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Friday, May 27, 2016

Is W-18 Too Powerful for Naloxone?

Over the last few years there have been a number of deadly cases of heroin laced with fentanyl overdoses. Fentanyl is a powerful opioid analgesic, typically used in a hospital setting for either surgery or the most severe pain. The drug is roughly 80 to 100 times more powerful than morphine and around 40 to 50 times more potent than pharmaceutical grade heroin, according to the Centers for Disease Control and Prevention (CDC). With potency like this, it is easy to see that mixing fentanyl and heroin together is a sure recipe for disaster.

Fentanyl is now being produced in clandestine labs in China, shipped to Mexico and mixed with inferior grades of heroin to increase potency. Heroin users in the United States are often times unaware of the deadly admixture when they use, so they do not adjust their dosage accordingly—overdose often ensues. You might find yourself wondering if there could be a more deadly amalgamation. The answer to that question, unfortunately, is yes.

A drug that could be as many as 10,000 times more potent than morphine is possibly being mixed with heroin in the Philadelphia area, The Philadelphia Inquirer reports. The drug, known as W-18, may be too powerful for the opioid overdose drug naloxone to reverse. The Drug Enforcement Administration (DEA) has released a bulletin warning of the dangers associated with mixing W-18 with other drugs, such as heroin. The agency pointed out that a microscopic dose of W-18 could be fatal.

Recently, anesthesiologist Anita Gupta, who works as a pharmacist and pain specialist at Drexel University College of Medicine, began seeing cases of overdose where patients didn’t have the typical response when naloxone was administered. Gupta’s suspicion for the atypical response was the presence of W-18.

“The symptoms were worse than we were used to seeing,” said Gupta. “We were getting patients with symptoms of near-death, and often required multiple doses of the antidote naloxone.”

Thursday, May 19, 2016

Alcohol Sales Fall Globally

alcohol use
Last month was Alcohol Awareness Month (AAM), April has been the  AAM since 1987. The event is sponsored by the National Council on Alcoholism and Drug Dependence, Inc. (NCADD), whose goal is to:
  • Increase Public Awareness
  • Reduce Stigma Related to Alcohol Use Disorder
  • Encourage Local Communities to Focus on Alcoholism and Alcohol-Related Issues
The headlines these days regarding addiction, 9 times out of 10, seem to focus on prescription opioids and heroin–and for good reason. Opioid overdoses are now the leading cause of preventable death in the United States, with over 70 people across the country losing their life from an overdose each day. Lawmakers and health officials continue to work towards solutions for the insidious opioid epidemic.

Opioid use disorder is not the only addiction taking people’s lives every year, alcohol still takes a dramatic toll and causes premature deaths even though the drug is legal for adult consumption. Prolonged, heavy drinking can lead to a number of life threatening health problems. The Centers for Disease Control and Prevention (CDC) reports that alcohol can cause:
  • High Blood Pressure
  • Heart Disease
  • Stroke
  • Liver Disease
Fortunately, global alcohol sales are down for the first time since Euromonitor International began monitoring alcohol sales in 2001, CNN Money reports. While it would be nice to owe the reduction in sales to alcohol education campaigns like AAM, the reasons that people are drinking less has more to with troubled economies around the globe. In 2015 consumption fell by:
  • 4.9 percent in Eastern Europe
  • 3.5 percent in China (the equivalent to Portugal and Chile abstaining from drink)
  • 2.5 percent in Brazil
"The once infinite growth narrative that used to exist proves to be not so infinite," said Euromonitor's alcoholic drinks analyst Spiros Malandrakis.

Friday, May 13, 2016

Ending the Opioid Epidemic

prescription addiction
Despite the fact that opioid narcotics are meant to be used for acute severe pain, they are most commonly doled out to treat chronic pain—that is pain that is persistent over long periods of time. Most of the nation is aware that the American opioid epidemic is the result of over-prescribing painkillers for just about any severity of pain. The market share of opioid prescriptions is written by primary care physicians, the majority of which lack any specific pain management training.

For years and years, doctors have handed out large, high-dose prescription painkillers for extended periods of time regardless of the addictive and potentially deadly nature of such drugs. Such irresponsible prescribing has resulted in elevated addiction rates, overdoses, and thousands of deaths that could have been prevented. On top of that, Americans experiencing any level of pain expect to walk out of the doctor’s office with a prescription to ease their pain—such as oxycodone or hydrocodone.

As a nation we have forgotten that pain can, more times than not, be treated without having to turn to opioids. It is almost as if we have been conditioned to think there is only one solution to every type of pain. As the nation’s lawmakers continue to mitigate the opioid addiction crisis, many doctors are not coming to terms with the fact that they were a major cause that led to the epidemic and it will be up to them to bring it to an end. CNN’s Chief Medical Correspondent Dr. Sanjay Gupta wrote an op-ed last week, stating that:

“We as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.” 

This week, Dr. Gupta went on CNN’s "Anderson Cooper 360" for a town hall special to discuss and inform the public about opioid narcotics, particularly reaching out to: parents, spouses, siblings et.al. The good news is you can watch this special online or on DEMAND via your cable company. The special is called: Prescription Addiction: Made in the USA.

If you are having trouble viewing the trailer, you can see it here.

Friday, May 6, 2016

Two Types of Alcoholics

Drugs and alcohol take their toll on the human brain, which can be measured through a number of scanning techniques. When compared to the brains of people who have not had a substance use disorder, clear differences can be seen. That being said, the brain of one alcohol user may look different than another, and new research may have found that there are two types of alcoholics. Researchers from the University of Eastern Finland found that while all alcoholics share similar brain changes, some alterations are exclusive to one type of alcoholic but not another, PsychCentral reports. The findings are published in the journal Alcohol and Alcoholism.

There are two types of alcoholics, anxiety-prone (Type I) and impulsive (Type II) based on Cloninger’s typology, according to the article. The researchers looked at post-mortem brains from both types of alcoholics and a control group.

“From the viewpoint of the study setting, this division was made in order to highlight the wide spectrum of people suffering from alcohol dependence. The reality, of course, is far more diverse, and not every alcoholic fits into one of these categories,” said Olli Kärkkäinen, M.Sc. (Pharm).

Typically, Type I alcoholics are more prone to anxiety and are more likely to become dependent on alcohol later in life, the article reports. On the other hand, Type II alcoholics usually become dependent on alcohol when they are younger and show greater impulsivity and antisocial behavior. In Type I alcoholic brains, the researchers found:
  • Changes in the endocannabinoid system, which modulates stress responses.
  • Increased Docosahexaenoylethanolamide levels in the amygdala, possibly linked to their anxiety prone nature.
With Type II alcoholic brains, the researchers found elevated levels of AMPA receptors in the anterior cingulate cortex, according to the article. That part of the brain has a hand in learning and the regulation of behavior, which could explain the impulsive nature of Type II alcoholics.

“These findings enhance our understanding of changes in the brain that make people prone to alcoholism and that are caused by long-term use. Such information is useful for developing new drug therapies for alcoholism, and for targeting existing treatments at patients who will benefit the most,” said Kärkkäinen, the study findings were part of his doctoral thesis.
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