Archive for the ‘drug addiction’ Category

Pain pills aren't the only problem: part three

Saturday, December 29th, 2012

I've seen a number of articles in The Wall Street Journal recently discussing the use and misuse of legal pain pills. I had planned to finish this series of blog posts today, but something changed my mind.

Which drugs when misused merit criminal punishment?

There was a July 2006 British House of Commons report authored by the UK Science and Technology Select Committee titled Drug Classification: making a hash of it. In brief it suggested the UK's system of classifying recreational drugs should be revised toward a more scientific measure of harm. Such a system was published in The Lancet in 2007 with the article's title being "Development of a rational scale to assess the harm of drugs of potential misuse."

The article was gripping, with the UK cost of drug misuse, in three spheres--healthcare, societal and resultant crime--being estimated at 10-16 billion British pounds a year. Looking at the exchange rates for 2007, one can approximately double that number, so we're looking at $20-32 billion/year in the UK alone.

Two expert panels were assembled (one composed of psychiatrists who specialized in addiction) and their results were compared in three areas; physical harm, dependence and social harms. The drugs they were compiling data on were not quite what I expected. In addition to  familiar illicit drugs (e.g., heroin, LSD, ecstasy and cocaine), they included khat, a stimulant-containing leaf that is chewed by ~10 million people worldwide (mostly in East Africa and the southwestern portions of the Arabian Peninsula). They also rated methadone and buprenorphine, drugs that are used in combatting withdrawal symptoms in patients being treated for addiction to narcotics.

I thought the most interesting portion of the study was the inclusion of alcohol, tobacco and  benzodiazepines (e.g., Klonopin, Valium, Xanax and Ativan) and the comparison of the three-sphere costs of these drugs with those of illegal substances.

Benzodiazepines are prescribed for anxiety and insomnia; they are widely used and relatively safe, but certainly can be addicting. Alcohol and tobacco, of course, are available without any doctors prescription.

In recent years we've been repeatedly told of the positive effects of red wine, especially as decreasing the risk of coronary heart disease . A health writer for the Beth Israel Deaconess Medical Center, a Harvard Medical School teaching hospital, published a 2008 review of the subject. The bottom line was 1). there were no randomized controlled studies on the subject; 2). exercise and a well-balanced diet can offer similar health benefits and 3). it's not possible, at this time to accurately predict who will develop alcohol dependence. The final paragraph of the paper said: "If you don't drink, don't start. If you drink excessively, stop. And if you drink moderately, you may continue to raise your glass and proclaim...'to my health!'"

highly addictive and dangerous

The study in The Lancet concluded that the current UK Misuse of Drugs Act (1971 version amended) was insufficient. That Act classifies drugs into three categories from A as the most harmful to C the least. But tobacco and alcohol account for about 90% of drug-related deaths in the UK and aren't on the list. Long-term smoking (over the age of 30) reduces life span by ten years on average. Smoked tobacco is the most addictive commonly used drug was the group's conclusion, with heroin and alcohol somewhat less so. Tobacco is estimated to cause up to 40% of all hospital illness and 60% of drug-related fatalities. Alcohol intoxication often rsults in violent behavior (I see this in our local paper on a regular basis) and is a common cause of auto and other accidents.

So where should we start in fighting drug abuse?






Pain Pills and their ugly cousin: Part 1

Thursday, December 20th, 2012

I had a total knee replacement nearly twelve years ago. On the Orthopedic ward I was told I could have one or two strong pain pills every 4 to 12 hours depending on how much pain I was experiencing. Since I have a fairly high pain threshold I decided to take the minimum dose, one every twelve hours. I took the first pill, felt considerable relief from the pain, but also felt strange, so I stayed at that dose.

One way to flex & extend after a total knee replacement

Then I ran into a snag. My release from the hospital depended on the degree of flexion I could achieve in the leg with the new knee. Several times a day I was hooked up to a device that gradually bent my leg. It really hurt, but I toughed it out. The nurses and the physical therapists (PT) didn't seem to communicate with each other and I was a bit slow to catch on.

"You're not making enough progress," my surgeon said. "I think we'll have to extend your stay."

Something finally clicked in my mind. I was hurting enough so the ward staff hadn't set the machines degree of flexion higher. I decided to take two of the pain pills an hour or so before the PT appeared to check my ability to have the leg bent passively.

This time I was in no pain, although I did feel weird.

"You're doing much better today," she said. "I'll tell your doc you can go home tomorrow."

I had been given a strong pain pill, probably oxycodone and they were going to give me a prescription for several weeks worth to take at home. I asked, "Can I have extra strength Tylenol instead?" I repeated that request when I had low back surgery six months later.

