26. October 2011 by stationmanager.

In the United States today, there are more than two million jail and prison inmates, of whom about 15 percent have histories of heroin dependence. Few inmates receive drug abuse treatment while incarcerated or immediately upon release. Research has shown that this population, once released from incarceration, is at high risk of relapse to heroin use, criminal behavior, HIV infection and of overdose death, resulting in a terrible toll on the individuals, their families and our communities.

The World Health Organization supports the international standard that prisoners have the right to access the health services that would be available to them in the community. Health care in prisons is then a human rights issue and treating drug-dependent prisoners in jail and prison is consistent with the spirit of that standard. However, the correctional systems in the U.S. have been slow to embrace this notion and have shown even less comfort with providing medications to treat addictive disorders.

There are now several FDA-approved medications available in the U.S. to treat opioid dependence. Methadone has been available to treat opiate dependence since the early 1970s. Buprenorphine (Subutex and Suboxone) has been available since 2003. Oral naltrexone, an opioid antagonist, has been available since 1984 and the recently-approved Vivitrol, a long-acting, injectable form of naltrexone, is now available. Unfortunately, these medications are infrequently provided to opioid-dependent adults in U.S. jails and prisons and in the community under parole or probation supervision.

There are multiple barriers impeding the improved treatment of opioid-dependent inmates, probationers and parolees. There is an inherent contradiction between custodial and treatment goals. Moreover, many correctional officials may not be aware of the strong evidence supporting the effectiveness of medications in reducing drug use and criminal activity. They may be philosophically opposed to the use of medications or reluctant to increase their budgets to include medical services for addiction treatment. Moreover, many corrections officials in charge of jails and prisons feel their responsibilities end when the inmate is released from their facility.

The question can then be asked: How can change be affected in the criminal justice system to improve the treatment of opioid-dependent prisoners? The answer may lie in current research, the majority of which is funded by the National Institute on Drug Abuse (NIDA).

Two different approaches are being used. The first is to test medications in opioid-dependent prisoners and those newly released from jail or prison. A recent study by Dr. Timothy Kinlock and colleagues at the Friends Research Institute established that adding methadone to counseling in prison increased the likelihood that a prisoner, upon release, would continue to receive drug abuse treatment in the community, reaping the benefits of this medication; e.g., reduced risk of drug use and of overdose. An ongoing multi-site study led by Dr. Charles O’Brien at the University of Pennsylvania is underway among adult probationers and parolees to evaluate the effectiveness of long-acting naltrexone, which protects from relapse and overdose for one month. The research team at Friends Research Institute is also conducting a study of the effectiveness of Suboxone in prisoners with histories of opioid dependence.

The second approach is to forge better linkages and enhance collaboration between the criminal justice systems and the treatment clinics where effective medications for the treatment of alcohol and/or opioid dependence are available. The Criminal Justice-Drug Abuse Treatment Studies initiative of NIDA is currently funding a multi-city study. Its intent is to improve service coordination between parole and probation agencies and drug treatment clinics that provide medications for addiction treatment through an intervention aimed at improving knowledge and attitudes among community corrections (CC) staff and enhancing inter-organizational relationships. It is anticipated that improved knowledge and attitudes among CC staff will increase the number of criminal justice referrals to the treatment clinics.

Everyone wins by bringing the power of science to bear on the challenges of drug dependence in the criminal justice system. The opioid-dependent individuals reduce their likelihood of relapsing and dying of drug overdose upon release. A reduction in criminal and HIV-risk behavior improves public safety and protects the public health, and avoided episodes of reincarceration save the taxpayers money.

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19. October 2011 by stationmanager.

 Ice cream and other tasty, high-calorie foods would seem to have little in common with cocaine, but in some people’s brains they can elicit cravings and trigger responses similar to those caused by addictive drugs, a new study suggests.

Women whose relationship to food resembles dependence or addiction — those who often lose control and eat more than they’d planned, for example — appear to anticipate food in much the same way that drug addicts anticipate a fix, according to the study, which used functional magnetic resonance imaging (fMRI) brain scans.

When these women saw pictures of a chocolate milk shake made with Häagen-Dazs ice cream, they displayed increased activity in the same regions of the brain that fire when people who are dependent on drugs or alcohol experience cravings. When presented with the same milk shake, women who don’t feel addicted to food showed comparatively less activity in those regions.

Once the women actually tasted the milk shakes, however, those who scored high on a food-addiction scale showed dramatically less activity in the “reward circuitry” of their brains than the other women — phenomenon, also seen in substance dependence, that could lead to chronic overeating and other problematic eating behaviors, researchers say.

“It’s a one-two punch,” says the lead author of the study, Ashley Gearhardt, a Ph.D. candidate in psychology at Yale University. “First, you have a strong anticipation, but when you get what you are after, there’s less of an oomph than you expected, so you consume more in order to reach those expectations.”

The study, which appears in the Archives of General Psychiatry, included 48 young women with a wide range of body sizes who had signed up for a program aimed at helping them control their weight and develop better eating habits.

