Naltrexone the addiction cure?

January 23rd, 2012

CNN released a news article a little while back titled “With anti-addiction pill, ‘no urge, no craving‘” that seems to suggest that a cure for addiction has been found. As usual, news reporting on these sort of topics revolves around a kernel of truth, with nice window dressing an a serving of embellishment.

While naltrexone, and topiramate, have been shown to improve outcomes in addiction treatment, they have by no means revealed anything that would warrant giving them the title “anti-addiction pills.”

Indeed, there are now a few different preparations of Naltrexone, including a long acting version called Vivitrol that while relatively expensive, has been shown to be relatively effective at cutting relapse rates for both alcoholics AND heroin (or opiate addicts). Note the difference though here between my language and that used by CNN; Naltrexone has been shown to reduce relapse rates, not eliminate them, and current research seems to show that it is most effective only for specific groups of alcoholics who have a specific type of Mu opioid receptor.

As the article points out, a combination of therapies, including behavioral therapies, medications, and social-support, are still the best option when it comes to addiction treatment.

We’re a long way off from finding anything that can be considered a cure for addiction, no matter what some treatment centers like to claim, but these pills should help us stem the tide while we keep looking…

Posted in:  Education, Medications, Opinions, Treatment Tags: addiction, addiction cure, addiction pill, alcoholics, anti addiction, CNN, cure, cure addiction, heroin, mu, naltrexone, news, opiate, opioid receptor, pill, relapse rates, topiramate, treatment, vivitrol

U.S. Drug overdose deaths are increasing

December 4th, 2011

The second leading cause of accidental death in the US is drug overdose (JAMA 2007). Prescription painkiller overdose deaths (opioid analgesics like OxyContin, Vicodin and methadone) account for nearly half of the 36,450 total fatal overdoses with 15,000 deaths that have claimed a number of celebrity lives including famous actor Heath Ledger (CDC 2011).

With so much concern over illegal drugs, it seems silly not to focus on a problem that is at least as deadly but far more accepted.

Drug overdose deaths increasing quickly

We’ve reported on this phenomenon before, so for the regular A3 readers this report might not seem new. But what’s staggering is just how quickly these numbers are moving up.

In 2004 there were 19,838 total accidental overdose deaths, with about 9,000 caused by prescribed drugs, and 8,000 more caused by illegal drugs like cocaine, heroin, and methamphetamines (Paulozzi, LJ, Budnitz 2006). That signals a near doubling in about 7 years, and when you look at numbers from 1999, we’re talking about triple the accidental drug overdose deaths in just over a decade! Fastest growing cause of death in our country ladies and gentlemen.

SAMHSA Reports that use of prescription pain relievers (opioid analgesics) have increased since 2002 from 360,000 to 754,000 people in 2010. That means that people are twice as likely to use these drugs now, which would be fine if 5% of the users weren’t dying every year.  A study I talked about on ABC’s Good Morning America earlier this year (see here) reported that people taking heavy doses are especially likely to die and that this might be at least partially due to additional opioid use over and above the prescribed regimen.Time to get this under control prescribers!!!

This increase in usage opioid analgesics like Oxycontin, Vicodin, and methadone has made them the some of the most deadly drugs in the USA (Paulozzi, LJ, Budnitz 2006). In 1999 to 2004 prescription overdose related to opioid analgesics increased from 2,900 to at least 7,500, this equates to 160% increase in just 5 years (Paulozzi).

A JAMA study conducted between 1999 to 2004 reported that white women showed a relative increase in unintentional drug related deaths of 136.5% followed by young adults aged 15-24 years (113.3%). But the latest report from the CDC suggest that Men and middle aged individuals are most likely to be affected by this growing epidemic. The bottom line is this problem is either moving around or is universal enough affect essentially every major group of Americans. One of the scariest findings from this most recent CDC study may be the conclusion that states are generally unprepared to deal with this growing epidemic.

What can we do about overdose deaths?

First of all, it is seriously time that we had more consistent state and federal computer systems keeping track of prescriptions for heavily controlled drugs in this country. We can keep track of packages moving across state lines with no problem, why is it so damn hard to watch pills that lead to 35,000 deaths? Most states have them in place but they’re not heavily used and there’s nothing at all that looks at cross federal prescription patterns.

Second, we wrote about some harm-reduction methods to reduce overdose deaths, things like intranasal naloxone, safe injection sites, and more. As far as I’m concerned, we need to get off our national moral horse and start acting responsibly when it comes to saving lives. If we have simple solutions that have been shown to reduce deaths while not increasing abuse, I say let’s implement!!! Anything else is simply wrong.

