Source: White House
The Obama Administration’s inaugural National Drug Control Strategy, published in 2010, charted a new course in our efforts to reduce illicit drug use and its consequences in the United States—an approach that rejects the false choice between an enforcement-centric “war on drugs” and drug legalization. Science has shown that drug addiction is not a moral failing but rather a disease of the brain that can be prevented and treated. Informed by this basic understanding, the 2010, 2011 and 2012 Strategies established and promoted a balance of evidence-based public health and safety initiatives focusing on key areas such as substance abuse prevention, treatment, and recovery.
The 2013 National Drug Control Strategy, released on April 24, builds on the foundation laid down by the Administration’s previous three Strategies and serves as the Nation’s blueprint for reducing drug use and its consequences. Continuing our collaborative, balanced, and science-based approach, the new Strategy provides a review of the progress we have made over the past four years. It also looks ahead to our continuing efforts to reform, rebalance, and renew our national drug control policy to address the public health and safety challenges of the 21st century.
Nonmedical Use of Prescription-Type Drugs, by County Type
Source: Substance Abuse and Mental Health Services Administration
- About 15.7 million persons aged 12 or older used prescription-type drugs nonmedically in the past year, and 6.7 million did so in the past month.
- Past year nonmedical use of prescription-type drugs was lower among persons living in rural counties than among those in metropolitan and urbanized non-metropolitan counties (5.4 vs. 6.4 and 6.6 percent); past month use was similar among all three types of counties.
- The rate of past year nonmedical use of pain relievers was lower in rural counties than in metropolitan and urbanized non-metropolitan counties (4.2 vs. 4.9 and 5.1 percent), as was the rate of nonmedical use of tranquilizers (1.8 vs. 2.1 and 2.3 percent); the rate of nonmedical use of stimulants and sedatives did not vary by type of county.
Source: Canadian Centre on Substance Abuse
Certain prescription drugs, like opioids, sedative – hypnotics and stimulants, are associated with serious harms like addiction, overdose and death. These drugs can have a devastating impact on individuals and their families, as well as place a significant burden on our health, social services and public safety syst ems. In countries like Canada, where these prescription drugs are readily available, the associated harms have become a leading public health and safety concern. Canada is the world’s second largest per capita consumer of one type of these drugs, opioids ( International Narcotics Control Board, 2013). Some First Nations in Canada have declared a community crisis owing to the prevalence of the harms associated with prescription drugs (Dell et al., 2012). While Canadian cost data is lacking, recent research from the United States estimates the annual cost of the non – medical use of prescription opioids to be more than $50 billion, with lost productivity and crime accounting for 94% of this amount (Hansen, Oster, Edelsberg, Woody, & Sullivan, 201 1).
Source: National Institute on Drug Abuse
Illicit drug use in America has been increasing. In 2011, an estimated 22.5 million Americans aged 12 or older—or 8.7 percent of the population—had used an illicit drug or abused a psychotherapeutic medication (such as a pain reliever, stimulant, or tranquilizer) in the past month. This is up from 8.3 percent in 2002. The increase mostly reflects a recent rise in the use of marijuana, the most commonly used illicit drug.
Acute Kidney Injury Associated with Synthetic Cannabinoid Use — Multiple States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)
In March 2012, the Wyoming Department of Health was notified by Natrona County public health officials regarding three patients hospitalized for unexplained acute kidney injury (AKI), all of whom reported recent use of synthetic cannabinoids (SCs), sometimes referred to as “synthetic marijuana.” SCs are designer drugs of abuse typically dissolved in a solvent, applied to dried plant material, and smoked as an alternative to marijuana. AKI has not been reported previously in users of SCs and might be associated with 1) a previously unrecognized toxicity, 2) a contaminant or a known nephrotoxin present in a single batch of drug, or 3) a new SC compound entering the market. After the Wyoming Department of Health launched an investigation and issued an alert, a total of 16 cases of AKI after SC use were reported in six states. Review of medical records, follow-up interviews with several patients, and laboratory analysis of product samples and clinical specimens were performed. The results of the investigation determined that no single SC brand or compound explained all 16 cases. Toxicologic analysis of product samples and clinical specimens (available from seven cases) identified a fluorinated SC previously unreported in synthetic marijuana products: (1-(5-fluoropentyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl) methanone, also known as XLR-11, in four of five product samples and four of six patients’ clinical specimens. Public health practitioners, poison center staff members, and clinicians should be aware of the potential for renal or other unusual toxicities in users of SC products and should ask about SC use in cases of unexplained AKI.
Amphetamine-induced psychosis – a separate diagnostic entity or primary psychosis triggered in the vulnerable?
