Meth Use is Rising Among People Who Use Opioids

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Over one-third of people using opioids in 2017 reported also using methamphetamine – more than double the rate in 2011, according to a new study.

The study included 13,251 participants in 47 states who entered a substance abuse treatment program for opioid use disorder. The researchers found past month concurrent opioid and methamphetamine use doubled from 16.7 percent in 2011 to 34.2 percent in 2017.

Concurrent meth and opioid use increased among both men and women, among whites and in those under age 45, the researchers found. Past-month meth use significantly increased among those using prescription opioids alone, heroin alone and both prescription opioids and heroin.

“We were surprised to see such an increase in meth use among people using opioids,” said lead researcher Theodore Cicero, Ph.D, John P. Feighner Professor of Psychiatry at Washington University in St. Louis, who described the findings at the recent annual meeting of the College on Problems of Drug Dependence. “We knew that since there was a clamp-down on opioid abuse, people were switching to other drugs, but our main concern was heroin. We were surprised to not only see a rise in heroin use, but a sharp increase in the use of methamphetamine.”

Specifically, Dr. Cicero said, amphetamines, such as meth, produce the opposite effect of opioids. “They wake you up, while opioids are downers,” he said. “Apparently, more people use both drugs so one counteracts the effect of the other – they can balance each other out.” He emphasized that each drug alone carries dangers, and mixing them is especially hazardous.

When meth use was at its peak, Congress passed the Combat Methamphetamine Act in 2005, which required stores to put the cold medicine pseudoephedrine – a key meth ingredient – behind the counter, and limited sales. Meth sales plunged as a result. Then Mexican drug cartels started bringing meth into the country, according to the Drug Enforcement Administration. In the past five years, the amount of meth seized has tripled, U.S. Customs and Border Protection reports.

The new study illustrates that public health policies can have unintended effects, Dr. Cicero says. “As we address the opioid epidemic, we’re creating a different problem,” he said. “We have to realize that people often take drugs trying to escape from depression, anxiety and the circumstances of their lives. We have to address the demand side of the equation – why do people need to escape from life, not just try to limit the supply.”

Synthetic Cannabis Laced With Rat Poison a Risk to US Blood Supply, FDA Warns

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Illegal synthetic cannabis products laced with rat poison continue to be sold in the United States and pose a significant health risk not only to people who use these products but also the US blood supply, the US Food and Drug Administration (FDA) said this week in an update on the ongoing problem.

Hundreds of people in about 10 states have been hospitalized with serious and sometimes fatal bleeding linked to use of synthetic cannabinoids laced with brodifacoum, a highly lethal long-acting vitamin K antagonist anticoagulant commonly used in rat poison, the agency said on July 19.

For months, the Centers for Disease Control and Prevention (CDC) and the FDA have been warning about the dangers of illegal synthetic cannabis products that are sold under names such as K2 and Spice in convenience stores and gas stations.

“But despite our efforts, certain entities continue to bypass state and federal drug laws by making and distributing these products — often marked or labeled as ‘not for human consumption’ — and changing the structure of the synthetic chemicals to try to skirt legal requirements,” the FDA said. In some cases, makers of synthetic cannabinoids have deliberately added brodifacoum, which is thought to extend the duration of the “high.”

In an advisory issued in May, the CDC said case patients have presented with a variety of signs and symptoms of coagulopathy, including bruising, nosebleeds, excessively heavy menstrual bleeding, hematemesis, hemoptysis, hematuria, flank pain, abdominal pain, and bleeding from the gums or mouth.

At the time, more than 95 biological samples from case patients tested positive for brodifacoum.

The effects of brodifacoum are treatable, and the FDA said people who use synthetic marijuana products should be vigilant for signs of bleeding and should seek immediate medical attention.

“We also want to alert health care providers, particularly those delivering care in emergency settings, to be aware of these risks and consider the possibility of synthetic cannabinoid exposure when individuals present with unexplained bleeding,” the FDA said. “Standard coagulation tests, such as the prothrombin time, can be dramatically elevated in these settings, and prompt treatment with high doses of vitamin K and other supportive care can potentially be life-saving,” they add.

