Drug Overdose Now Leading Cause of Injury-Related Deaths

Drug overdose deaths continue to increase in the United States and are now the leading cause of deaths from injury in the United States, a new report shows.

Every year, nearly 44,000 people die from drug overdoses. Deaths due to drug overdose have more than doubled in the past 14 years, and half of them are related to prescription drugs (22,000 per year), the report shows.

During the past 4 years, the number of overdose deaths rose significantly in 26 states and Washington, DC, and decreased in only six states. In 36 states and Washington, DC, overdose deaths now exceed motor vehicle–related deaths.

The findings from The Facts Hurt: A State-By-State Injury Prevention Policy Report were released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation. The report was developed in partnership with leading injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Prevention (SAVIR).

Prescription drug abuse is a “national epidemic,” Jeffrey Levi, PhD, TFAH executive director, said during a media briefing, but it affects some states much more than others. West Virginia has the highest number of drug overdose deaths (33.5 per 100,000), and North Dakota, the lowest (2.6 per 100,000).

“More than two million Americans misuse prescription drugs. The prescription drug epidemic is also contributing to an increase in heroin use,” noted Corrine Peek-Asa, PhD, MPH, professor and associate dean for research, College of Public Health, University of Iowa, in Iowa City.

She noted that 34 states and Washington, DC, now have “rescue drug” laws in place to expand access to and use of naloxone (multiple brands) ― twice the number of states with these laws in 2013. Although every state except Missouri has some form of prescription drug monitoring program in place to help reduce doctor shopping and misprescribing, only 25 states require mandatory use by health providers in at least some circumstances.

During the past 4 years, injury death rates have increased significantly in 17 states, have remained stable in 24 states, and have decreased in nine states. The national rate is 58.4 per 100,000 people.

West Virginia has the highest number of injury-related deaths of any state (97.9 per 100,000), a rate more than twice that of the state with the lowest rate, New York (40.3 per 100,000).

Motor vehicle death rates have declined 25% in the past decade (to 33,000 per year); 21 states have drunk driving laws that require ignition interlocks for all offenders; most states have graduated drivers licenses that restrict times when teens can drive; 10 states restrict nighttime driving for teens starting at 10 pm; and 35 states and Washington, DC, require car safety or booster seats for children up to the age of 8 years.

Homicide rates have fallen 42% in the past 20 years (to 16,000 per year). For black male youth (aged 10 to 24 years), the rate of death by homicide is 10 times higher than it is for the overall population; 1 in 3 female homicide victims are killed by an intimate partner; 31 states have homicide rates at or below the national goal of 5.5 per 100,000 people.

Suicide rates have remained stable but have been persistently high for the past 20 years (41,000 per year); more than 1 million adults attempt suicide, and 17% of teens seriously consider suicide each year; 70% of suicides deaths are among white males.

One in 3 Americans older than 64 years suffers a serious fall each year; falls are the most common nonfatal injuries, and the number of fall injuries and deaths are expected to increase as the baby boomer cohort ages; 13 states have unintentional fall-related death rates that are lower than the national goal of 7.2 per 100,000 people.

Traumatic brain injury from sports/recreation among children has risen by 60% in the past decade.

Predictable, Preventable

“One person dies from an injury every 3 minutes in the United States,” Dr Levi said. “Injuries are the leading cause of death for all Americans between the ages of 1 and 44. They are responsible for nearly 193,000 deaths each year, and more than 27 million Americans seek medical treatment for injuries each year.”

“Injuries are not just acts of fate. Research shows that they are pretty predictable, and they are actually very preventable,” he noted. Preventing injuries “is not rocket science, but it requires common sense and an investment in good public health practice,” he added.

“Injuries are persistent public health problems,” added Dr Peek-Asa. “New troubling trends, like the prescription drug overdose epidemic, increasing rates of fall-related deaths, and traumatic brain injuries, are serious and require immediate response. But we cannot afford to neglect or divert funds from ongoing concerns like motor vehicle crashes, drownings, assaults, and suicides. We spend less than the cost of a box of bandages, at just $.028 per person per year, on core injury prevention programs in this country.”