Source: BMC Psychiatry
Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. Schizophrenia spectrum disorder and amphetamine-induced psychosis are further linked together by the finding of several susceptibility genes common to both conditions. These genes probably lower the threshold for becoming psychotic and increase the risk for a poorer clinical course of the disease.The complex relationship between amphetamine use and psychosis has received much attention but is still not adequately explored. Our paper reviews the literature in this field and proposes a stress-vulnerability model for understanding the relationship between amphetamine use and psychosis.
Parental Drug Use as Child Abuse
Source: Child Welfare Information Gateway
This factsheet discusses laws that address the issue of substance abuse by parents. Two areas of concern are the harm caused by prenatal drug exposure to the health and development of affected infants and the harm caused to children of any age by exposure to illegal drug activity in their homes or environment. Summaries of laws for all States and U.S. territories are included.
Source: Substance Abuse and Mental Health Services Administration
The number of people aged 18 to 25 who used prescription drugs for non-medical purposes in the past month declined 14 percent — from 2.0 million in 2010 to 1.7 million in 2011 — the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) announced today, during the 23rd annual national observance of National Recovery Month. Non-medical use of prescription drugs among children aged 12 to 17 and adults aged 26 or older remained unchanged.
In addition, the 2011 National Survey on Drug Use and Health (NSDUH), a survey conducted annually by SAMHSA, showed that the rates of past month drinking, binge drinking and heavy drinking among underage people continued a decline from 2002. Past month alcohol use among 12 to 20 year olds declined from 28.8 percent in 2002 to 25.1 percent in 2011, while binge drinking (consuming 5 or more drinks on a single occasion on at least 1 day in the past 30 days) declined from 19.3 percent in 2002 to 15.8 percent in 2011, and heavy drinking declined from 6.2 percent in 2002 to 4.4 percent in 2011.
Overall, the use of illicit drugs among Americans aged 12 and older remained stable since the last survey in 2010. The NSDUH shows that 22.5 million Americans aged 12 or older were current (past month) illicit drug users — (8.7 percent of the population 12 and older in 2011 versus 8.9 percent in 2010).
Marijuana continues to be the most commonly used illicit drug. In 2011, 7.0 percent of Americans were current users of marijuana — up from 5.8 percent in 2007. Among youths aged 12 to 17, the rate of current marijuana use remained about the same from 2009 (7.4 percent) to 2011 (7.9 percent). Increases in the rate of current marijuana use occurred from 2007 to 2011 among adolescents (ages 12-17), young adults (ages 18 to 25), and adults (ages 26 or older). Additionally, the number of people aged 12 and older who used heroin in the past year rose from 373,000 in 2007 to 621,000 in 2010 and 620,000 in 2011.
People often arrive in substance abuse treatment programs with multiple problems—including dependency on or addiction to both alcohol and drugs. National data from the Treatment Episode Data Set (TEDS) for 2009 show that 730,228 substance abuse treatment admissions (37.2 percent) reported abuse of alcohol and at least one other drug; 23.1 percent of all admissions reported the abuse of alcohol and one other drug, and 14.1 percent reported the abuse of alcohol and two other drugs.When alcohol is used with other drugs, it tends to be ingested in greater quantities than when used in their absence.2 Combining alcohol with other drugs is dangerous. For example, taking benzodiazepines concomitantly with alcohol increases the chances of benzodiazepine-involved death. It is important for treatment providers to identify patients who use alcohol with other drugs since that is an especially dangerous usage pattern.
Source: RAND Corporation
Discussions about reducing the harms associated with drug use and antidrug policies are often politicized, infused with questionable data, and unproductive. This paper provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain. Comparing these needs, old and new, to the current funding patterns suggests eight opportunities to improve understanding of drug problems and drug policies in the United States: (1) sponsor young scholars and strengthen the infrastructure of the field, (2) accelerate the diffusion of good ideas and reliable information to decisionmakers, (3) replicate and evaluate cutting-edge programs in an expedited fashion, (4) support nonpartisan research on marijuana policy, (5) investigate ways to reduce drug-related violence in Mexico and Central America, (6) improve understanding of the markets for diverted pharmaceuticals, (7) help build and sustain comprehensive community prevention efforts, and (8) develop more sensible sentencing policies that reduce the excessive levels of incarceration for drug offenses and address the extreme racial disparities. The document offers some specific suggestions for researchers and potential research funders in each of the eight areas.
New GAO Report and Testimony
Source: Government Accountability Office
1. Drug Control: Initial Review of the National Strategy and Drug Abuse Prevention and Treatment Programs. GAO-12-744R, July 6.