All Young Cannabis Users Face Psychosis Risk

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Cannabis use directly increases the risk for psychosis in teens, new research suggests.

A large prospective study of teens shows that “in adolescents, cannabis use is harmful” with respect to psychosis risk, study author Patricia J. Conrod, PhD, professor of psychiatry, University of Montreal, Canada, said.

The effect was observed for the entire cohort. This finding, said Conrod, means that all young cannabis users face psychosis risk, not just those with a family history of schizophrenia or a biological factor that increases their susceptibility to the effects of cannabis.

“The whole population is prone to have this risk,” she said.

The study was published online June 6 in JAMA Psychiatry.

Rigorous Causality Test
Increasingly, jurisdictions across North America are moving toward cannabis legalization. In Canada, a marijuana law is set to be implemented later this year.

With such changes, there’s a need to understand whether cannabis use has a causal role in the development of psychiatric diseases, such as psychosis.

To date, the evidence with respect to causality has been limited, as studies typically assess psychosis symptoms at only a single follow-up and rely on analytic models that might confound intraindividual processes with initial between-person differences.

Determining causality is especially important during adolescence, a period when both psychosis and cannabis use typically start.

For the study, researchers used random intercept cross-lagged panel models (RI-CLPMs), which Conrod described as “a very novel analytic strategy.”

RI-CLPMs use a multilevel approach to test for within-person differences that inform on the extent to which an individual’s increase in cannabis use precedes an increase in that individual’s psychosis symptoms, and vice versa.

The approach provides the most rigorous test of causal predominance between two outcomes, said Conrod.

“One of the problems in trying to assess a causal relationship between cannabis and mental health outcomes is the chicken or egg issue. Is it that people who are prone to mental health problems are more attracted to cannabis, or is it something about the onset of cannabis use that influences the acceleration of psychosis symptoms?” she said.

The study included 3720 adolescents from the Co-Venture cohort, which represents 76% of all grade 7 students attending 31 secondary schools in the greater Montreal area.

For 4 years, students completed an annual Web-based survey in which they provided self-reports of past-year cannabis use and psychosis symptoms.

Such symptoms were assessed with the Adolescent Psychotic-Like Symptoms Screener; frequency of cannabis use was assessed with a six-point scale (0 indicated never, and 5 indicated every day).

Survey information was confidential, and there were no consequences of reporting cannabis use.

“Once you make those guarantees, students are quite comfortable about reporting, and they become used to doing it,” said Conrod.

Marijuana Use Highly Prevalent
The first time point occurred at a mean age of 12.8 years. Twelve months separated each assessment. In total, 86.7% and 94.4% of participants had a minimum of two time points out of four on psychosis symptoms and cannabis use, respectively.
The study revealed statistically significant positive cross-lagged associations, at every time point, from cannabis use to psychosis symptoms reported 12 months later, over and above the random intercepts of cannabis use and psychosis symptoms (between-person differences). The statistical significances varied from P < .001 to P < .05.

Cannabis use, in any given year, predicted an increase in psychosis symptoms a year later, said Conrod.

This type of analysis is more reliable than biological measures, such as blood tests, said Conrod.

“Biological measures aren’t sensitive enough to the infrequent and low level of use that we tend to see in young adolescents,” she said.

In light of these results, Conrod called for increased access by high school students to evidence-based cannabis prevention programs.

Such programs exist, but there are no systematic efforts to make them available to high school students across the country, she said.

“It’s extremely important that governments dramatically step up their efforts around access to evidence-based cannabis prevention programs,” she said.

Currently, marijuana use in teens is “very prevalent,” she said. Surveys suggest that about 30% of older high school students in the Canadian province of Ontario use cannabis.

“I’d like to see governments begin to forge some new innovative policy that will address this level of use in the underaged,” Conrad said.