The report also includes a report card of 10 key indicators of leading evidence-based strategies that help reduce injuries and violence. Twenty-nine states and Washington, DC, scored a 5 or lower out of the 10 key injury-prevention indicators. New York received the highest score of 9 out of 10; the four states that scored the lowest are Florida, Iowa, Missouri, and Montana, scoring 2 out of 10.

“This report provides state leaders and policy makers with the information needed to make evidence-based decisions to not only save lives but also save state and taxpayers’ money,” said Amber Williams, executive director of the Safe States Alliance.

“The average injury-related death in the US costs over $1 million in medical costs and lost wages. Preventing these injuries will allow for investments in other critical areas, including education and infrastructure,” she said.

The complete report is available at www.healthyamericans.org.

High-Potency ‘Blowtorch’ Marijuana Gaining Ground

A novel form of marijuana involving the inhalation of highly potent tetrahydrocannabinol (THC) created via butane extraction is becoming increasingly common, placing both producers and users at risk for fires and burns, warn US researchers.

The practice, known as dabbing, uses less potent parts of the cannabis plant to create concentrated butane hash oils (BHO), which are crystalized, then heated with a blowtorch so that the vapors can be inhaled.

John M. Stogner, PhD, from the University of North Carolina, at Charlotte, and Bryan Lee Miller, PhD, from Georgia Southern University, in Statesboro, warn that there is a lack of research into the practice, although a number of accidents and injuries have been reported.

“Health care professionals have the responsibility to remind their patients, particularly those who have used marijuana, of the dangers that may be associated with a stronger product,” the investigators write.

“They serve a key role in educating young people that BHO extract use potentially carries risks beyond that of flower cannabis smoking,” they add.

The researchers also advise that “primary care physicians avoid hyperbolic arguments like those of the media that describe dabbing as ‘the crack of pot,’ and instead urge caution.”

“Patients should be advised that research is lacking, information is still largely anecdotal, and the safest option is to refrain from use when definitive answers are absent.”

Flammable, Volitile

The investigators explain that BHO can be produced at home in a process called “blasting,” because it is relatively uncomplicated, needs few resources, and there are a number of instructional videos available on the Internet.

THC and other hydrophobic compounds within the cannabis dissolve into the butane, and once it has evaporated, it leaves behind crystalized resins that can have a THC concentration of up to 80%. This means that less potent parts of the cannabis plant can be salvaged.

However, the authors describe the process as “extremely dangerous” because of the flammable and volatile nature of the butane. This has led to a number of fires, explosions, and severe burns, with the risks comparable to that of producing methamphetamine.

Once the crystals have been created, what is termed as an “oil rig” is set up, in which a titanium rod is heated with a blowtorch to vaporize small amounts of crystals, or “dabs,” which are then inhaled through a glass water pipe.

Alongside the risks of using a blowtorch to heat the titanium rod to over 400º C, there are long-term health risks associated with inhaling solder, rust from oxidized metal parts, and benzene.

The authors stress that there is a lack of research into dabbing. Proponents suggest that it is safer than smoking marijuana, but others believe that there are greater acute risks from inhaling a more potent form of the drug.

Dr Stogner said that it is “very important” to start monitoring practices such as dabbing.

“Our past experience, particularly in America, has been to wait for a problem to develop before we start to monitor whether we have an issue at all…. I think it’s a trend we ought to pay attention to and that might become problematic in the near future,” he said.

Dr Stogner believes that one of the driving forces for dabbing is the novelty, based on the idea that users can create something stronger and have a new experience.

“It’s much higher in terms of THC concentration, and it appears to be faster in terms of speed of effect, and I think those are both desirable traits for certain drug users and one of the things they look for,” he noted.

Consequences of Legalization

What does Dr Stogner think can be done to curb the practice? “There is very little that can done,” he said.

“You have got two or three different avenues you can go policy-wise between legalization, decriminalization, prohibition, and so forth. Each one has pros and cons for marijuana use more generally, but each one has pros and cons for dabbing.”

He explained that in jurisdictions where marijuana has been legalized, the risk that people are going to engage in home production is minimized. However, there is an increased likelihood of usage due to the availability of traders.

The opposite effect occurs in areas where there is prohibition, because prohibition may limit the number of people that are dabbing, but it conversely increases the risks of creating the dabs, because more people engage in the practice.

Looking at the wider topic of legalization, where does Dr Stogner feel that the United States is heading in the longer term?

