision of VA outpatient (take-home) opioids and monitoring of patients on opioid therapy. The population consisted of nearly half a million patients who were not receiving hospice/palliative care and who filled at least 1 oral or transdermal opioid prescription from VA for self-administration at home in FY 2012. The average and the median patient age was 59.4 and 61, respectively, and nearly 94 percent of them had been diagnosed with either pain or mental health issues and 58.4 percent with both. We determined that take-home benzodiazepines were dispensed to 7.4 percent of the study population, and 71 percent were dispensed concurrently with opioids. Take-home acetaminophens were given to 92.3 percent of the patients, and 2.0 percent of them were given an average daily dose that exceeded the maximum recommended daily dose of 4 grams. We found that 38.8 percent of the patients received medication management or pharmacy reconciliation. We determined that 6.4 percent of the new patients received both a urine drug test (UDT) prior to and a follow-up within 30 days of therapy initiation, that 37.0 percent of the existing opioid patients received both an annual UDT and a follow-up contact within 6 months of each filled opioid prescription, and that 10.5 percent of active substance use patients received both treatment for substance use and a UDT within 90 days of each filled opioid prescription. Even for the subpopulation of 19,724 active substance use patients who were on opioids for more than 90 days in FY 2012, we determined that only 18.8 percent of them received both a substance use disorder treatment in the FY and a UDT for each 90 days on opioids. We made six recommendations.

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

May 7, 2014 Comments off

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement
Source: Annals of Internal Medicine

Description:
Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for illicit drug use.

Methods:
The USPSTF reviewed the evidence on interventions to help adolescents who have never used drugs to remain abstinent and interventions to help adolescents who are using drugs but do not meet criteria for a substance use disorder to reduce or stop their use.

Population:
This recommendation applies to children and adolescents younger than age 18 years who have not been diagnosed with a substance use disorder.

Recommendation:
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. (I statement)

Report Recommends Insurers Use Prescription Monitoring Data to Reduce Opioid Abuse, Deaths

April 28, 2014 Comments off

Report Recommends Insurers Use Prescription Monitoring Data to Reduce Opioid Abuse, Deaths (PDF)
Source: Prescription Drug Monitoring Program Center of Excellence at Brandeis University

The Prescription Drug Monitoring Program (PDMP) Center of Excellence at Brandeis University has issued a ground-breaking report recommending that medical insurers use prescription monitoring data to reduce overdoses, deaths and health care costs associated with abuse of opioids and other prescription drugs.

The report describes the proceedings of a December 2012 Washington, DC meeting of over 75 medical insurers, federal agency heads and state PDMP administrators, who explored the value and feasibility of sharing prescription data collected by PDMPs with third party payers.

As detailed in the report, meeting participants agreed that data sharing between PDMPs and third party payers would significantly enhance insurers’ capability to monitor prescribing of opioids and other commonly abused prescription drugs, permitting better detection of inappropriate prescribing and dispensing. Workgroups at the meeting formulated data sharing policies and procedures for consideration by regulatory agencies.

Gender Differences in Primary Substance of Abuse across Age Groups

April 16, 2014 Comments off

Gender Differences in Primary Substance of Abuse across Age Groups
Source: Substance Abuse and Mental Health Services Administration

+ In 2011, about 609,000 of the 1.84 million admissions to substance abuse treatment were female (33.1 percent), and 1.23 million were male (66.9 percent)
+ Compared with their male counterparts, a larger proportion of female admissions aged 12 to 17 reported alcohol as their primary substance of abuse (21.7 vs. 10.5 percent)
+ Marijuana as the primary substance of abuse was less common among female than male admissions aged 12 to 17 (60.8 vs. 80.7 percent) and 18 to 24 (22.1 vs. 33.4 percent)
+ Within the 65 or older age group, the proportion of female admissions reporting primary abuse of prescription pain relievers (e.g., oxycodone) was nearly 3 times that of their male counterparts (7.2 vs. 2.8 percent)

Big Five Personality Traits Reflected in Job Applicants’ Social Media Postings

April 8, 2014 Comments off

Big Five Personality Traits Reflected in Job Applicants’ Social Media Postings
Source: Cyberpsychology, Behavior, and Social Networking

Job applicants and incumbents often use social media for personal communications allowing for direct observation of their social communications “unfiltered” for employer consumption. As such, these data offer a glimpse of employees in settings free from the impression management pressures present during evaluations conducted for applicant screening and research purposes. This study investigated whether job applicants’ (N=175) personality characteristics are reflected in the content of their social media postings. Participant self-reported social media content related to (a) photos and text-based references to alcohol and drug use and (b) criticisms of superiors and peers (so-called “badmouthing” behavior) were compared to traditional personality assessments. Results indicated that extraverted candidates were prone to postings related to alcohol and drugs. Those low in agreeableness were particularly likely to engage in online badmouthing behaviors. Evidence concerning the relationships between conscientiousness and the outcomes of interest was mixed.