Reducing access to and demand for cannabis among youth could lead to reductions in risk for major psychiatric conditions, she said.

A limitation of the study was that cannabis use and psychosis symptoms were self-reported and were not confirmed by clinicians. However, as the authors note, previous work has shown positive predictive values for such self-reports of up to 80%.

Unique Research
Commenting on the findings Robert Milin, MD, child and adolescent psychiatrist, addiction psychiatrist, and associate professor of psychiatry, University of Ottawa, said the study is at “the vanguard” of major research investigating cannabis use in adolescents over time that is being carried out by that National Institute on Drug Abuse in the United States.

“The study is at the forefront because it is specifically looking to measure psychosis symptoms and cannabis use in adolescents, and the model they are using strengthens the study,” said Milin.

That model uses “refined measures or improved measures to look at causality, vs what we call temporal associations,” he said.

The fact that the study investigated teens starting at age 13 years is unique, said Milin. In most related studies, the starting age of the participants is 15 or 16 years.

He emphasized that the study examined psychosis symptoms and not psychotic disorder, although having psychotic symptoms increases the risk for a psychotic disorder.

Heavy Drinking and Early-onset Dementia

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A new study suggests heavy alcohol consumption is a major risk factor for all types of dementia, but particularly early-onset dementia.

The retrospective analysis involving 30 million people in France shows that those with a history of alcohol use disorders had a threefold increased risk for dementia and that over half those with early-onset dementia had a history of alcohol problems.

“Our results suggest that heavy drinking is the strongest potentially modifiable risk factor for dementia that we have ever seen,” lead author, Michaël Schwarzinger, MD, Translational Health Economics Network, Paris, France, said.

Their data make a strong argument for lower consumption of alcohol generally, he added. “If people are consuming more than a couple of alcoholic drinks a day, they could be putting themselves at increased risk of dementia. Our results suggest that one of the best things you can do for your brain health is to cut down your alcohol intake.”

The study is published online in Lancet Public Health on February 20.

In an accompanying Comment, Clive Ballard, MD, and Iain Lang, MD, University of Exeter Medical School, United Kingdom, say the study is “immensely important and highlights the potential of alcohol use disorders, and possibly alcohol consumption, as modifiable risk factors for dementia prevention.”

“This study used a phenomenally large database, and the result showing that half the cases of early-onset dementia were associated with alcohol use disorders is truly staggering,” Ballard told Medscape Medical News.

“This has flagged something that has long been neglected, so it is a very important contribution to our knowledge,” he added. “It does suggest that heavy drinking increases the risk for dementia and could be a significant contributing factor to early-onset dementia. That is important to know as we can potentially do something about it.”

In the paper, the researchers call for screening and interventions for heavy drinking and treatment for alcohol use disorders to reduce the alcohol-attributable burden of dementia.

“In our view, this evidence is robust and we should move forward with clear public health messages about the relationship between both alcohol use disorders and alcohol consumption, respectively, and dementia,” Ballard and Lang add. “We might want to consider the extent to which the growing prevalence of dementia worldwide might be curbed by reductions in population-level alcohol consumption.”

Quite a lot of work has looked at the effects of light drinking, with several cohort studies suggesting health benefits, including a possible reduction in dementia. But there has been very little research on the effects of heavy drinking, Schwarzinger noted, “so we wanted to look at this.”

For the study, they analyzed a database covering all hospital admissions in France. “We had data on around 30 million people over a 6-year period, including 80% of the French population more than 60 years of age,” Schwarzinger reported.

The researchers used diagnostic codes on hospital records to identify patients with dementia and those who had a history of alcohol use disorders. They found over a million cases of dementia, after excluding people with diseases that can lead to rare types of dementia and those with early-life mental disorders that can increase or confound dementia diagnosis. There were also 945,000 people with alcohol use disorders.
Results showed a strong association between a history of alcohol problems and dementia. This was especially noticeable in early-onset dementia, with 57% of the 57,000 patients who had developed dementia under the age of 65 years having a history of alcohol use disorders (66% of men and 37% of women).

