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.
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
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
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
April 11th, 2011
A new article just published in JAMA (see here) reports a strong relationship between high-dose opiate prescribing and accidental overdose deaths. The authors focused on a sample of Veterans and found that those prescribed more than 50mg of morphine per day, or the equivalent of other opiate drugs, we much more likely to die of such overdose than patients being prescribed lower doses. Fortunately, only about 20% of the patient-months (a measure of how many people were prescribed a specific dose for how long) were prescribed these high doses but the rate of overdose for this group was 3 to 20 times higher! Read the rest of this entry »
|Posted in: Education
Tags: accidental death, Alcohol, benzo, benzodiazepines, Drugs, JAMA, marijuana, medication, Medications, nicotine, opiate, opiate presciption, overdose, overdoses, pain, patients, prescribed, prescription, veterans
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
October 11th, 2010
We’re back with our weekly post about addiction news and research. We’ve got harm reduction in Australia, heroin ads that don’t work, the impact of drug abuse on children, and more. Get your 30 seconds of education for the day.
Using Drugs – Heroin, HIV, the law, and recovery
The Australian- There is a state approved heroin injecting room in Australia. The center opened to create a safer place for drug users to shoot heroin. 3500 individuals have overdosed on the premises without a single fatality, making for a very interesting way of combating drug addiction that would definitely fall under that harm-reduction model American hate so much!
Star Advertiser- When it comes to scaring individuals into not using drugs, specifically heroin, fear appeals do not seem to work in preventing future drug users. Fear appeals ads show drug users as violent, and often have missing teeth or skin problems. Apparently, audiences are smart enough to see these as not really representative of heroin users in general and they’re not buying it, making the ads useless in combating drug addiction.
Global Development- Eastern Europe and Central Asia have the fastest growth rate of HIV infection in the world (Russia accounts for between 60% and 70% of the epidemic). This may be due to sharing dirty needles when using drugs and the biggest problem is likely lack of prevention efforts for high risk groups.
Guardian- A senior police officer from Britain thinks that individuals should not be criminally prosecuted for possessing marijuana. By focusing less on drugs found among youth the police can focus on things they see as more important like hard core criminals. I’m sure our legalization friends will love this, although again, this isn’t legalization but decriminalization and parents will hate it.
Addiction Inbox- Meditation and exercise play a role in drug addiction recovery. Both methods apparently help to eliminate the panic and anxiety that plays a role in detoxification. Although it may not be the most popular method of recovery, we at A3 have already written about this and think you should give it a try!
Breaking the cycles- A program called Partnership for a Drug Free America has five new drug programs in order to eliminate drug use among teens. These programs educate teens as well as their parents with a variety to drug information.
Smoking, pregnancy, and attitude
Science Daily- Women who smoke during pregnancy can hinder their children’s coordination and physical control (likely affecting boys more). Smoking during pregnancy can damage development in the fetal stage, so if you are expecting try not to light up (as our other post on pregnancy and smoking recommends).
Decoder- You are in for a good read on the changing attitudes of smoking. This blog gives an inside perspective on smoking and how it has evolved from the time it was considered “cool”.
Addiction’s impact on others
Philly Daily News- Addiction impacts not only the drug addict but their children as well. 15% of all children live in a household with an alcoholic and one in four children is exposed to a family member’s alcohol abuse or dependence. These children are often neglected when their parents are under the influence and that neglect can lead to some pretty terrible outcomes for the children themselves down the line.
Addiction Recovery- This is an excellent read on the importance of patience when it comes to addiction recovery. Rome wasn’t built in a day and neither will a drug addict’s wonderful new life. Recovery takes time so take a deep breath and enjoy!
|Posted in: Education, Links
Tags: about addiction, addiction, addiction recovery, alcoholism, children, combating drug addiction, drug, Drug addiction, drug users, Drugs, exercise, heroin, HIV, individuals using drugs, marijuana, medtation, neglect, overdose, pregnancy, smoking, using drugs
May 26th, 2010
Back in the 70s, heroin was mostly filler, and the good stuff was 5% pure or so. Nowadays a new, more potent, version of the stuff is killing people all around the country with widely varying purities as high as 90%.
What makes black tar dangerous
When heroin was weak, shooting it was the best way to get high, which kept many people away from it. But this relatively new stuff (it’s been around California for a while), brought in from Mexico and known by the name Black Tar, is strong enough to make smoking, or snorting, it a viable option for a nice long high. It’s a much easier sell for the dealers too – no more ugly needles, they tell their customers you can “just smoke it like weed,” which is true until you get hooked.
Like any other form of heroin, black tar will cause some serious changes in a user’s body and brain, messing with the body’s pain, digestion, and mood systems. The problem is that at these purity levels, the chance of a user overdosing are much higher too, and that’s where the body-count comes in.