FDA approves new hand-held auto-injector to reverse opioid overdose

April 4, 2014 Comments off

FDA approves new hand-held auto-injector to reverse opioid overdose
Source: U.S Food and Drug Administration

The U.S. Food and Drug Administration today approved a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Evzio (naloxone hydrochloride injection) rapidly delivers a single dose of the drug naloxone via a hand-held auto-injector that can be carried in a pocket or stored in a medicine cabinet.

It is intended for the emergency treatment of known or suspected opioid overdose, characterized by decreased breathing or heart rates, or loss of consciousness.

Drug overdose deaths, driven largely by prescription drug overdose deaths, are now the leading cause of injury death in the United States – surpassing motor vehicle crashes. In 2013, the Centers for Disease Control and Prevention reported the number of drug overdose deaths had steadily increased for more than a decade.

Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for overdose. However, existing naloxone drugs require administration via syringe and are most commonly used by trained medical personnel in emergency departments and ambulances.

Hallucinogens and Dissociative Drugs

February 17, 2014 Comments off

Hallucinogens and Dissociative Drugs
Source: National Institute on Drug Abuse

Offers the latest research findings on hallucinogens and dissociative drugs, describing what they are, how they are abused, and basic facts about different drugs within this classification of drugs.

CRS — Constitutional Analysis of Suspicionless Drug Testing Requirements for the Receipt of Governmental Benefit

February 13, 2014 Comments off

Constitutional Analysis of Suspicionless Drug Testing Requirements for the Receipt of Governmental Benefit (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

For decades, federal policymakers and state administrators of governmental assistance programs, such as the Temporary Assistance for Needy Families (TANF) block grants (formerly Aid to Families with Dependent Children (AFDC)), the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps), the Section 8 Housing Choice Voucher program, and their precursors, have expressed concern about the “moral character” and worthiness of beneficiaries. For example, the Anti-Drug Abuse Act of 1988 made individuals who have three or more convictions for certain drug-related offenses permanently ineligible for various federal benefits. A provision in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 went a step further by explicitly authorizing states to test TANF beneficiaries for illicit drug use and to sanction recipients who test positive. Some policymakers have shown a renewed interest in conditioning the receipt of governmental benefits on passing drug tests. For example, in February 2012, the President signed into law an amendment to the Social Security Act that authorizes states to condition the receipt of certain unemployment compensation benefits on passing drug tests. Additionally, lawmakers in a majority of states reportedly proposed legislation in 2011, 2012, and 2013 that would require drug testing beneficiaries of governmental assistance under certain circumstances, while at least nine state governments over that time have enacted such legislation.

Federal or state laws that condition the initial or ongoing receipt of governmental benefits on passing drug tests without regard to individualized suspicion of illicit drug use may be subject to constitutional challenge. To date, two state laws requiring suspicionless drug tests as a condition to receiving governmental benefits have sparked litigation, and neither case has been fully litigated on the merits. The U.S. Supreme Court has not rendered an opinion on such a law; however, the Court has issued decisions on drug testing programs in other contexts that have guided the few lower court opinions on the subject.

In Harm’s Way: State Response to Sex Workers, Drug Users and HIV in New Orleans

January 1, 2014 Comments off

In Harm’s Way: State Response to Sex Workers, Drug Users and HIV in New Orleans
Source: Human Rights Watch

This 57-page report documents government violations of the right to health and other abuses of at-risk populations in New Orleans. It calls for changes in state and local laws and policies that stigmatize, discriminate against, and facilitate police abuse of sex workers and drug users, and interfere with health services for people at high risk for HIV. The report was released in advance of the third annual Southern Harm Reduction and Drug Policy Conference, which opens in New Orleans on December 12, 2013.

American teens more cautious about using synthetic drugs

December 19, 2013 Comments off

American teens more cautious about using synthetic drugs (PDF)
Source: University of Michigan (Monitoring the Future)

—The use of synthetic marijuana by the nation’s teens dropped substantially this year, and a sharply increasing proportion of them see great risk in using so-called “bath salts.”

Both of these drugs are synthetics sold over the counter in many outlets such as gas stations and convenience stores, as well as on the Internet. They have been the subject of great concern because of their serious and unpredictable consequences for the user’s health. These and other findings come from the University of Michigan’s Monitoring the Future study, which is funded by the National Institute of Drug Abuse.

Prescription Drug Abuse: A Policy Position Paper From the American College of Physicians

December 10, 2013 Comments off

Prescription Drug Abuse: A Policy Position Paper From the American College of Physicians
Source: Annals of Internal Medicine

Prescription drug abuse is found throughout all aspects of the U.S. population and is a serious public health problem. Physicians and other health professionals with prescribing privileges are entrusted with the authority to use medications in the treatment of their patients and therefore have an important role in helping to ensure safe and effective use of this treatment option and the deterrence of its abuse. This paper is intended to provide guidance to prescribers and policymakers regarding measures to effectively address the problem of prescription drug abuse and offers the following recommendations:

1. ACP supports appropriate and effective efforts to reduce all substance abuse. These include educational, prevention, diagnostic, and treatment efforts. As physicians dealing with the health effects of this condition, we also support medical research on addiction and its causes and treatment.

2. ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements.

3. ACP supports the consideration by physicians of the full array of treatments available for the effective treatment and management of pain.

4. ACP supports the establishment of a national Prescription Drug Monitoring Program (PDMP). Until such a program is implemented, ACP supports efforts to standardize state PDMPs through the federal National All Schedules Prescription Electronic Reporting (NASPER) program. Prescribers and dispensers should check PDMPs in their own and neighboring states (as permitted) prior to writing or filling prescriptions for medications containing controlled substances. All PDMPs should maintain strong protections to assure confidentiality and privacy.

5. ACP supports efforts to educate physicians, patients, and the public on the appropriate medical uses of controlled drugs and the dangers of both medical and nonmedical use of prescription drugs.

6. ACP favors a balanced approach to permit safe and effective medical treatment utilizing controlled substances and efforts to reduce prescription drug abuse. However, educational, documentation, and treatment requirements toward this goal should not impose excessive administrative burdens on prescribers or dispensers.

7. ACP recognizes that defined maximum dosage (i.e., morphine equivalent) and duration of therapy limitations are not applicable to every clinical encounter. ACP favors establishment of evidence-based, nonbinding guidelines regarding recommended maximum dosage and duration of therapy that a patient taking controlled substance medications may receive.

8. Patients identified by Medicare, Medicaid, private insurance plans, or law enforcement authorities as being at significant risk of prescription drug abuse may be required to participate in a drug monitoring program and undergo random drug testing. Physicians may be required to report suspected cases of drug abuse, but should not be mandated to conduct random drug testing without the patient’s consent. The financial cost of mandatory drug testing should be borne by the authority requiring the testing; neither the patient nor the physician should bear the financial cost of random drug testing mandated by a third-party authority.

9. ACP recommends the consideration of patient-provider treatment agreements between physician and patients as a tool for the treatment of pain.

10. ACP recommends the passage of legislation by all 50 states permitting electronic prescription for controlled substances.

VA OIG — Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center

December 4, 2013 Comments off

Healthcare Inspection: Alleged Improper Opioid Prescription Renewal Practices, San Francisco VA Medical Center
Source: U.S. Department of Veterans Affairs, Office of Inspector General

The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection in response to complaints concerning improper opioid prescription renewal practices in the Medical Practice Clinic at the San Francisco VA Medical Center (facility), San Francisco, CA. We reviewed the following allegations: (1) attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar, (2) providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record, and (3) there have been patient hospitalizations and deaths related to opioid misuse.

We substantiated that attendings on-duty are tasked with evaluating numerous opioid renewal requests for patients with whom they are unfamiliar; however, Veterans Health Administration regulations and local policy do not prohibit such practice.

We partially substantiated that providers do not routinely document patients’ opioid prescription renewal problems in the electronic health record. The providers did not consistently document an assessment for adherence with appropriate use of opioids and monitor patients for misuse, abuse, or addiction. The primary care providers did not consistently complete the templated Narcotic Instructions Note for patients with opioid prescription renewal problems.

We partially substantiated that there have been hospitalizations and deaths of patients related to opioid misuse. Seven patients were hospitalized for opioid overdose; however, the primary care provider, Psychiatry Service, and/or the facility’s Substance Abuse Program assessed and appropriately monitored the patients for misuse. There were no deaths related to opioid overdose.

We recommended that the Facility Director (1) ensure that providers comply with all elements of the management of opioid therapy for chronic pain, as required by Veterans Health Administration and the VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain, and (2) ensure that the Narcotic Instructions Note is reevaluated for appropriate use in the Medical Practice Clinic and that providers comply with established protocol.

The Veterans Integrated Service Network and Facility Directors concurred with our recommendations and provided an acceptable action plan. (See Appendixes A and B, pages 6–9 for the Director’s comments.) We will follow up on the planned actions until they are completed.

Prescription Drug Abuse: Strategies to Stop the Epidemic

November 13, 2013 Comments off

Prescription Drug Abuse: Strategies to Stop the Epidemic
Source: Trust for America’s Health

Prescription Drug Abuse: Strategies to Stop the Epidemic finds that 28 states and Washington, D.C. scored six or less out of 10 possible indicators of promising strategies to help curb prescription drug abuse. Two states, New Mexico and Vermont, got the highest score, receiving all 10 possible indicators, while South Dakota scored the lowest with two out of 10.

According to the report, prescription drug abuse has quickly become a top public health concern, as the number of drug overdose deaths – a majority of which are from prescription drugs – doubled in 29 states since 1999. The rates quadrupled in four of these states and tripled in 10 more of these states.

Prescription drug related deaths now outnumber those from heroin and cocaine combined, and drug overdose deaths exceed motor vehicle-related deaths in 29 states and Washington, D.C. Misuse and abuse of prescription drugs costs the country an estimated $53.4 billion a year in lost productivity, medical costs and criminal justice costs, and currently only one in 10 Americans with a substance abuse disorder receives treatment.

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