Each of the women filled out a 25-item questionnaire, adapted from assessments for drug and alcohol dependence, in which they were asked how strongly they agreed with statements such as “I find myself continuing to consume certain foods even though I am no longer hungry” and “When certain foods are not available, I will go out of my way to obtain them.” They were also asked to identify any foods — from a list including ice cream, chocolate, chips, pasta, cheeseburgers, and pizza — that gave them “problems.”

Then the researchers brought on the milk shakes, made with four scoops of Häagen-Dazs ice cream and Hershey’s chocolate syrup. While their brains were being scanned, the women were shown a picture of the milk shake to whet their appetite; five seconds later, they got to taste it. (As a comparison, each of the women was also shown a picture of a glass of water followed by a tasteless beverage.)

In addition to exhibiting patterns of craving and tolerance similar to those seen in drug addiction, the brains of women who scored high on the food-addiction scale showed less activity in areas responsible for self-control, which suggests that their brain chemistry may prime them to overindulge, Gearhardt says.

“It’s a combination of intense wanting coupled with disinhibition,” she says. “The ability to use willpower goes offline.”

The junk foods that are most likely to trigger cravings may be part of the problem. Over the past several decades, many foods have become less natural and more heavily refined, as sugars and fats have been added to make them tastier and more satisfying, says Gene-Jack Wang, M.D., a senior scientist at Brookhaven National Laboratory, in Upton, New York, who studies the brain’s role in obesity and eating disorders.

“Natural foods take a long time for the body to absorb,” says Wang, who was not involved in the study. “But the added sugars hit the brain right away.”

Some people, Wang adds, might be especially vulnerable to developing a dependence on such foods. “They may be genetically hardwired to like certain foods and to absorb them faster,” he says.

Over time, however, a person’s food of choice becomes less important as the cycle of dependence takes over, Gearhardt says. “At first you want it because it tastes good,” she explains. “But as you go from use to abuse to dependence, you begin to crave it and liking it doesn’t play as much of a role.”

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2. October 2011 by stationmanager.

It will come as no surprise to anyone reading this that we have a prescription drug problem in the United States. As I see it, however, we are not devoting our attention to the real root of the problem. Yes, we have prosecuted the drug-dealing doctors, pain clinics and pharmacies. Yes, we have taken on the middle-men (or women) between the doctors and the users. And yes, we have offered help to the addicts. But the real victims are their children, and they have gone overlooked.

I sentence pill peddlers every month. They tell me the same story in nearly every case: Good person gets hurt, gets prescribed pain killers, gets addicted, loses job, and starts dealing to sustain his habit. “A doctor prescribed it so it can’t be bad for you,” they thought. And more often than not, they have kids. Kids who lost their parents to drugs and will now lose them again to jail. With broken homes and terrible role models, they, too, are likely to turn to drugs.

Pills are the new drug of choice for kids. A recent survey revealed that young people 12 and older are abusing prescription drugs at greater rates than cocaine, heroin, hallucinogens, and methamphetamine combined.¹ Only marijuana abuse is more common.² And, most troubling, every day approximately 7,000 young people abuse a prescription narcotic for the first time.³

In turn, young adults are joining the ranks of prison inmates, state and federal. Recently, I sent two young women to the federal penitentiary—ages 22 and 23.

This is the new crack-cocaine epidemic, but worse. Not because it is both rural and urban—crack and other drugs have reached past the cities. Not because it is lethal—many drugs are lethal. It is worse because (1) doctors are the enablers (sometimes knowingly), (2) the supply seems to be endless, and (3) some of our youth falsely believe that prescription narcotics are a safe alternative to other illicit drugs.

And unlike other drugs which kids had to seek out, prescription drugs find them. In a recent survey, 55 percent of 12 to 17 year olds said they obtained prescription drugs from a relative or friend for free; 9 percent paid a friend or relative; and 5 percent took drugs from a friend or relative without asking.⁴ Less than 5 percent obtained the illicit drugs from a dealer, and approximately 18 percent obtained the prescription from a doctor.⁵

This problem is insidiously rampant, and law enforcement cannot handle it alone. Indeed, they can arguably only attack a small percentage of those providing our youth with drugs (the dealers and doctors). And while I think stiff sentences for those peddling drugs to our children can help, more action is needed to solve the problem.

Luckily, this is not a problem without a solution. First, every state should have a system like we have here in Kentucky that monitors every prescription. Budgets may be tight, but this is worth the cost. Second, we must educate our children. Studies have shown that talking to our children early and often deters them from using drugs. Third, we must educate adults about the problem: (1) they must act as role models; (2) be involved in their children’s lives, including paying attention to whom their children are spending time with; and (3) make sure they themselves are not the supplier by properly discarding old or unused prescriptions. Children with involved parents have a 50 percent lesser chance of trying and using drugs.⁶ Finally, we must educate doctors about the problem. While most doctors would not illegally prescribe pills, they should still be cognizant of the widespread abuse and exercise special care when prescribing these drugs. And, the few that ultimately choose to become dealers must be prosecuted and sentenced to very lengthy jail times.

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