In an analysis of just those patients in whom the first record of dementia occurred in 2011-2013 and adjusted for other risk factors found in the medical records, the risk for dementia was three times greater if the patient had a history of alcohol use disorders. The hazard ratio was 3.36 for men and 3.34 for women.

Is There a J-shaped Curve?

“We have very little information on the effects of heavy drinking as these people don’t generally participate in studies and if they do they frequently drop out,” Schwarzinger explained. “So this is the first solid data we have on this issue.”

But he pointed out that some small neuroimaging studies have shown a relationship between alcohol use and gray matter damage. “This association appears to be linear — the more alcohol is consumed the more gray matter damage — right down to very low levels.”

Because the current study used diagnostic codes to identify people with alcohol use disorders, it doesn’t give a level of alcohol consumption considered to be hazardous for dementia risk.

“We don’t know how much they were actually drinking, but usually anyone with an alcohol use disorder would be drinking more than 5 units of alcohol a day,” he said.

The World Health Organization defines chronic heavy drinking as consuming more than 60 g of pure alcohol a day for men (around six or more standard drinks per day on average) and more than 40 g per day for women (around four or more standard drinks per day), the study authors note.

“Cohort studies suggest a J-shaped curve for the alcohol and dementia relationship, with low and moderate levels of drinking possibly having a benefit, but our study shows a clear harmful effect of heavy levels of drinking,” Schwarzinger said. “We don’t know where the threshold is. We cannot discern that information from this study.”

He himself is not convinced about a J-shaped curve. “Personally I doubt there is a J-curve for the relationship between alcohol and brain health — the suggestion of benefit with low alcohol consumption has been seen in cohort studies in healthy people, which can have many biases, and the neuroimaging studies show brain damage with even low doses of alcohol.”

Ballard added: “There is a fair amount of evidence that modest alcohol consumption may be protective against dementia, and this study now suggests strongly that heavy drinking is harmful. We don’t know the specifics and we need to do a lot more work to find where the threshold may be, but possibly one or two drinks a day could be protective while five or more could be harmful.”

He further pointed out that there were almost certainly confounding factors that could have contributed to the current results.

“People with alcohol use disorders often also have many other risk factors for dementia, such as depression, social isolation, and poor nutrition, that may not have shown up in this study,” he said. “But having said that, the very high hazard ratio in this study is certainly a big push for further research on heavy drinking.”

Drugs, Alcohol, Suicide: Deaths of Despair killing Americans at Record Rates

“Despair deaths” from drugs, alcohol and suicide have reached new peaks in the U.S. and are not just killing whites, but spiking in communities of color, as well, according to a new report released Thursday.

More than 142,000 Americans died from drug or alcohol overdoses and from suicide in 2016, an 11 percent increase over 2015, the report from the Trust for America’s Health and the Well Being Trust finds.

“These 142,000 ‘despair deaths’ in 2016 add to the more than one million Americans who died from drugs, alcohol or suicide in the previous decade,” the report reads.

While the increased deaths from opioid overdoses and suicide are well documented, the team that wrote the report say their analysis shows some troubling differences.

“We had been seeing increases in these trends among these individuals who are dying from drugs, alcohol and suicide,” said Ben Miller, a clinical psychologist at the Well Being Trust.

“But between 2015 and 2016 the racial differences popped out. We saw literally a 39 percent increase in deaths of people of color due to drug overdose,” added Miller, formerly of the Department of Family Medicine at the University of Colorado School of Medicine.

“That is unheard of. This stood out like, holy cow what is going on?”

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory.”

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory.”
The report found that suicide rates went up 10 percent among blacks from 2015 to 2016 and rose 9 percent among Latinos.

“While drug overdoses were still highest among whites in 2016, there were disproportionally large increases in drug deaths among racial/ethnic minority groups, particularly among black Americans,” the report reads.

