July 29, 2014, 03:12 pm
By Cristina Marcos
The House on Tuesday passed legislation by voice vote to establish enforcement standards for prescription drug abuse.
Specifically, the measure would amend the Controlled Substances Act to modify the definition of "imminent danger to the public health or safety" so that it applies to drugs that pose present or foreseeable health risks.
The bill would also allow prescription drug companies registered with the Drug Enforcement Administration to submit a "corrective action plan" before a drug is suspended.
Members of both parties said the legislation would help combat abuse of prescription drugs.
"By approving this legislation, we will be giving our nation's law enforcement additional tools while protecting our patients and securing our drug supply chain in a reasonable and common-sense way," said Rep. Joe Pitts (R-Pa.).
Rep. Tom Marino (R-Pa.), the bill's sponsor, said it would not hinder law-abiding companies.
"Any legitimate business involved in distributing or dispensing prescriptions welcomes appropriate oversight and regulation," Marino said.
The legislation would also require the Department of Health and Human Services to provide Congress with a report on the collaboration between enforcement agencies.
Democrats agreed that it would strengthen the prescription drug supply chain and federal enforcement of drug laws.
"This bill would help prevent prescription drug abuse, establish clear and consist enforcement stands, and ensure patients have access to needed medications," said Rep. Frank Pallone (D-N.J.).
Share and Enjoy
Share and Enjoy
“Right is right even if no one is doing it; wrong is wrong even if everyone is doing it.”
Share and Enjoy
Although brief interventions in primary care can make a difference for patients with risky alcohol use, similar approaches are ineffective for patients with problem drug use, according to a pair of studies published in this month’s JAMA.
"Brief counseling can work for a lot of things, but we found no evidence to support the widespread implementation of universal screening and brief intervention for illicit drug use or prescription drug misuse," said Richard Saitz, MD, a researcher at Boston University School of Public Health and School of Medicine.
"In retrospect, drug use is a complicated problem. While there might have been some hope that something as simple as this would work, it now appears it doesn't."
In the first study, researchers randomly assigned 868 patients who admitted to problematic drug use at seven primary care sites deemed “safety-net” clinics in Washington State to either enhanced care as usual (a handout and list of substance abuse resources) or a brief intervention (a handout and list, as well as provider feedback on the patient’s drug use screening results, motivational interviewing, and an attempted 10-minuted telephone booster within two weeks of the visit).
During 12 months of follow-up, researchers found no significant difference in drug use between patients who received care as usual and patients who received a brief intervention. Furthermore, the two groups showed no significant difference in secondary outcomes, which included hospital admissions, arrests, and death.
In the second study, researchers tested the effectiveness of two well-established brief interventions on 528 adults with unhealthy use of marijuana, cocaine, or opioids seeking primary care. A third of the study’s participants received a 10-minute structured interview intervention; another third underwent a 30-minute motivational interviewing intervention followed by a 20-minute session with counselors; and the remaining third received no intervention other than a standard list of substance abuse resources.
Over six months of follow-up, researchers found no significant differences among the groups for drug use, drug-use consequences, healthcare utilization, and unsafe sex.
Dr. Saitz, who led the second of the two studies, said the take-away message is not the ineffectiveness of drug screenings, rather, the insufficiency of one brief intervention to solve a patient’s drug problems.
"The message is not that we don't want to address drugs in medical settings—in fact, I believe we must, just as we address other risk factors and health conditions," he said. "Instead, the message is that this approach is inadequate. We're going to need something more. As doctors, we're going to have to take more responsibility for this problem, the same way we take responsibility for other factors that impact health."
1. Roy-Byrne P, Bumgardner K, Krupski A, et al. Brief intervention for problem drug use in safety-net primary care settings: a randomized clinical trial. JAMA. 2014; 312:492-501.
2. Saitz R, Palfai RP, Cheng DM, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA. 2014; 312:502-513.
3. Study examines effectiveness of brief intervention for problem drug use [press release]. EurekAlert!: Washington, DC; August 5, 2014.
4. Brief counseling for drug use doesn’t work, BU study finds [press release]. EurekAlert!: Washington, DC; August 5, 2014.
Share and Enjoy
NEW YORK - Young people may not see meaningful benefits from a counseling approach designed to curb their alcohol use, according to a new analysis of previous research.
Teens and young adults who took part in so-called motivational interviewing targeted to their risky drinking behaviors ended up drinking less alcohol and drinking less often, but the differences were not meaningful, researchers found.
"These programs aren't working or aren't working as well as we thought they should and we as society, policymakers and practitioners need to think of what we can do instead," said David Foxcroft, the study's lead author, from Oxford Brookes University in the UK.
Counselors who practice motivational interviewing interact with their patients in a non-judgmental way to highlight the dangers of an activity in the hope of coaxing a person past their ambivalence about changing their behavior.