The stuff is cheap, at least in relation to the old heroin that used to come in from the far-east, but the body count’s mounting and the problems only getting worse. Heroin overdose death rates have gone up at 20%-50% and they’re still going strong. Many of the people who are most concerned about this are hoping that heroin doesn’t bring about the same epidemic that crack did in the 80s.
Avoiding death by talking
As usual, I don’t believe in running away from a problem like this. Instead, this is exactly the kind of thing that education, information, and a good dose of harm reduction can fix. We need to make sure people know that the potency of this stuff can kill you. The only way to make sure that less people die from black-tar heroin is to let them know that they need to be careful with it because one mistake can mean death.
I’m hardly ever the “just say no” type and I think that in this situation, an approach like that will leave us in deeper and deeper trouble. The AP article I based this on talked about yearly seizures of heroin quadrupling to 86 kilograms across the U.S.-Mexico border last year. By comparison, cocaine seizures in 2008 totaled more than 8000 Kilos! I can tell you one thing, as someone with experience as a drug dealer, getting 86 kilos across the border isn’t that hard with the amount of Mexican corruption and “help” dealers can get. Where’s there’s money, there’s a way, and it seems that this heroin trend is offering up some money.
It’s that experience of mine that makes me believe we have to work towards understanding addiction and who develops it, and getting better at prevention, intervention, and treatment. Try as we might, solving this problem by the supply side isn’t going to work, I don’t care how hard Calderon is willing to fight.
|Posted in: Education
Tags: Black, body, calderon, corruption, dealer, death, harm reduction, heroin, hooked, mexico, needle, od, overdose, prevention, pure, syringe, tar, treatment
February 4th, 2010
Well, it seems the toxicology reports are in and Brittany’s death was, at least partially, caused by her taking of multiple prescription drugs. Still, it seems that she was trying to medicate a host of conditions brought on by her underlying anemia and pneumonia. It’s sad to think that this death could have likely been prevented had she simply taken better care of herself and gone to seek emergency care rather than loading her body with those pills. Unfortunately, this seems to be another in a string of medically preventable deaths… Sad.
Brittany Murphy, the actress from “Clueless,” and “8 Mile” died last night at Cedars-Sinai in Beverly Hills at the age of 32. Brittany has been rumored to be suffering from severe eating disorders, and recent pictures seem to support that notion. Given that she apparently died from cardiac arrest, I’m wondering if drugs (even prescription drugs) played a role in the death as well… I’ll keep updating the story as more becomes available.
My heart goes out to her family and friends. Certainly a loss suffered far too early.
UPDATE: According to the police report, a number of prescription drugs were discovered in Brittany’s bedroom including (read past the list for my take on this):
- Topamax - While TMZ reported this drug to be used as anti-seizure medication, it is also used to reduce weight-gain associated with the use of many other prescription drugs on this list. Lastly, it is considered to be a mood stabilizer.
- Methylprednisolone – An anti-inflammatory that may be used to treat bronchial infections
- Prozac - A commonly prescribed SSRI anti-depression med.
- Klonopin - A benzodiazepine anti-anxiety prescription medication that is also used to help with insomnia. Like most benzos, the probability of overdose is low if used properly, but overdose would lead to cardiac arrest.
- Carbamazepine – Another anti-convulsant mood stabilizer often used to treat bipolar disorder. This prescription drug can be very dangerous when combined with other medications due to its actions on GABA and extensive alteration of Sodium channel activity. It is also a bipolar med.
- Ativan - Once again a benzodiazepine that is often used to treat anxiety and insomnia.
- Vicoprofen - A pain reliever that includes an opioid (it sounds like vicodin for a reason).
- Propranolol - Prescription med used to treat hypertension and as an alternative, less habit-forming anti-anxiety drug.
- Biaxin - An antibiotic.
- Hydrocodone - Same as Vicoprofen, an analgesic (pain reducing) prescription drug.
What do I think killed Brittany?
With 2 benzodiazepine medications, 2 opiates, and antidepressant, and a drug that is made to lower one’s heart pressure, it’s no wonder that Brittany was found not breathing. I’m going to wait until the final toxicology report to draw a definite conclusion, but from this list, it seems highly likely that a dangerous combination of these prescription drugs was taken, which resulted in Brittany’s heart stopping. Even when taken at their prescribed strengths, these medication, when combined, can form a lethal cocktail.
You should ALWAYS check with your doctor regarding interactions between different prescriptions you’re taking, especially when those medications haven’t all been prescribed by the same physician!
|Posted in: Addiction Stories
Tags: addiction, anemia, anti, anti anxiety, antidepressant, benzo, Brittany Murphy, cardiac arrest, death, drug, drug use, Drugs, eating disorder, medication used, news, opiate, opiates, overdose, pneumonia, prescription, prescription drugs, propranolol, prozac, use, used, vicodin