“In the previous decade, blacks had relatively low drug overdose rates — averaging 35 percent lower than whites between 2006 and 2015. However, between 2015 and 2016, blacks experienced an alarming increase — of 39 percent — in drug-related deaths.”

The opioid abuse epidemic is so bad that it has hit overall U.S. life expectancy. Life expectancy falls when people start dying at younger ages, and that’s what’s happening in the U.S. with opioid overdoses.

The National Center for Health Statistics has found that 63,600 people died of drug overdoses in 2016, and that in turn drove down overall U.S. life expectancy for the second year in a row.

Teen drug overdoses double in U.S.
Suicide rates have also soared. Sometimes, the causes are clear: just this week Puerto Rico health authorities reported that at least 103 people have committed suicide in the aftermath of Hurricane Maria, which devastated the island territory on Sept. 20.

The trends are related, Miller said.

“When we talk about deaths from alcohol, drugs and suicide, we recognize that there is a relationship there — that we can’t just look at the issue of suicide in isolation without tackling drugs and alcohol because the data show that they are related,” he said.

And now the epidemic has engulfed Latinos and other minorities across the U.S., the new report finds.

“Latinos and Asian Americans also historically have had relatively low rates of opioid and synthetic opioid drug overdoses and saw disproportionately large increases between 2015 and 2016,” it reads.

Suicide rates soar
“Latinos saw opioid death rates increase 35 percent and synthetic opioids death rates increase 183 percent between 2015 and 2016. Asians saw opioid deaths rates increase 41 percent and synthetic opioids death rates increase 140 percent between 2015 and 2016.”

If deaths continue to increase at the same rate, more than 2 million people could be dying from drug overdoses, suicide and alcohol abuse over the next decade, the report projects.

“The substantial rise in deaths in 2016 puts the country past the ‘worst case scenario’ projection trajectory,” it says. “This would mean more than 287,700 individuals could die from these three causes in the year 2025, double the current number who died in 2016.”

Miller says the country needs a comprehensive approach to treating pain — both physical pain and mental distress.

Alcohol kills six Americans a day
“People will continue to die until we come up with a systematic approach to take care of them,” he said.

“We talk about creating a national resilience strategy. How can we go into communities and see so much more than presence or absence of disease, but begin to take into account the social factors, to actually take care of people’s pain in more comprehensive ways instead of just treating them like a diagnosis or just labeling them as having some problem.”

Mental health reform is an obvious place to start, Miller said, but better strategies are also needed for treating acute and chronic pain.

“There is acute pain, there is chronic pain and sometimes there is this more emotional pain,” Miller said.

“They might be medicating the pain they feel from their family, from their community, from the trauma they suffered.”

Medical Device Helps Heroin Addicts Detox

The US Food and Drug Administration (FDA) has just approved
a “percutaneous nerve field simulator” for use in treating those
addicted to heroin and other opioid drugs.
The United States is currently in the grip of an opioid addiction
epidemic, caused largely by over-prescription of painkillers such
as Oxycontin and Vicodin. As a result, drug overdoses are now the
leading cause of death among under-50s in the US, having overtaken
car accidents and shootings. One reason this problem has proven so
intractable is that for those addicted to opiates, withdrawal symptoms
can be crippling.
The NSS-2 Bridge from Innovative Health Solutions is designed
to make coming off such drugs easier, by vastly reducing those
.ymptoms. The electrical nerve stimulator is placed behind the
t1>atient’s ear, and contains a battery-powered chip that emits
/ electrical pulses to stimulate branches of certain cranial nerves via
diodes that attach to the skin. These pulses are said to offer relief
from withdrawal symptoms such as sweating, gastrointestinal upset,
agitation, insomnia and joint pain. The device, which will only be
available on prescription, can be worn for up to five days, which is
about how long acute physical symptoms of withdrawal usually last.
FDA commissioner Dr Scott Gottlieb said: “The FDA is committed
to supporting the development of novel treatments, both drugs and
devices, that can be used to address opioid dependence or addiction,
as well as new, non-addictive treatments for pain that can serve as
alternatives to opioids.”