Since that time there's been considerable controversy about strong pain medications. The initial question was whether physicians were under-prescribing for patients with severe pain, usually cancer-related, in fear of getting them "hooked" on the drug. Subsequently there have been at least two tidal shifts in how pain medicines are viewed, one urging more treatment of pain including giving the most potent meds for chronic non-malignant pain (CNMP) as well as for cancer patents (who clearly needed to have adequate pain control and weren't always getting it).

Very recently there's been a re-evaluation of the trend. I want to go back to the basics and then follow the timeline of expert opinion that's been expressed on the subject in the last two hundred years. But I'll begin much further back than that.

A 2008 article now available online and authored by staff from the National Development and Research Institutes and from the Department of Pain Medicine and Palliative Care at New York City's Beth Israel Hospital explored the treatment of chronic pain in depth. A few comments from that article surprised me.

a field of opium poppies

In Mesopotamia, nearly 5,500 years ago, Sumerian farmers cultivated a plant called Hul Gil which translates as the "joy plant." We call it the opium poppy. An August 2002 PBS special titled "Bitter Harvest" walks through how this plant is processed into the highly potent street drug, heroin, with at that time 13 million addicts worldwide The United Nations Office on Drugs and Crimes (UNODC) has a 2009 paper online estimating similar numbers. The major alklaloid (a usually colorless, complex and bitter organic chemical) in opium  was isolated in 1903 and named morphine (the Greek god of dreams was Morpheus). Then the Bayer company made a chemical from morphine and gave it the brand name Heroin.

Nowadays much of the world's crop of opium poppies is grown in Afghanistan. The 2009 estimate from UNODC was for $60 billion of the worldwide total of $68 billion.

But I've strayed away from my theme, which isn't street drugs, but prescription medications, so I'll stop here and get back to the synthetic opiods in my next post..


Meth Madness: Part 1

Wednesday, December 28th, 2011

Some people just pop pills

Recently our local paper, the Fort Collins Coloradoan, published a USA Today article titled "Missouri grapples with meth." I read about the nearly 7,000 law-enforcement seizures of laboratories and methamphetamine-related material in 2011 (through late November), saw that Colorado wasn't in the top ten states involved (at least in methamphetamine lab seizures) and wondered why Missouri, with 1,744 confiscations, was clearly the hot spot for this drug

A contentious issue is whether state law requires a  doctor's prescriptions for over-the-counter medications containing pseudoephedrine, a chemical also used for meth production. That's not true in Missouri where, at present the rules vary from county to county. Oregon and Mississippi have already passed such laws with impressive declines in meth seizures as a result. Fifteen other states have proposed similar legislation.

Then I found a series of articles that brought this issue squarely home to my state. In April 2011  the Denver Post published  two articles about proposed Colorado legislation that, if passed by the state Senate, would have made a number of pseudoephedrine-containing medications, used to treat the symptoms of colds and allergies, available only by prescription; eventually the potential new law went down to defeat by a 7 to 2 vote.

Yet the Colorado Meth Project, part of a much larger, multi-state prevention program whose focus is reducing the usage of this drug, said my home state ranked 7th in the U.S. in total number of "past-year meth users" aged 12 and up in a national survey on drug use during the 2006 to 2009 time frame. Did the "12 and up" catch your attention? This campaign, named the world's 3rd most effective charitable endeavour by a national magazine, was started in 2005 and works in three arenas: public service messages, public policy and community outreach.

It's been given credit for marked reduction of methamphetamine use in a number of states. As part of an ongoing CDC surveillance system, monitoring six types of health-risk behaviors that contribute to the leading causes of death and disability among youth and adults, the 2010 Youth Risk Behavior Survey saw a highly significant decline of teen meth use: 52% in Idaho, 63% in Montana and 65% in Arizona.

But we're not just speaking about teens. In late November of 2011, a 68-year-old former Colorado county sheriff was arrested; he allegedly was trading meth for gay sex. If proven guilty, he clearly wasn't alone in his drug-related activities.

Others inject their drug of choice

So returning to the question of why is this particular illegal substance so important? It's a highly addictive stimulant responsible for risky sexual behavior and extreme violence. The Centers for Disease Control and Prevention (CDC), published an extensive  2007 review on methamphetamine use and the risk for HIV/Aids. After discussing research indicating that meth-using gay men may increase their risk factors, they mentioned that heterosexual adults and adolescents who use meth may also engage in sexual practices that markedly increase their possibility of developing STDs including HIV.

That's by no means all that methamphetamine does to its users, but I'll write more concerning the chemistry and effects of the drug in my next post.