Testing It Up

Following a long battle against rampant methamphetamine abuse, officials from the western part of the country have a new enemy to fight in the form of painkiller abuse.

The Wall Street Journal reports that the epidemic of painkiller abuse which is gripping the Southern and Eastern U.S. has made a move on the western states and officials are unprepared for the invasion.

According to the 2010-11 survey released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in January, Oregon, Colorado, Washington and Idaho were among the western states that have the highest rates of prescription drug abuse in the nation.

The SAMHSA report said 6.5 percent of Oregon residents aged 12 and older abuse opioid painkillers, compared with the 4.5 percent of residents who abused similar drugs in Kentucky.

Elisha Figueroa, Idaho’s drug policy administrator, said she started noticing that prescription drug abuse was becoming pervasive in the state about two years ago. At this point, they are “just in the beginning stages of grasping the full magnitude of this issue.”

In Colorado, hospital admissions due to opioids rose to 7 percent of all visits in 2012, compared to 2.5 percent in 2004. But the state’s task force still has its eyes on tackling meth abuse. Colorado’s Attorney General  John W. Suthers said lawmakers will begin exploring freeing up resources this year to address painkiller abuse.

Arizona, which ranked 6th in the SAMSHSA survey, has yet to establish a unified strategy that would combat the problem, though officials had launched pilot programs last year aimed at educating physicians in three counties about safely prescribing painkillers.

In Oregon, data shows painkiller overdose increased from 218 in 2004 to 378 in 2011. Over a year ago, the state introduced a program to monitor and track painkiller prescriptions.

Opioid therapy is typically prescribed by physicians to patients experiencing chronic pain. The treatment is supposed to be helpful in improving the patient’s mood functioning and in relieving pain, but a new study shows that chronic opioid therapy on patients with depressive symptoms can lead to opioid misuse through self-medication.

Mark Sullivan, MD, PhD, professor of psychiatry at the University of Washington School of Medicine, and a team of researchers investigated the links between depression and opioid misuse in patients being treated for pain management. The group used the patient data provided by the Kaiser Permanente health care group of Northern California and the Group Health Cooperative, as well as interviewed 1,334 patients with chronic opioid therapy (COT) for non-cancer pain. The patients in the study have no history of substance abuse and each one was assessed for depression via three specific questions: Did they take their opioid for any symptoms other than the physical pain the medication was prescribed for? Did they increase their doses themselves? Did they give or get opioids from others?

The researchers found that patients experiencing depressive symptoms are more likely to misuse opioids by taking them for something other than their physical pain. Given the findings, they are suggesting that prescribing health care professionals should screen for depression in patients even when the patients don’t have a history of drug abuse in order to prevent the risk of opioid misuse other than for medication purposes.

The study was funded by a grant from the National Institute for Drug Abuse and published in the July/August issue of Annals of Family Medicine.

A study conducted by researchers from the Department of Veterans Affairs in Ann Arbor, Michigan, indicated that patients who are prescribed opioids in higher dosage are more at risk of suffering from unintentional overdose – and succumbing to it. The findings were published in the Journal of the American Medical Association (JAMA).

A feature on Medical News Today shared various excerpts from the study. Opioids are commonly prescribed to treat pain, and include such prescription drugs as codeine, oxycodone, morphine, and methadone. Brand names of this group of drugs include Lomotil, Percocet, Vicodin, Demerol, Darvon, Percodan, and OxyContin.

Over the last ten years, according to the VA researchers, death due to opioid overdose has become a serious public health concern, owing to the increase in incidence of these deaths. The rate of death due to unintentional overdose increased by 124 percent, according to the researchers; this figure was then attributed to an increase in overdose on prescription opioids.

The study authors wrote: “Achieving a better understanding of the factors contributing to prescription opioid overdose death is an essential step toward addressing this troubling and dramatic increase in overdose mortality.”

Researchers looked into the relationship between prescribing patterns for these drugs, and the risk of death from overdose, from 2004 to 2008. Groups of patients included in the study consisted of cancer, acute pain, substance abuse disorders, and chronic pain patients.

Information was taken from a national sample of patients from the Veterans Health Administration. This included information from unintentional death due to opioid overdose, as well as a random sample of patients who received opioids as they made use of medical services during the period of the study.

Michigan Drug Screening

A study shared on CNN.com reveals that OxyContin and other opioids can increase the risk of suffering from fractures as well as heart conditions in older people.

Daniel H. Solomon, M.D., a rheumatologist and epidemiologist at Brigham and Women’s Hospital in Boston, Massachusetts, served as lead author for the study. Dr. Solomon shared: “Opioids are not as safe as people had hoped… We need to recognize that opioids are not without risk.”

The results of the study suggest that elderly arthritis patients who are prescribed with and take opioids – which include OxyContin – are 4.5 times more likely to break their hip, pelvis, wrist or upper arm, when compared against patients who are suffering from similar condition, but are given non-steroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen.

In addition, it was determined that around 1 in 10 older people who are taking opiods will break a bone within a period of one year, as opposed to only 1 in 50 among those who take COX-2 inhibitors. COX-2 inhibitors are a more targeted form of NSAID, according to the feature.

The research involved studying almost 13,000 low-income Medicare patients who are suffering from osteoarthritis or rheumatoid arthritis. These patients have received prescriptions for either NSAIDs, COX-2 inhibitors, or opioids, over a period of six years.

Despite these findings, the study does not categorically discourage doctors from prescribing opioids to elderly patients. What doctors may want to do is to come up with a treatment regimen that also includes NSAIDs and other alternative methods for pain management. Dr. Solomon shared: “As an arthritis specialist, I will still use opioids, but I will do so in an informed manner and make sure the patients are aware of the risks.”

The Food and Drug Administration released data that shows an alarming increase rate in overdose of prescription drugs.

From the data collected in 1999 to 2006, there have been 14000 deaths in opioid overdose which is triple the number compared to years before 1999. Emergency room visits related to OTC drug abuse also increased from 500000 in 2004 to 1 million in 2008, according to the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network. The data collected were from among 231 U.S. emergency rooms that took notice in the increasing trend of such cases.

The top abused prescription drugs are opioids which account for more than 300000 visits to emergency departments in 2008. Symptoms of overdose usually involve a collapse in respiratory system which makes a patient unresponsive. They may eventually stop breathing that can pave the way for cardiac arrests.

Susan E. Foster, vice president of policy research and analysis at the National Center on Addiction and Substance Abuse at Columbia University in New York states that availability and access are the main reasons why there is an increase in OTC drug abuse. When people know that these drugs are prescribed by doctors and that they can be found in most medicine cabinets, they feel safe using them, but then again safety of these drugs do not extend to their misuse.

Drug manufacturers are being tasked by the FDA to further educate doctors and patients on the use of these prescribed drugs. By using patient education sheets and drug medication guides, they may be able to help the government resolve this problem. Drug makers would also be responsible to monitor doctor’s prescription techniques which can somehow indicate if they have improved their knowledge in correct opioid prescribing practices.  However, plans for manufacturers to keep track of patients who use opioids were rejected.

New York Drug Screening