May 30th, 2012
A recent user question on VYou (see my response here) addressed the issue of prescribing addicts with opioid pain medication. Since prescription medication abuse and addiction is on the rise and getting more and more attention in the media every year, the question of whether addicts in recovery, or people who have dealt with substance abuse and addiction problems in the past, should be prescribed these medications is a very relevant one.
Chronic pain affects a substantial portion of the population worldwide (as many as 30%, see here). Opiate medications are one of the most commonly used approaches to treating such pain, which if untreated can cause serious disruptions to sufferers’ lives. Even when treated, chronic pain can be pretty debilitating. Some research (1) brings up good questions about the true effectiveness of opiate therapy for chronic pain, especially among long-term opiate users (like heroin and prescription pain medication addicts) but also among other drug using populations.
So how common is the practice? What sort of results do drug addicts usually get from these opiate therapies? And finally, how many of the addicts or drug abusers who receive these therapies end up abusing them and can we identify those people early so we can stop prescribing to them? In this three-part series of articles we’re going to cover these questions in-depth.
Prescription pain medication use in addict populations
Clinicians treating chronic back pain choose from a range of options, including opioid medications, exercise therapy, nonsteroidal anti-inflammatory medications, tricyclic antidepressants, acupuncture, and electrical stimulation. One study (1) found wide variability in the percent of chronic pain patients prescribed opioids (from 3%-66%) although the studies varied widely in their size and population served – some even looks at general back pain and not chronic pain alone (they tended to have much lower opioid prescription percentages). Among chronic pain clinic patients, chronic opioid pain medication use was estimated at 19% (2).
Among addicted populations, concerns about tolerance, withdrawal, and abuse tend to cut prescription rates for opioid pain medications. However, past drug abuse can exacerbate pain issues, especially for people who abuse, or have abused, opiates in the past. For this reason, it can sometimes be difficult to properly manage pain in people with a history of addiction. One study (3) found that as many as 67% of patients in a Methadone Maintenance Program and 52% of patients in short term residential treatment programs were being prescribed opiates for pain. It’s important to note that these numbers are higher than those reported in other studies but that populations in treatment do generally show prescription rates higher than the general population. A study in Finland (a country that has great medical record data) found that opiate prescription rates in substance abuse populations were equivalent (not higher or lower) to those in the general population. The College of Problems on Drug Dependence itself had released an official statement noting that a balance must be reached between fear of opioid prescriptions for pain and the usefulness of opioid pain medication for chronic and severe pain (4).
Interestingly, it seems that of all opioid pain medication prescriptions, the largest increases in troubling use has been around oxycodone (Oxycontin), which gets mentioned as often in emergency departments (ED) around the country even though it is prescribed about one-third as often as hydrocodone (Vicodin). This is less surprising when you consider the fact that many addicts report using oxycontin in different ways including smoking, snorting, and injecting the stuff, which is stronger and does not have the same amount of fillers as most hydrocodone preparations. The fact that oxycodone is stronger also means it is more effective for pain relief through higher activation of the opioid system that is relevant for addiction.
In our next piece we are going to explore whether opiate pain medication is helpful in controlling pain among addicts and substance abusers, see you then!
1. Martell, O’Connor, Kerns, Becker, Morales, Kosten, Fiellin. (2007). Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine, 146, 116-127.
2. Chabal, Erjavec, Jacobson, Mariano, Chaney (1997). Prescription Opiate Abuse in Chronic Pain Patients: Clinical Criteria, Incidence, and Predictors. Clinical Journal of Pain, 13, 150-155.
3. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.
4. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.
|Posted in: Education, Opiates, Prescription
Tags: abuse, addicts, chronic, chronic pain, college on problems of drug dependence, CPDD, drug, effectiveness, heroin, medication, morphine, opioid, opioid pain, opioid pain medication, oxycontin, pain, pain medication, prescription, vicodin, VYou
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
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
February 7th, 2011
Are you ready for some more exciting information about addiction? Well, it’s here anyway so you might as well look. We try to make A3 the central place where you can find out about addiction matters (saving you the typing work) so if there are any topics we’re not covering, make sure to write us!
Drugs- Reducing Stigma, and Oxycontin
Victoria News- Stigma is often discussed when talking about addiction. The stigma a drug user is stamped with often deters them from seeking treatment. AIDS Vancouver Island is promoting Anti-Stigma Week, which runs until Feb. 14. Hopefully an activity like anti-stigma week will allow individuals to leave behind their fears about being stigmatized and seek treatment for their addictions. Read the rest of this entry »
|Posted in: Links
Tags: about addiction, abuse, addiction, AIDS, Alcohol, anti stigma, anti stigma week, charlie shee, Dr. Drew, drug, drug dealers, marijuana, oxycontin, rehab finder, seeking treatment, stigma week, treatment
December 13th, 2010
One of the perks of being an alcohol, drug use, and addiction researcher, as well as of writing for a website like this and Psychology Today, is that sometimes we get to talk to people that most can’t reach or to receive information that others might not have access to. NIDA‘s Monitoring the Future, a national survey of about 50,000 teens between 8th and 12th grades is a huge annual undertaking the results of which will be released tomorrow for general consumption.
