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Thursday, January 19, 2017

Opioids With A History of Mental Illness

mental-illness
It may seem like common sense that people with a history of psychiatric illness would be more susceptible to developing an addiction, at least to those who work in the field of addiction medicine. However, many doctors do not look at a patient’s complete medical history before deciding whether to prescribe opioid painkillers, or not. Or so a new study has found. Such lapses regarding a patient's background can have devastating consequences on certain patients.

New research suggests that people with pre-existing psychiatric and behavioral conditions are at greater risk of long-term use of opioid pain medications, according to a press release. The findings highlight the need for providers to run complete histories on patients they are considering prescribing narcotics. The research was published in the Pain: The Journal of the International Association for the Study of Pain.

The researchers found that about 1.7 percent of patients prescribed opioids become long-term opioid users (six months or longer), according to the report. However, those with a history of mental health conditions or psychoactive medication use, became long-term opioid user at a much greater rate. The findings come from an analysis of data on prescriptions and health history for 10.3 million people, part of a nationwide insurance database, from 2004 to 2013.

"We found that pre-existing psychiatric and behavioral conditions and psychoactive medications were associated with subsequent claims for prescription opioids," study author Patrick D. Quinn, PhD, of Indiana University, Bloomington, and colleagues write. "Our findings support the ideas that clinical practice has deviated from the 'careful selection' under which most clinical trials are conducted and that thorough mental health assessment and intervention should be considered in conjunction with the use of long-term opioid therapy." 

In the field of addiction, it is quite common for people battling substance abuse to also have a co-occurring mental health disorder. Treatment becomes more complex because success depends on treating both the substance use and co-occurring disorder. So, it stands to reason that prescribing opioids to people who are already likely to be more susceptible to addiction, may not be a good choice. Looking for opioid alternatives when treating the pain of patients with history of mental illness or substance use, would have a positive effect all around.

Thursday, January 12, 2017

Addicts Make Riskier Decisions

cocaine
It is hardly a secret that people who abuse drugs and alcohol often make rash decisions that can greatly impact their life. People under the influence of alcohol will often choose to get behind the wheel of a car. Heroin addicts will inject another dose despite the risk of overdose, while already sufficiently intoxicated. Inside each addict and alcoholic is a force that is not acting with their well-being in mind.

Researchers continue to probe the mind to better understand what is operating. And in some cases, they would like to better understand the decision-making product of people with substance use disorders. New findings suggest that cocaine addicts make riskier decisions, because of an exaggerated decrease in the reward processing region of the brain, according to a press release. The findings were published in the journal Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

The researchers came to their findings by using gambling models, or what are known as a Risky Gains Task, according to the report. They compared the data from 29 people diagnosed with cocaine use disorder to 40 control participants. The participants were asked to perform a Risky Gains Task, where they could earn money by selecting between three monetary values -- the lowest value being the safest option and higher values being riskier. While undergoing the task, participants' behaviors were observed and neuroimaging was conducted. The findings could lead to a way of tracking the progress of a cocaine addicts recovery.

"This paradoxical relationship between how someone acts in response to a loss can give us clues for how to develop better interventions and how to track the recovery of the brain from cocaine addiction," said first author Joshua Gowin, of the University of California San Diego. 

Observations indicated that as potential monetary value increased, the control group and cocaine addict group made different choices. Neuroimaging showed a proportional increase in activity of the ventral striatum in the brains of the control group, not seen in the cocaine use disorder group, the article reports. The ventral striatum is believed to be important for processing of rewards. The researchers believe that the risky behavior exhibited by cocaine addicts was not motivated by reward.

"In an interesting parallel to their real life behavior, brain activity and choice behavior during a gambling task used in this study indicate an aberrant sensitivity to loss and a tendency to double down and make risky choices," said Cameron Carter, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

Thursday, January 5, 2017

Cocaine, Heroin and Overdose

cocaine
For an addict, there is such a thing as “more high.” Even if tolerance says otherwise. With some drugs, such as marijuana, a continued effort to increase one’s euphoria may not be that dangerous. But for drugs like prescription opioids or heroin, riding the line between intoxication and overdose is never in one's best interest—but highly sought after. What is considered to be a good high, can quickly turn into a deadly overdose.