Citations:

Paulozzi, LJ, Budnitz, DS, Xi, Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology Drug Safety 2006; 15: 618-627. (originally published in 2006 and recently updated)

Posted in:  Education Tags: A3, accidental death, analesics like oxycontin, analgesics, CDC, cocaine, death, deaths opioid analgesics, drug overdose, heath ledger, heroin, JAMA, methadone, methamphetamine, opioid, opioid analgesics, overdose, overdose deaths, oxycontin, vicodin

Saving lives made easy – Treating opiate overdose with intranasal naloxone

October 24th, 2011

Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

• Contact was made with 278 of the original participants.
• 222 reported witnessing no overdoses during the 15-month span.
• 7 had their naloxone stolen, lost, or confiscated.
• 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)

Posted in:  Education, For addicts, For others, Opiates, prevention, Tips, Treatment Tags: addiction, addiction help, death, heroin, naloxone, opiate, opiate overdose, opioid, overdose, prevention, substance abuse

Promising new medical treatment options for drug addiction!!!

October 17th, 2011

Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.

• These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
  
• By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.

What else is new aside from medications?

There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!

Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.

I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…

I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.

citations:
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2) A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.

Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?

Posted in:  Drugs, Drugs, Education, Medications, Treatment Tags: Buprenorphine, cocaine, contingency management, drug treatment, Drugs, heroin, medical treatment, medication, residential treatment

Addiction stories: Hellish Heroin – Bambi’s heroin addiction story

May 14th, 2011

Addiction stories seem to have an impact that objective research can never have. This is another in a series of addiction stories submitted by our readers. I hope that everyone will benefit from learning about others’ experiences. There’s no doubt that Bambi’s experience of escalation in use from what seemed initially innocent is a common one. If you, or someone you know, needs help with their opiate addiction, try our rehab-finder for the best way to get reliable, verified, rehab recommendations.

A harrowing tale of heroin addiction:

When most people hear the word heroin, some things come to mind. Those of you who have never even thought of doing a drug like heroin, would never understand. And for those of you who you know who you are, whether you have found your way out, or are slowly still slipping away… Believe me, if you know who you are, then you know how it is. Realizing you’re addicted to something doesn’t hit you, until you mentally find your way out by accepting what has happened and letting go with only one hell of a memory. Read the rest of this entry »

Posted in:  Addiction Stories, Drugs, Opiates Tags: addiction help, addiction stories, dope, drug withdrawal, finder, heroin, heroin addiction, heroin addiction stories, hydrocodone, hydrocodone withdrawal, methadone, methadone treatment, OC, opiate addiction, opiate addiction stories, opiate withdrawal, oxy, oxycodone, oxycodone addiction stories, oxycontin, oxycontin addiction, oxycontin addiction stories, rehab, rehab-finder, suboxone, suboxone treatment, time

About Addiction: Drug Withdrawal in Newborns, Heroin, and Harm Reduction

February 28th, 2011

There’s so much to learn about addiction nowadays – Psychological theories, new stories, neuroscience research, and more. At All About Addiction we try to make the information easy to digest, so when you need to sort of the latest information about addiction, come see us, we’ll help.

Harm reduction – Heroin and Injecting Drugs

Irish Examiner-After four individuals died from heroin overdoses in Ireland drug workers are issuing warnings to heroin users. The heroin that is being used is of better quality so it elevates the risk for overdose. Heroin has been off of the streets of Ireland for the past couple of months due to supplying issues but now heroin is back, and it is so pure that it is killing people. Another issue could be that the short absence of the drug has left people with less tolerance then before.

The Body- The International Harm Reduction Association (IHRA) and HIV rights groups are urging the UN’s to legalize methadone in order to fight HIV/AIDS and heroin addiction In Russia. Russia is home to 1 million HIV-positive people (for comparison, the U.S> has about 500,000) and has one of the fastest growing HIV/AIDS epidemics in the world. In addition to this Russia has 3 million heroin addicts.  Russia is refusing to employ harm reduction programs such as needle exchanges, or to legalize methadone to treat heroin addicts.  Many Russian officials such as Gennady Onishchenko feel that legalizing methadone will not help as it is “just another narcotic.” We’ve hear the same argument here, but perhaps the IHRA can convince Russia to use harm reduction problems in order to help individuals.

Harm Reduction Coalition- This “webinar” allow its viewers to gain cultural competency when it comes to learning about the injecting drug user. It asks questions like:  ”Why is there a need for IDU cultural competency?” and “What is IDU Cultural Competency?”. Check out the webinar and see what it has to offer!

Mental Health and Prescription Drug Withdrawal in Newborns

Orlando Sentinel- Prescription drug abuse is already a problem in our society; in Florida alone prescription abuse is responsible for at least seven deaths a day. Prescription drug abuse is becoming even more problematic as it is now affecting newborns. In 2009 alone 1,000 babies were born and treated for drug-withdrawal syndrome.  In the past babies that were going through drug-withdrawal symptoms were most likely to suffer from crack cocaine addiction but now the babies are more likely to be addicted to prescription drugs.