1. Federal Real Property: Improved Data and a National Strategy Needed to Better Manage Excess and Underutilized Property, by David Wise, director, physical infrastructure, before the Subcommittee on Economic Development, Public Buildings and Emergency Management, House Committee on Transportation and Infrastructure. GAO-12-958T, August 6.
Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Vital statistics data suggest that the opioid pain reliever (OPR) methadone is involved in one third of OPR-related overdose deaths, but it accounts for only a few percent of OPR prescriptions.
CDC analyzed rates of fatal methadone overdoses and sales nationally during 1999–2010 and rates of overdose death for methadone compared with rates for other major opioids in 13 states for 2009.
Methadone overdose deaths and sales rates in the United States peaked in 2007. In 2010, methadone accounted for between 4.5% and 18.5% of the opioids distributed by state. Methadone was involved in 31.4% of OPR deaths in the 13 states. It accounted for 39.8% of single-drug OPR deaths. The overdose death rate for methadone was significantly greater than that for other OPR for multidrug and single-drug deaths.
Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.
Implications for Public Health Practice:
Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing. Providers should use methadone as an analgesic only for conditions where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice by prescribers or insurers.
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
Neonatal Abstinence Syndrome and Associated Health Care Expenditures
Source: Journal of the American Medical Association
Context: Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use. No national estimates are available for the incidence of maternal opiate use at the time of delivery or NAS.
Objectives: To determine the national incidence of NAS and antepartum maternal opiate use and to characterize trends in national health care expenditures associated with NAS between 2000 and 2009.
Design, Setting, and Patients: A retrospective, serial, cross-sectional analysis of a nationally representative sample of newborns with NAS. The Kids’ Inpatient Database (KID) was used to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The Nationwide Inpatient Sample (NIS) was used to identify mothers using diagnosis related groups for vaginal and cesarean deliveries. Clinical conditions were identified using ICD-9-CM diagnosis codes. NAS and maternal opiate use were described as an annual frequency per 1000 hospital births. Missing hospital charges (<5% of cases) were estimated using multiple imputation. Trends in health care utilization outcomes over time were evaluated using variance-weighted regression. All hospital charges were adjusted for inflation to 2009 US dollars.
Main Outcome Measures: Incidence of NAS and maternal opiate use, and related hospital charges.
Results: The separate years (2000, 2003, 2006, and 2009) of national discharge data included 2920 to 9674 unweighted discharges with NAS and 987 to 4563 unweighted discharges for mothers diagnosed with antepartum opiate use, within data sets including 784 191 to 1.1 million discharges for children (KID) and 816 554 to 879 910 discharges for all ages of delivering mothers (NIS). Between 2000 and 2009, the incidence of NAS among newborns increased from 1.20 (95% CI, 1.04-1.37) to 3.39 (95% CI, 3.12-3.67) per 1000 hospital births per year (P for trend < .001). Antepartum maternal opiate use also increased from 1.19 (95% CI, 1.01-1.35) to 5.63 (95% CI, 4.40-6.71) per 1000 hospital births per year (P for trend < .001). In 2009, newborns with NAS were more likely than all other hospital births to have low birthweight (19.1%; SE, 0.5%; vs 7.0%; SE, 0.2%), have respiratory complications (30.9%; SE, 0.7%; vs 8.9%; SE, 0.1%), and be covered by Medicaid (78.1%; SE, 0.8%; vs 45.5%; SE, 0.7%; all P < .001). Mean hospital charges for discharges with NAS increased from $39 400 (95% CI, $33 400-$45 400) in 2000 to $53 400 (95% CI, $49 000-$57 700) in 2009 (P for trend < .001). By 2009, 77.6% of charges for NAS were attributed to state Medicaid programs.
Conclusion: Between 2000 and 2009, a substantial increase in the incidence of NAS and maternal opiate use in the United States was observed, as well as hospital charges related to NAS.