“I think the way that we are, as a country, handling marijuana now is in an interesting and proactive way,” he said.
“It allows you to run natural experiments by setting policies in different states and determining how those states react in terms of the portion of the population using, the health consequences, and the health benefits.”

“So I see some merits in the nonuniversal policy that the United States has at present.”

However, he stated: “I think that, in many cases, the consequences of legalization were not completely thought out. The idea that other forms, stronger forms might be available, and might be available to very young people, wasn’t considered.”

Refreshing Perspective

Joseph J. Palamar, PhD, MPH, assistant professor in the section on tobacco, alcohol, and drug use in New York University Langone Medical Center’s Department of Population Health, said that the authors provide a “refreshing perspective” on dabbing.

He said that it was particularly important that they mentioned that healthcare providers should provide honest information about the practice and not engage in “scare tactics.”

However, he was concerned about dabbing and the potential risks to users.

“It seems that the process of making this new drug is actually much more dangerous than the drug itself,” he said.

“Marijuana is not known to be one of those harmful drugs. It depends on THC content and so on, but the process of making this [novel] drug is a lot more dangerous than the drug itself.”

He continued: “Most of the time, like with these new drugs, we worry about the drug effect. With this new form of drug, we have to worry more about the manufacturing than the drug itself.”

“But this is all a product of prohibition. If marijuana were regulated, we wouldn’t have kids using blowtorches, possibly blowing themselves up, just for marijuana.”

Dr Palamar explained that if one looks at alcohol prohibition, people were resorting to very high-potency products. “Beer was the big thing before alcohol prohibition in the US, and when alcohol became illegal, people went on to very high-potency liquor,” he said.

“That’s when all the criminal gangs and so on started coming in and overseeing everything. People engaged in riskier alcohol consumption practices underground, in speakeasies, and they were consuming very high–potency products.”

Returning to dabbing, Dr Palamar believes that this high-potency product is being used “because marijuana use is illegal in most of the US,” adding: “You figure, if it’s illegal, you might as well get as much bang for your buck as possible.”

“People turn to harder, more condensed forms of the drug in times of prohibition, and that’s what’s happening with marijuana. People would rather have a small amount of high-potency product than a weaker product that takes up more space and that you’re more likely to get caught with,” he concluded.

Recovery Radio Needs Your Help

Well this last year was a busy time here at Recovery Radio. We had over 600,000 logins to our website and provided audio files that were played over 875,000 times this past year. We added many new speakers and workshops and now have a database of over 1600 audio files comprising more than 100 Gigabytes of data stored online for your use and enjoyment. And use it you are! We are currently serving over 500 Gigabits of bandwidth per month providing these files to the recovery community.
We have users from all around the world logging in to Recovery Radio. Our traffic comes from every continent except Antarctica.

Since our mission here at the Recovery Radio Network has expanded and become more popular, our expenses have risen as well. Because of the popularity of our Podcasts, we have increased the amounts of Internet Bandwidth we are using to the point where our provider felt it necessary to raise our costs just to defray the additional expenses he was incurring., As the result of these increased prices our expenses are starting to exceed our comfort level so something will need to change.
The idea for the Recovery Radio Network was hatched in 2002 when Internet Broadcasting was relatively new. The idea that we could make the huge library of recovery experience widely available relatively cheaply was very appealing. It took about two years of research and development before we were ready to proceed.. This was before podcasting was a stable platform so, we signed on with the Radio 365 network to provide streaming audio broadcasts and went live in February 2004.. This worked well for a number of years The Live 365 network was the largest Internet Broadcaster in the world at that time, hosting over 14,000 stations worldwide, and Recovery Radio was ranked in the top 10% of all stations by number of listeners.The growth was good but it began to cost us additional fees as our bandwidth and server usage increased, We began to look around for more cost effective alternatives when we discovered podcasting. It proved to be precisely what we needed. It was cost effective and allowed us to use distribution channels that were unavailable to streaming audio broadcasters thereby boosting our accessibility to our audience,So in May of 2009 we signed up with Podcastpeople.com as our platform provider and began our first podcast.
We have been successfully using the Podcastpeople.com platform for the last six years and have seen our traffic grow every year. This year we are on track to provide more than 1,000,000 hours of recovery audio to people on five continents. As you might imagine, this level of success comes with a price. That 1,000,000 hours of audio translates into a lot of Internet bandwidth and a very large server farm. Podcastpeople.com has generously agreed to cover over $3,000.00 of unexpected usage out of their own pockets this year because, they believe in and support our mission. However there will be an additional financial shortfall totaling approximately $5,000.00 that will need to be covered for us to continue.
This is where you come in. We need your financial support to help us grow our mission and continue the work we have been doing for the last 11 years. We have started a fundraising campaign on youcaring and ask for your help in reaching our goals. .Recovery Radio is a fully accredited 501(C)3 nonprofit charity recognized by the IRS so, all donations are tax deductible. Please help us become part of the solution supporting people suffering from Alcoholism, Addiction, and the people who love them. As Marty D. used to say “Give until it feels good!” Please use the “Donate Now” link on the right side of this page to make your tax deductible donation. And please give your friends both in,and out of the recovery community,the opportunity to participate in the solution by passing this information along to them as well.
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Recovery Radio