In a report released August 20 by The Cochrane Library, Foxcroft and his colleagues say motivational interviewing is a popular technique used to target excessive drinking among teens, but until now it has not been examined by the Cochrane Collaboration, an international organization that evaluates medical evidence.
For this review, the researchers pooled data from clinical trials of motivational interviewing targeted to drinking among young people between 15 and 26 years old and comparing the method to no counseling or to some other intervention or therapy.
Overall, they found 66 trials involving 17,901 people. Most were conducted on college campuses. The rest were in other settings such as youth prisons and centers.
Foxcroft said a typical person included in these trials would be a college student deemed to be at risk for alcohol abuse through behavior caught by campus officials or through some sort of screening tool or test.
Most participants attended one individual session with a counselor while the rest attended either group sessions or a mix of individual and group sessions.
The researchers found that after four months, those who went through the counseling reported drinking an average of about 12.2 alcoholic drinks per week, compared to about 13.7 drinks per week among people who didn't go through motivational interviewing.
Those who went through motivational interviewing also reported drinking an average 2.5 days during the week four months later, compared to about 2.7 days per week among those who didn't go through the counseling.
The counseling group also saw a slight decrease in their maximum blood alcohol levels, but the average blood alcohol level did not change. Risky behaviors like binge drinking or driving drunk did not change at all among the young counseling participants.
Although some of the differences were greater than could be attributed to chance, the size of the effects overall are too small "to be of relevance to policy or practice," the study authors conclude.
"This review challenges what has been previously thought or concluded in previous research on motivational interviewing," Foxcroft said.
While the study casts doubts on the effectiveness of the counseling, the researchers cannot say it doesn't work for certain subgroups of young adults or that it's not effective for older populations like the elderly, he added.
For example, the new study included many college students who went to counseling as punishment for drinking in college and who may not be ready to make a meaningful behavior change.
Dr. Ken Carpenter, clinical director of the Substance and Treatment Research Service at Columbia Psychiatry/NY State Psychiatric Institute in New York, said the study's findings are limited by the quality of the research and data included in the analysis.
"A lot of these studies say they do (motivational interviewing) but a lot of them don't show how well it's being done," said Carpenter, who has been a motivational interviewing trainer and practitioner for the past 10 years.
He said the new findings won't change how he practices other than to look for other ways to support his patients.
"Certainly we should think through learning the boundaries and that these brief interventions may not be as helpful as we hoped they would be," he said.
Cochrane Library 2014.
(c) Copyright Thomson Reuters 2014
Share and Enjoy
A group of students and a professor of neuroscience have discovered that Oreo cookies may be as addictive as cocaine or morphine - to lab rats at least.
Professor Joseph Schroeder and his students at Connecticut College were conducting research on the addictiveness of high-fat and high-sugar foods, and how, for instance, they may contribute to the obesityepidemic.
Prof. Schroeder says:
"Our research supports the theory that high-fat, high-sugar foods stimulate the brain in the same way that drugs do. It may explain why some people can't resist these foods despite the fact that they know they are bad for them."
One of the students, Jamie Honohan (who has since graduated with a BA in Behavioral Neuroscience), was particularly interested in human motivation and food, and how the obesity epidemic may be linked to the prevalence of high-fat, high-sugar foods in low-income neighborhoods. It was her idea to use Oreos, as she explains in a statement issued this week:
"We chose Oreos not only because they are America's favorite cookie, and highly palatable to rats, but also because products containing high amounts of fat and sugar are heavily marketed in communities with lower socioeconomic statuses."
The results of their study are being presented at the Society for Neuroscience conference that is taking place early November in San Diego, CA.
Measuring pleasurable effects
The study shows that for rats, the association between the pleasurable effects of eating Oreos and a specific environment were as strong as for cocaine or morphine and a specific environment.
Oreo is the best selling cookie in the United States (source
For their study, the students gave Oreos to hungry rats on one side of a maze, and on the other side of the maze they gave them a "control" food, in this case, rice cakes (Prof. Schroeder comments that like humans, rats do not seem to relish rice cakes very much).
Then they gave the rats the option to go to either side of the maze (without the food present), and measured how long they spent on the side where they were typically fed with Oreos compared with the side they were fed with rice cakes.
The researchers then repeated the experiment with another group of rats. This time, instead of feeding them Oreos and rice cakes, they injected them with addictive drugs - such as cocaine and morphine - when they were on one side of the maze, or saline, when they were on the other side. (Prof. Schroeder is licensed to carry out this kind of experiment).
The results show that the rats "addicted" to Oreos spent as much time on the side where they had been conditioned with Oreos as the rats that had been conditioned with addictive drugs spent on the drugs side of their maze.