The death toll related to drug abuse is almost always focused on opioid narcotics these days. While such drugs do not need any help with regard to being dangerous, addicts will commonly mix opioids with other narcotics, sometimes “uppers” and sometimes with more “downers.” It is quite common for people who mix opioids with benzodiazepines to experience a fatal overdose. However, there is another trend that has the power to take one’s life, commonly referred to as “speedballing.” That is mixing opioids and cocaine together, to be injected simultaneously. You may be aware that a number of celebrities have lost their life to the admixture, including:
  • John Belushi
  • Chris Farley
  • Philip Seymour Hoffman
The general public almost never hears about cocaine anymore, being overshadowed by drugs like heroin and fentanyl. If you did hear about cocaine, it is likely that it was because somebody famous died using the drug recently. But make no mistake, cocaine abuse is still a very real problem affecting many Americans. And for those with an opioid use disorder, who are finding that their tolerance is making it difficult to experience euphoria, cocaine might be the solution they consider. Anyone who has ever done a speedball will tell you that there is no other high quite like it, or as dangerous.

While cocaine use rates have been down in recent years, the U.S. Drug Enforcement Agency's (DEA) 2016 National Drug Threat Assessment has shown a significant increase in cocaine-related overdose deaths in recent years, according to the U.S. News & World Report. Cocaine can be deadly on its own; but when mixed with opioids the drug becomes exponentially more fatal.

“When there are no opioids involved in cocaine-overdose deaths you see an overall decline in recent years,” says Christopher M. Jones, an acting associate deputy assistant secretary with the Department of Health and Human Services. “But when you look at cocaine and opioids together, we see a more than doubling in the number of overdoses since 2010, with heroin and synthetic opioids increasingly involved in these deaths."

Thursday, December 29, 2016

Treating Depression and Anxiety With Marijuana

cannabis
When looking for a silver lining in the American electorate's ever changing stance on marijuana, two things often come to mind. 1) Medical marijuana and legalized recreational use will keep countless Americans out of jail or prison. 2) The loosening of the legislative grip on marijuana allows for some long awaited (previously impossible) research to be conducted. The findings of which will hopefully lead to more informed decisions regarding the use of cannabis.

Marijuana, like alcohol, is often used as a stress reliever at the end of a long day of work. While the stereotypical “pot” smokers are teenagers and young adults with Bob Marley shirts and healthy appetites, your average pot smoker is often the farthest thing from that picture. In fact, with the lightening of policies related to marijuana, we can now see a more accurate picture of cannabis users, free from what is portrayed in Hollywood. And what is being seen is college freshmen to businessmen partaking in marijuana use.

More American adults than ever can now easily access marijuana, so it is vital that they know the risks. When people think about the risks associated with cannabis use, cognitive and memory problems often come to mind. But, past research has found connections between heavy cannabis use and mental illness, especially among teenagers and young adults. Users beware!

There are also many pot smokers who use marijuana to self-medicate anxiety and depression. However, it has long been uncertain how effective marijuana is for treating mental illness, and it is likely that the drug may actually worsen one’s symptoms. Researchers at Colorado State University conducted a questionnaire-based analysis of 178 college-aged, legal users of cannabis to shed some light on how the drug affects emotional processing, KDVR reports. The findings were published in PeerJ.

The researchers found that people who use cannabis to treat their depressive symptoms, had less anxiety but were more depressed, according to the article. Those who used the drug to lessen anxiety symptoms had fewer symptoms of depression, but were more anxious.

The findings are important, and hopefully will influence some people’s choice to use the drug for alleviating symptoms of depression or anxiety.

Saturday, December 24, 2016

Celebrate Your Program Of Recovery On Christmas

addiction recovery
From Portland, Oregon, to Portland, Maine—Americans working a program of recovery have a difficult day ahead of them with Christmas on our doorstep. People in recovery often dread the holiday season, and for good reason. Emotions tend to run high during the holidays, often revealing the vulnerability and fragility of recovery. Letting up on one’s program, even in the slightest degree, can bring about serious consequences. Staying plugged into your program of recovery during on Christmas is the best way to ensure that you keep your sobriety.

Whether you are new to recovery, or an old timer, the stakes are equally high. It is not just newcomers who struggle with the holiday season, people with many years of sober time have a hard time, too. Christmas can bring back memories of a time before one's drinking or drugging became unmanageable. Nostalgia can be a slippery slope for people in recovery.

It is important to set such feelings aside and work hard to develop new holiday rituals and traditions with your peers in recovery. A number of people working program will have an urge to isolate tomorrow, thinking that it will make the day easier. But solitude usually has an opposite effect, causing people to get lost in their mind with unsafe thoughts. The head of an addict or alcoholic, as you are probably aware, can be a dangerous place.

The best way to get out of yourself is to channel your energy elsewhere. Attending 12-Step or SMART Recovery meetings on Christmas is great way to keep your sobriety intact this Christmas. If you are feeling shaky, you should share with the group about it. You are definitely not alone, and your words may help someone is even shakier. It is likely that someone will give you some feedback, imparting some wisdom for dealing with your feelings.