Science Daily- A study was conducted and found that children with attention-deficit hyperactivity disorder (ADHD) are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood. Kate Humphreys, a colleague of Dr. Jaffe’s and a graduate student at UCLA was a coauthor of the research.

Addiction Recovery- Peer support

Stop Medicine Abuse-Often times it is best for teens to get information from their peers in order for something to have an effect in their lives. This website approaches substance abuse prevention with that specific mentality. Check out the testimony on this website as well as other resources that can be used by teens to learn about drug abuse.

Posted in:  Links Tags: about addiction, abuse, addiction, ADHD, cultural competency, drug, drug abuse, drug withdrawal, harm, harm reduction, heroin, prescription drug, prescription drug abuse, UCLA

Alcoholism , Sniffing Bath Salts, and Prescription Medication Abuse

January 17th, 2011

If you care about addiction you’re going to want to read our weekly update from across the globe. It’ll make you smarter – promise (at least when it comes to alcohol and drug abuse issues)!

Drug Abuse – Vaccines to treat addictions, and Sniffing Bath Salts

Medical News Today-A biochemical breakthrough by researchers at Cornell  produces a unique vaccine that combines bits of the common cold virus with a particle that mimics cocaine. Researchers believe the vaccine could be tailored to treat other addictions, such as to nicotine, heroin, and methamphetamine. While similar to other vaccine discussions we’ve had here, the method and generalizability here are of specific interest.

BBC News-Publicity of scholastic journals back fired on Dr. David E. Nichols as drug makers profit off his research findings. Dr. Nichols says while some drugs can be manufactured in the kitchen the scale to which these “legal high” drugs are produced indicates some small companies are involved.

Fox News.com- A new “drug abuse” trend of sniffing bath salts to try to get high is emerging in Louisiana and is creating a issue for the Louisiana Poison Center. It appears that more kids are attempting this “trend” resulting in of paranoia, hallucinations, delusions, as well as hypertension and chest pain. The problem’s gotten so bad in the state that the Governor had to make the active ingredient in the bath salts illegal. The bath salts contain a chemical called “Mephadrone and Methylenedioxypyrovalerone or MDPV, which is known to be a stimulant that may also cause paranoia and hostility.

Alcoholism – Studies and Personal Stories about alcohol

Science Daily- A new study has been conducted which shows that midlife alcohol consumption may be related to dementia which is often assessed about 20 years later. The study found that both abstainers and heavy drinkers had a greater risk for dementia and cognitive impairment than light drinkers. Again, it seems that drinking no-alcohol is associated with risk factors and outcomes that are not as ideal as moderate consumption and somewhat similar to heavy drinking.

Counselor Magazine Blog- Everyone loves watching a good and inspirational movie from time to time. The new movie “Country Strong” deals with many issues that everyday individuals face such as alcoholism, mental illness, co-dependency, ageism, and grief. These are elements that a person goes through when they are dealing with alcoholism. The movie depicts that alcoholism is a family disease and does not affect just the alcoholic. Another great point that the movie shows is that if there are underlying issues that are often not resolved that relapse is very common.

Prescription Drug abuse and death

Reuters- A new study has found that an increasing amount of individuals are dying from abusing and misusing prescription drugs as well as illegal drugs. In recent times deaths from “accidental poisonings” or overdose are more than ten times higher than they were in the late 1960s. This increase in drug deaths is higher across almost all age groups than it was in previous decades, especially amongst white Americans.

Chicago Sun Times- Prescription drug abuse is a growing problem in our country, and deaths from unintentional drug overdoses in the US have increased five-fold over the last two decades. The drugs that are commonly causing these deaths are particularly painkillers such as OxyContin (oxycodone), Vicodin (hydrocodone) and fentanyl. What many individuals do not realize is prescription drugs can be much more deadly than illegal drugs. In 2007 alone, abuse of prescription painkillers was responsible for more overdose deaths than heroin and cocaine combined. Prescription painkillers, most of which are opioids, are synthetic versions of opium used to relieve moderate to severe chronic pain, however in large and excessive quantities, they can suppress a person’s ability to breathe and are very dangerous when they are mixed with alcohol or other drugs.

Posted in:  Education Tags: about addiction, addiction, Alcohol, alcoholism, bath salts, BBC, cocaine, Country Strong, crystal meth, death, drug, drug abuse, Drugs, heroin, illegal drugs, methamphetamine, new study, nicotine, opiates, overdose, prescription, prescription drug, prescription drug abuse, prescription drugs, sniffing bath salts, stories, vaccine