A new study takes a look at the prevalence of alcohol use disorder among U.S. adults.

Nearly one-third of adults in the U.S. engage in problem drinking — also known as an alcohol use disorder — at some point in their lives, a new study shows.

The study, published in JAMA Psychiatry, also shows that a startlingly low number of people actually receive treatment — 19.8 percent.

“These findings underscore that alcohol problems are deeply entrenched and significantly under-treated in our society,” George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism, said in a statement.

The study included in-person interviews with 36,000 people who were part of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III.

Researchers asked the study participants about their alcohol use, drug use, and psychiatric conditions. They also assessed whether any of the participants’ answers qualified them for a diagnosis of alcohol problems based on the Diagnostic and Statistical Manual of Mental Disorders (DSM). They analyzed whether the participants’ answers would qualify them for either alcohol abuse or alcohol dependence, which were considered two distinct disorders in the fourth edition of the DSM, or for the single disorder called alcohol use disorder (which has mild, moderate, and severe subclassifications), which is in the fifth and current edition of the DSM.

The results? Nearly 14 percent of adults met the criteria in the past year for alcohol abuse disorder, while 29.1 percent of adults met the criteria for alcohol abuse disorder at some point in their lives.

Researchers also noticed the rates of alcohol use disorders increasing over the last decade. Prevalence was higher among men, younger people, people who were previously or never married, white people, and Native American people.

The findings highlight “the urgency of educating the public and policy makers about AUD [alcohol use disorder] and its treatments, destigmatizing the disorder and encouraging those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” the researchers wrote in the study.

According to the Centers for Disease Control and Prevention, women should keep alcohol consumption to up to one drink per day and men should keep their consumption to up to two drinks per day. Alcohol abuse has a number of dangerous effects on the body — it can damage the heart, liver, and pancreas and is known to increase the risk of developing certain cancers.

To be diagnosed with alcohol abuse disorder, you must meet at least 2 of 11 criteria in the same 12-month period (the more criteria met, the more severe the disorder). To determine how many of the criteria you meet, according to the NIAAA, ask yourself if you have:

Had times when you ended up drinking more or longer than you intended?
More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
Spent a lot of time drinking? Or being sick or getting over the aftereffects?
Experienced craving — a strong need, or urge, to drink?
Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
Continued to drink even though it was causing trouble with your family or friends?
Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

Overdose Death Risk Rises Dramatically as Opioid Users Age

As users of heroin and other opioids get older, their risk for overdose death increases dramatically, a new study of age trends in excess deaths shows.

Although male users had almost double the rate of drug-related poisoning in early adulthood compared with female drug users, the difference narrowed considerably with age, the study found.

“Our analysis provides the first demonstration of a highly significant, age-related increase in opioid users’ drug-related poisoning mortality rate that persists beyond 45 years of age,” the authors, led by Matthias Pierce, Institute of Brain Behavior and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, United Kingdom, write.

The study was published in Drug and Alcohol Dependence.

Suicide, Homicide

Researchers extracted data from the Drug Data Warehouse, an anonymous, case-linked collection of secondary datasets about substance users in England and Wales. The Warehouse includes data from drug treatment services, prison and probation services, and criminal justice referrals.