But we got a little sneak peek before everyone else.
If you follow this sort of stuff, you know that teen alcohol and drug use is always shifting as new drugs become more popular and others lose favor with that group of Americans that can’t make up their minds. This year seems to give us more of the same.
Monitoring the future: Early alcohol and drug use results
- Daily marijuana use, after being on the decline for a short while is apparently rising once again among teens, following last year’s continuing trend of a reduction in teens’ perceptions of marijuana harmfulness – We’ve written on A3 about some of the specific issues relevant to marijuana use including writing about Marijuana’s addictive potential and its medical benefit. There’s no doubt that the national marijuana debate will continue but the idea of 8th graders smoking weed doesn’t seem to be part of anyone’s plan.
- Among some groups of teens drug use is proving more popular than smoking cigarettes – I guess this could be taken as evidence of the effectiveness of anti-smoking campaigns, though until we see the full numbers I’m not going to comment any further on that.
- While Vicodin use among high-school seniors (12th graders) is apparently down, non-medical use of prescription medications is still generally high among teens, continuing a recent upward trend – Abuse of prescription stimulants has been on the rise for a number of years as the number of prescriptions for ADHD goes up, increasing access. It is interesting to see Vicodin use go down though the data I’ve received says nothing about abuse of other prescription opiate medications such as oxycontin, so I’m not sure if the trend has to do with a general decrease in prescription opiate abuse among teens.
- Heroin injection rates up among high-school seniors (12th graders) – I think everyone will agree that this is a troubling trend no matter what your stance on drug use policy. The associated harms that go along with injecting drugs should be enough for us to worry about this, but again, I’ll reserve full judgment until I actually see the relevant numbers. I’m also wondering if this is a regional phenomenon or a more general trend throughout the United States.
- Binge drinking of alcohol is down – As we’ve written before, the vast majority of problems associated with the over consumption of alcohol (binge drinking) among high-school students has to do with the trouble they get themselves in while drunk (pregnancies, DUI accidents, and the likes), so this is an encouraging trend though hopefully it isn’t simply accounting for the above mentioned increases in marijuana and heroin use.
Some general thoughts on NIDA’s annual Monitoring the Future results
I am generally a fan of broad survey information because it gets at trends that we simply can’t predict any other way and gives us a look at the overall population rather than having to make an educated guess from a very small sample in a lab. NIDA‘s annual MTF survey is no different although until I get to see all of the final numbers (at which point there will probably be a follow-up to this article) it’s hard to make any solid conclusions. Nevertheless, I am happy to see binge drinking rates among teens going down and if it wasn’t for that pesky increase in heroin injection rates I would say that overall the survey makes it look like things are on the right tracks.
I’ve written about it before and will certainly repeat it again – I personally think that alcohol and drug use isn’t the problem we should be focusing on exclusively since it’s chronic alcohol and drug abuse and addiction that produce the most serious health and criminal problems. Unfortunately, drug use is what we get to ask about because people don’t admit to addiction and harmful abuse because of the inherent stigma. Therefore, I think that it’s important for us to continue to monitor alcohol and drug use while observing for changes in reported abuse and addiction patterns. Hopefully by combining these efforts we can get a better idea of what drugs are causing increased harm and which are falling by the wayside or producing improved outcomes in terms of resisting the development of abuse problems.
|Posted in: Education, Opinions
Tags: 12th graders, abuse, addiction, ADHD, Alcohol, alcohol drug, alcohol drug use, binge drinking, drug, drug use, heroin injection rates, high school seniors, high-school, marijuana, monitoring the future, NIDA, oxycontin, prescription drug use, prescription opiate, smoking, stimulant, teen, teen drug use, trend, use, vicodin
August 12th, 2010
On last week’s episode of A&E’s Intervention, we were able to see how a prescription drug abuse problem can devastate the lives of addicts and their families. As we’ve already mentioned on A3, prescription drug abuse is the fastest growing drug problem in the U.S. at the moment having gone up more than 400% in only a few years.
Prescription Drug Abuse on A&E’s Intervention
Andrew, a 21-year-old, had been terribly addicted to OxyContin for the past 4 years. Because of his addiction, his father and two brothers were on the brink of homelessness as they watched Andrew snort his father’s last 40 dollars. This now made them unable to pay for the motel they had been staying in and all knew it was only a matter of time before they would be asked to leave.