See: About One Baby Born Each Hour Addicted to Opiate Drugs in U.S. (Science Daily)
Prevalence and co-use of marijuana among young adult cigarette smokers: An anonymous online national survey
BackgroundThere is elevated prevalence of marijuana use among young adults who use tobacco, but little is known about the extent of co-use generated from surveys conducted online. The purpose of the present study was to examine past-month marijuana use and the co-use of marijuana and tobacco in a convenience sample of young adult smokers with national US coverage.MethodsYoung adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited online between 4/1/09 and 12/31/10 to participate in an online survey on tobacco use. We examined past 30 day marijuana use, frequency of marijuana use, and proportion of days co-using tobacco and marijuana by demographic characteristics and daily smoking status.ResultsOf 3512 eligible and valid survey responses, 1808 (51.5%) smokers completed the survey. More than half (53%, n = 960) of the sample reported past-month marijuana use and reported a median use of 18 out of the past 30 days (interquartile range [IR] = 4, 30). Co-use of tobacco and marijuana occurred on nearly half (median = 45.5%; IR = 13.1, 90.3) of the days on which either substance was used and was more frequent among Caucasians, respondents living in the Northeast or in rural areas, in nonstudents versus students, and in daily versus nondaily smokers. Residence in a state with legalized medical marijuana was unrelated to co-use or even the prevalence of marijuana use in this sample. Age and household income also were unrelated to co-use of tobacco and marijuana.ConclusionThese results indicate a higher prevalence of marijuana use and co-use of tobacco in young adult smokers than is reported in nationally representative surveys. Cessation treatments for young adult smokers should consider broadening intervention targets to include marijuana.
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Prescription Medication Abuse and Illegitimate Internet-Based Pharmacies
Source: Annals of Internal Medicine
Abuse of controlled prescription medications in the United States exceeds that of all illicit drugs combined except marijuana and has grown considerably in the past decade. Although available through traditional channels, controlled prescription medications can also be purchased on the Internet without a prescription. This issue has gained the attention of federal regulators, law enforcement, and the media, but physician awareness of the problem is scarce. This article describes the nature of the problem and its magnitude, discusses the challenges to federal and private efforts to combat illegitimate online pharmacies, and outlines strategies for physicians to recognize and minimize the unwarranted effects of the availability of these medications on the Internet.
Drug overdose death rates have increased steadily in the United States since 1979. In 2008, a total of 36,450 drug overdose deaths (i.e., unintentional, intentional [suicide or homicide], or undetermined intent) were reported, with prescription opioid analgesics (e.g., oxycodone, hydrocodone, and methadone), cocaine, and heroin the drugs most commonly involved (1). Since the mid-1990s, community-based programs have offered opioid overdose prevention services to persons who use drugs, their families and friends, and service providers. Since 1996, an increasing number of these programs have provided the opioid antagonist naloxone hydrochloride, the treatment of choice to reverse the potentially fatal respiratory depression caused by overdose of heroin and other opioids (2). Naloxone has no effect on non-opioid overdoses (e.g., cocaine, benzodiazepines, or alcohol) (3). In October 2010, the Harm Reduction Coalition, a national advocacy and capacity-building organization, surveyed 50 programs known to distribute naloxone in the United States, to collect data on local program locations, naloxone distribution, and overdose reversals. This report summarizes the findings for the 48 programs that completed the survey and the 188 local programs represented by the responses. Since the first opioid overdose prevention program began distributing naloxone in 1996, the respondent programs reported training and distributing naloxone to 53,032 persons and receiving reports of 10,171 overdose reversals. Providing opioid overdose education and naloxone to persons who use drugs and to persons who might be present at an opioid overdose can help reduce opioid overdose mortality, a rapidly growing public health concern.
Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis
ObjectiveTo determine whether the acute consumption of cannabis (cannabinoids) by drivers increases the risk of a motor vehicle collision.DesignSystematic review of observational studies, with meta-analysis.Data sourcesWe did electronic searches in 19 databases, unrestricted by year or language of publication. We also did manual searches of reference lists, conducted a search for unpublished studies, and reviewed the personal libraries of the research team.Review methodsWe included observational epidemiology studies of motor vehicle collisions with an appropriate control group, and selected studies that measured recent cannabis use in drivers by toxicological analysis of whole blood or self report. We excluded experimental or simulator studies. Two independent reviewers assessed risk of bias in each selected study, with consensus, using the Newcastle-Ottawa scale. Risk estimates were combined using random effects models.ResultsWe selected nine studies in the review and meta-analysis. Driving under the influence of cannabis was associated with a significantly increased risk of motor vehicle collisions compared with unimpaired driving (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I2=81). Collision risk estimates were higher in case-control studies (2.79 (1.23 to 6.33); P=0.01) and studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) than in culpability studies (1.65 (1.11 to 2.46); P=0.07) and studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11).ConclusionsAcute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions. This information could be used as the basis for campaigns against drug impaired driving, developing regional or national policies to control acute drug use while driving, and raising public awareness.
Emergency Department Visits Involving Illicit Drug Use among Males
Source: Substance Abuse and Mental Health Services Administration
Examines characteristics of emergency department treatment visits involving illicit drug use among males based on annual averages for combined 2004 to 2009 data. Reports trends in age, drug involved, and disposition of the visit.
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