Tomorrow is a perfect opportunity to reach out to newcomers, as they are often the most likely to relapse. Having a conversation with a newcomer may help them stay the course, making it through Christmas without “using.” Helping others makes you feel better about yourself, which can actually keep you stay sober for one more day.

At Celebrate Hope at Hope by The Sea we would like to wish everyone working a program of recovery a safe and sober Christmas Eve and Day. And please remember, we don’t drink or drug—no matter what.

Saturday, December 17, 2016

War On Drugs In South America

war on drugs
The “war on drugs” in the United States has had a terrible impact on millions of Americans since President Nixon first made the declaration. The reactionary punitive approach to containing substance use and abuse in the U.S. disproportionately affects minorities and the millions of Americans living in poverty. The result, America has the largest prison population in the world, as many as half the people behind bars are serving time for nonviolent drug offenses.

Over the last eight years there have been several efforts to rein in the war on drugs. Such as ending or amending mandatory minimum sentencing laws and commuting hundreds of nonviolent drug offenders who are serving unjust, lengthy sentences. The significantly greater number of lawmakers are in favor of treatment over jail, seeing that what’s needed is compassion rather than punishment.

It can be easy to view the war on drugs as a campaign that only affected Americans. However, unlike typical armed conflicts, the war on drugs has had an impact on citizens of several countries—specifically in South America. Realizing that the bulk of illegal drugs coming into our country came from south of the border, our government pushed its agenda on countries like Colombia and funded campaigns to take out coca farmers and cocaine traffickers. The result, as you are probably aware—bloodshed.

In many ways, the last several decades in Colombia have been shaped by our country's goal of eradicating illegal drugs. It is a trend that may be coming to an end, with Colombia’s peace treaty with the Revolutionary Armed Forces of Colombia, or FARC—a 52-year old Marxist insurgency. The peace treaty earned Colombian President, Juan Manuel Santos, a Nobel Peace Prize, Civilized. reports. Acknowledging his role in ending a conflict that killed 220,000 people and displaced 8 million.

During Santos acceptance speech, he used the opportunity to criticize America's war on drugs, according to the article. He pointed out that the campaign in Colombia and other South American nations produced both violence and environmental damage. Santos believes that laws prohibiting consumption of drugs should be eased.

"It makes no sense to imprison a peasant who grows marijuana, when nowadays, for example, its cultivation and use are legal in eight states of the United States," said Santos.

Friday, December 9, 2016

Reversing Overdose Has A Heavy Price

naloxone
In a perfect world, opioid addicts would have free-access to the lifesaving drug naloxone. The drug can reverse the deadly effects of an opioid overdose, and one could argue that doctors should co-prescribe naloxone when they write an opioid prescription and community outreach programs should handout naloxone free to heroin addicts who cannot afford to buy it from a pharmacy. Sadly, that is not the world we live in, but some lawmakers in the United States have been fighting to expand access to the miracle drug, which has proved difficult because of price.

If one were looking to buy naloxone, they can expect to pay upwards of $150 for two doses. Certainly, you cannot put a price tag on life, but if you can’t afford the naloxone kit you may lose yours. Lawmakers have received a lot of pressure from addiction experts to reign in the ever-increasing price of the lifesaving drug. This week, experts called on the government to act in The New England Journal of Medicine, according to HealthDay. The experts write:

“Naloxone’s price increase is part of an overall trend of increasing prescription-drug prices for both new brand-name drugs and old, off-patent generics. Public frustration with rising drug prices has led to a number of recent policy proposals, including Vermont’s new legislation requiring companies to justify price increases, California’s attempt to constrain drug payments, and the recently proposed and bipartisan-supported Fair Accountability and Innovative Research Drug Pricing Act. None of the federal or state initiatives expanding naloxone’s availability, however, address the drug’s rising cost.” 

Part of the issue is that there are limited options. An increase in demand for the drug has the expected effect of drug makers seeing an opportunity to increase profit, regardless of the deadly consequence of people being unable to afford the drug. Here are the numbers:
  • Hospira (a Pfizer Inc. company) charges $142 for a 10-pack of naloxone —a 129 percent increase since 2012.
  • Amphastar's 1 milligram version of naloxone costs around $40—a 95 percent increase since September 2014.
  • A two-dose package of Evzio (naloxone) costs $4,500, a more than 500 percent increase over two years.
“The challenge is as the price goes up for naloxone, it becomes less accessible for patients,” said study lead author, Ravi Gupta, a fourth-year Yale medical student. "Taking action now is essential to ensuring that this lifesaving drug is available to patients and communities."
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