Andrew’s journey with addiction began at 13 when he started experimenting with alcohol and marijuana. By 14, Andrew was using cocaine, crack, and ecstacy. He had also dropped out of school. By 17 he had a baby on the way and had begun his love affair with OxyContin. Though OxyContin is a prescription painkiller, it is attributed to a growing number of debilitating addictions and deaths every year. As the U.S. Drug Enforcement Administration warns, “OxyContin abuse can lead to weakened skeletal muscle, heart and respiratory failure and death”.
Oxycontin – the other heroin addiction
OxyContin is the brand name of the drug Oxycodone and is also known as “hillbilly heroin”. Many who abuse OxyContin crush the pills and then either snort or inject them, giving them a very similar high to that of heroin. Research has shown that when adolescent mice are exposed to OxyContin, lifelong and permanent changes to the brain’s reward system result. OxyContin is highly addictive and withdrawal symptoms are severe. OxyContin related deaths are usually linked to ingestion of the drug in combination with some other depressant of the central nervous system such as alcohol or barbiturates. Prescription drug abuse is a growing problem in the U.S. and according to recent government data, conducted between 1998 and 2008, there has been a 400 percent increase in substance abuse treatment admissions for people abusing prescription drugs.
Like the many others who abuse OxyContin, the drug had taken a fatal grip on Andrew’s life. He now found himself selling drugs to support his habit, stealing from his family and in debt to many drug dealers. In the past 2 years, he had stolen more than $4,000 from his grandmother and in the past year had been in over a dozen drug-related fights. As the dealers were hunting for him, Andrew began to fear for his life.
Gambling addiction can ruin lives
His family’s situation was even worse. His father had lost his car and home and could no longer feed Andrew’s two younger brothers. They often did not eat for days. Andrew’s violent behavior when he did not have the OxyContin made matters worse. Within 2 years, they had been evicted from 7 apartments because of the destruction Andrew caused to them when in a rage. As the situation worsened, Andrew’s father, Dan, was fired from his job of 19 years because he was caught stealing. But just as we begin to blame Andrew for the devastating situation he has placed his family in, the producers of A&E’s intervention revealed that there may be more than one addiction contributing to this family’s pain.
Over the past 9 years, Andrew’s father, Dan, had lost over $80,000 dollars through gambling and had taken more than $100,000 from his mother to support his gambling addiction. Dan had been able to mask his habit by focusing attention on Andrew’s oxycontin addiction. However, once their extended family saw an opportunity for Dan to get help, they came forward, hoping he too would seek treatment.
According to the Illinois Institute for Addiction Recovery, recent evidence indicated that pathological gambling is an addiction similar to chemical addiction. It has been observed that some pathological gamblers have lower levels of norepinephrine than normal gamblers. Norepinephrine is secreted under stress, arousal or thrill so pathological gamblers make up for their deficiency by gambling despite the negative consequences to their lives and the lives of those around them. Brain activation in gambling addict’s brains while receiving a monetary reward has also been linked to the brain activation of a cocaine addict when receiving cocaine. All of this makes gambling addiction difficult to treat and often requires the help of a treatment center or group therapy, like that of drug addiction.
Fortunately, after Andrew agreed to go to a 90-day treatment program, Dan did as well. Andrew has been sober since February 4, 2010 and Dan has not gambled since being featured on A&E’s Intervention. In the future, we’re going to follow up some of our favorite personalities from the show and see how they’re doing now.
|Posted in: Drugs, Education, Treatment
Tags: A&E, A&E's Intervention, abuse, addiction, andrew, drug, drug abuse, gambling, gambling addiction, intervention, oxycontin, prescription drug, prescription drug abuse
March 9th, 2010
On the way to New York city to visit my father this morning (he’s not doing so well), I saw an amazing journalistic piece on the prescription drug problem, especially as it relates to loose prescription-record keeping laws in Florida, which is apparently the reason for the five times higher rates of prescription pain medication rates in that state!
We’ve talked about this problem here before, and it’s one of (if not THE) the fastest growing drug abuse problems in this country, but what can I say, Mariana van Zeller knows how to tell a story. I’m now not only a fan of hers but also of the Current TV team, and especially of Vanguard Journalism. I’ll be watching them – you should be too.
|Posted in: Drugs, Education, Links, Prescription
Tags: current, drug abuse, express, florida, journalism, new york, opiate addiction, oxycodone addiction, oxycontin, oxycontin addiction, pill addiction, prescription, prescription addiction, prescription drug, television, vanguard, zanax