High-fat, high-sugar foods 'addictive'
Prof. Schroeder and one of the students, Lauren Cameron, furthered the research by measuring the expression of a protein called c-Fos in the pleasure center of the rats' brains.
"It basically tells us how many cells were turned on in a specific region of the brain in response to the drugs or Oreos," Prof. Schroeder explains.
They found Oreos stimulated many more neurons than cocaine or morphine. This is in line with the findings of the earlier behavioral experiments and supports the idea that the high-fat, high-sugar foods are addictive.
In 2011, a team from Yale University reported finding that food addiction and substance dependence have similar brain activity.
And finally, one interesting observation - it seems that just like humans, rats eat the middle of an Oreo first.
Written by Catharine Paddock PhD
Share and Enjoy
Read More at www.ecigarettedirect.co.uk
Share and Enjoy
In an earlier blog entry, I discussed how our dialogue around cannabis has lost credibility with young people, the group more likely to use cannabis.
I have a common kind of patient in my practice—he (it’s typically a young man, but increasingly, I see young women like this) is somewhere in his late teens or early twenties, usually living at home, maybe taking a class or two at the community college, more often working but certainly not able to support himself without the help of his parents. His hobbies are often solitary, like video games. And he’s using a lot of cannabis.
The patient isn’t particularly depressed, and fortunately, he’s not developing a psychosis (more on this risk in a later blog entry), but it’s clear that he’s failing to launch.
His presentation is a little nonchalant, but it’s more awkward than oppositional. Responses are brief, monotone, and without eye contact. Then there’s that laugh, that anxious chuckle that has come to be the stereotype of the young cannabis user. He looks like he can’t wait to be somewhere else. It’s become clear to me that this lack of confidence, this inability to take risks, this social isolation, are all symptoms of social anxiety.
This should not be surprising, as Julia Buckner and her colleagues at Louisiana State University found in a 2012 paper (1), that 29% of people with a DSM-IV cannabis dependence (this is before the newer DSM5 nomenclature of “cannabis use disorder”) also had a diagnosis of social anxiety. Even more interesting was the sequence of events—85% of the subjects had the social anxiety before they began using cannabis. That is to say, the anxiety came first.
The obvious explanation is that these socially anxious young people are self-medicating, using a drug which can, for some people, be anxiolytic. However, I suspect that the explanation is actually more complex.
Cannabis use is common in many youth subcultures. The ritual of using cannabis is often quite social, as the old reggae lyric of “pass the duchie to the left hand side” reminds us (2). Social rituals and conventions, be they handshakes or small talk, help us to manage the anxiogenic uncertainty that comes with social meetings, and I suspect that this group use of cannabis is appealing to socially awkward young people.
It is the cost of this ritual that concerns me the most. Young people who use cannabis heavily are more prone to cognitive declines over time (3) and more at risk to develop psychosis (4), especially individuals who are genetically vulnerable (5, 6). In addition, users who also have social anxiety were found to be less likely to be in meaningful relationships and tended not to go as far in their education.
It’s been said that chronic cannabis use delays emotional maturation. This notion, while initially appealing and resonant with some of my clinical experiences, lacks specificity. What exactly is “emotional maturation,” anyways? I would define one aspect as “being able to manage uncomfortable social situations without resorting to avoidance.”
Avoidance, as any behavioral therapist will tell you, is exactly the thing that keeps an anxiety-driven behavior going. So, if cannabis and the rituals surrounding its use is a means of avoiding social anxiety, is it any wonder that these young people appear to be lacking skills in navigating the adult world?
So how do we help young people who are trying to reduce or quit using cannabis? If social anxiety is present, it’s important to identify it and treat it. There are several useful treatments for this anxiety, from SSRIs and benzodiazepines to social skills training and exposure therapy.
Really, the best treatment for any anxiety is exposure to the anxiogenic stimulus. Can we, as clinicians, use the therapeutic opportunity of the clinical encounter to take these socially anxious young people and role-model social confidence and help them learn how to navigate the challenges of adulthood without resorting to cannabis?
If this subject is of interest to you, please come to my session “Medicine or Menace: Working with Cannabis use in a Time of Legalization” in Orlando Florida at the 27th Annual US Psychiatric & Mental Health Congress.
1. Buckner et al. Drug Alch Dep. 2012. 124(1-2).
2. Musical Youth. YouTube. https://www.youtube.com/watch?v=dFtLONl4cNc
3. Meier et al. PNAS. 2012;109(40).
4. Di Forti et al. Schiz Bull. 2013;[Epub Dec 17, 2013].
5. Estrada G et al. Acta Psychiatr Scand. 2011;123(6):485-492.
6. Verdejo-Garcia et al. Neuropsychopharmacology. 2013;38: 1598-1606.
Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Assistant Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, CA, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.
Share and Enjoy