The study cohort included 198,247 men and women actively using or being treated for opioid use in England from April 1, 2005, to March 31, 2009. Their median age at cohort assessment was 32.1 years, and 72% were male. Most (93%) were identified as heroin users.

For the analysis, researchers used crude mortality rate (CMR); a CMR of 73 per 10,000 person-years translates to 73 deaths occurring among 10,000 people during a period of 1 year or to 73 deaths among 20,000 people during a period of 6 months. They also compared observed deaths to sex- and age-appropriate expected mortality to derive standardized mortality ratios (SMRs).

During a median follow-up period of 3.1 years and through linkages with national mortality records, researchers determined that there were 3974 deaths from all causes, more than 5.5 times the number of deaths than would be expected in the age- and sex-appropriate general population.

Drug-related poisonings were the most common cause of mortality, accounting for 43% of deaths. Next were “external causes” (excluding drug-related poisonings), which accounted for 21% of all deaths, notably, suicide (5%) and homicide (2%).

The rate of suicide, when it was not also classified as drug-related poisoning, was 3 times higher (SMR, 2.9) than expected. With drug-related poisonings included, the SMR for suicides was 4.3 (95% confidence interval [CI], 3.9 – 4.8).

Sex Differences

The study uncovered some sex differences. The all-cause CMR for men was higher than that for women, reflecting lower female mortality in the general population. For men, the drug-related poisoning CMR was substantially higher than for women.

And they noted differences across ages. For both sexes, drug-related poisoning CMR increased markedly with age, from 19 (95% CI, 16 – 23) for persons aged 18-34 years to 45 (95% CI, 40 – 50) for persons aged 45-64 years (P < .001) and was higher for those aged 45-64 years than for those aged 35-44 years (P = .04). The sex difference was considerably more marked among those younger than 35 years. Men had almost double the drug-related poisoning CMR than women at ages 18-34 (29 vs 15), but this difference narrowed considerably with increased age. “These findings underline the importance for public health policy and treatment providers of delivering effective addiction treatment for older age groups, who are characterised by multiple and complex health problems,” the authors write. National targets need to be adjusted for age to effectively monitor the impact of policies, with the aim of reducing drug related poisoning deaths, they said. The study also found that other major causes of death, including circulatory, respiratory, and liver diseases, were much more common among opioid users than in the general population. The analysis may include some misclassifications, and the use of self-reports may lead to underestimations of levels of behavioral risks. Other potential study limitations were that factors contributing to excess mortality that are common in opioid users, for example, high rates of smoking, alcohol consumption, and depression and low socioeconomic status, were not measured, and that treatment effects on mortality risk were not considered.

Marijuana vs Alcohol: What to say to your Teens

Marijuana vs. Alcohol: What to Say to Your Teen When it comes to talking to your teen about marijuana (and alcohol), it’s not always easy to know what to say.

While there is no exact “script” for talking with your teen about marijuana, our new Marijuana Talk Kit explores common teen questions and arguments – and offers tips for what you can say in response.

For example, what should you say if your teen asked you, “Would you rather I drink alcohol? Weed is so much safer.”

First, instead of getting rattled by your teen’s question, try posing a question back. (This acts as a buffer while you think about your answer.) Try something like: “What is going on in your life that makes you feel like you want to do either?”

Your teen may likely mumble back, “Nothing” (or another one-word answer), but keep in mind that even the word “nothing” is an opportunity to lead to another supportive statement from you.

You can then try, “I’m glad to hear there isn’t anything going on in your life that makes you want to drink or smoke.”

Lastly, it’s a good idea to say something along these lines: “Honestly, I don’t want you to be doing anything that can harm you — whether that’s smoking pot, cigarettes, drinking or behaving recklessly. I’m interested in knowing why you think weed is safer than alcohol.”

This type of sentiment reminds your teen that you care deeply about his health and well-being, and expresses genuine curiosity about his thought process, is going to help him open up.

And that’s what it’s all about. Engaging your teen so you can have ongoing, open and positive conversations. That’s how you’ll better understand the pressures he or she may be facing. And that’s how you can express your concern and support and love. And while your teen may not admit it, deep down that’s something all teenagers want.

Learn more about what to say to your teen about marijuana. Download your free Marijuana Talk Kit