Bup Feeds

Buprenorphine Treatment for Probationers and Parolees.

Buprenorphine Research (PubMed) - Tue, 04/08/2014 - 6:00am

Buprenorphine Treatment for Probationers and Parolees.

Subst Abus. 2014 Apr 4;

Authors: Gordon MS, Kinlock TW, Schwartz RP, Couvillion KA, Sudec LJ, O'Grady KE, Vocci FJ, Shabazz H

Abstract
ABSTRACT Background: Pharmacotherapy studies involving buprenorphine have rarely been conducted with US community corrections populations. This is one of the first reports of buprenorphine treatment outcomes of adult opioid-dependent probationers and parolees. Methods: This longitudinal study examined the 3-month treatment outcomes for a sample of probation and parole clients (N=64) who received community-based buprenorphine treatment. Results: Approximately two-thirds of the sample (67%) were still in treatment at three months post-baseline. Furthermore, there was a significant decline in the number of self-reported heroin use days and crime days from baseline to three months post-baseline. While there was not a significant reduction in reincarcerations, there was no evidence that they had increased. Conclusions: Given that buprenorphine is approved by the FDA as a safe, effective treatment for opioid use disorders, individuals on parole or probation should have the opportunity to benefit from it through community-based programs.

PMID: 24701967 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Comparison of intrathecal dexmedetomidine with buprenorphine as adjuvant to bupivacaine in spinal asnaesthesia.

Buprenorphine Research (PubMed) - Sat, 04/05/2014 - 3:45pm

Comparison of intrathecal dexmedetomidine with buprenorphine as adjuvant to bupivacaine in spinal asnaesthesia.

J Clin Diagn Res. 2014 Feb;8(2):114-7

Authors: Gupta M, Shailaja S, Hegde KS

Abstract
Background: The supplementation of local anaesthetics with adjuvants to improve the efficacy of subarachnoid block has been recognised since long. The most preferred drug has been opioids, but newer drugs like dexmedetomidine has also been introduced and investigated as an effective adjuvant. Aim: This study was conducted to evaluate and compare the characteristics of subarachnoid blockade, hemodynamic stability and adverse effects of intrathecal buprenorphine and intrathecal dexmedetomidine as an adjuvant to 0.5% hyperbaric bupivacaine for lower abdominal surgeries. Materials and Methods: The present study included 60 patients aged between 18-60 years classified as American Society of Anesthesiologists (ASA) Physical Status (PS) I/II scheduled for elective lower abdominal surgeries. The patients were randomly allotted to two groups to receive intrathecal 3ml of 0.5% bupivacine with 60µg of buprenorphine (Group B; n=30) or 3ml of 0.5% bupivacaine with 5µg of dexmedetomidine (Group D; n=30). The onset time to peak sensory level, motor block, sedation, Haemodynamic variables, duration of motor block, analgesia and any adverse effects were noted. Results: There was no significant difference between groups regarding demographic characteristics and type of surgery. The motor, sensory blockade and time of rescue analgesia were significantly prolonged in Group D compared to Group B. The sedation level was higher in Group D compared to Group B. There was no significant difference in haemodynamic variables although Group B had lower Heart Rate (HR) than Group D. Conclusion: Intrathecal dexmedetomidine when compared to intrathecal buprenorphine causes prolonged anaesthesia and analgesia with reduced need for sedation and rescue analgesics.

PMID: 24701498 [PubMed]

Categories: Bup Feeds

Naltrexone implant treatment for buprenorphine dependence - Mauritian case series.

Buprenorphine Research (PubMed) - Fri, 04/04/2014 - 7:30am

Naltrexone implant treatment for buprenorphine dependence - Mauritian case series.

J Psychopharmacol. 2014 Apr 2;

Authors: Jhugroo A, Ellayah D, Norman A, Hulse G

Abstract
Although substitution therapy with opiate agonist treatments such as methadone and buprenorphine has resulted in a reduction of illicit drug use related harm, such treatment has also resulted in severe problems in some countries where opioid-dependent individuals now inject illicitly sold buprenorphine or buprenorphine-naloxone instead of heroin. There is no approved treatment for buprenorphine dependence. Naltrexone is an opioid antagonist which has been used for the treatment of both alcohol and opioid dependencies. Although both buprenorphine and heroin resemble each other concerning their effects, buprenorphine has a higher affinity to opioid receptors than heroin. Therefore, it is not known if naltrexone can block the psychoactive effects of buprenorphine as it does for heroin. This paper presents observational case series data on the use of a sustained-release naltrexone implant for the treatment of buprenorphine dependence. To the authors' knowledge this is the first use of sustained-release naltrexone for this indication.

PMID: 24695742 [PubMed - as supplied by publisher]

Categories: Bup Feeds

A Retrospective Study of Retention of Opioid-Dependent Adolescents and Young Adults in an Outpatient Buprenorphine/Naloxone Clinic.

Buprenorphine Research (PubMed) - Fri, 04/04/2014 - 7:30am

A Retrospective Study of Retention of Opioid-Dependent Adolescents and Young Adults in an Outpatient Buprenorphine/Naloxone Clinic.

J Addict Med. 2014 Apr 1;

Authors: Matson SC, Hobson G, Abdel-Rasoul M, Bonny AE

Abstract
OBJECTIVES:: Opioid abuse and dependence rates continue to rise among US adolescents. Medication-assisted treatment with buprenorphine/naloxone (BUP/NAL) has been shown to be effective up to 12 weeks. Few data are available regarding extended treatment outcomes. The objective of this study was to describe 1-year retention and compliance of a specific pediatric, outpatient BUP/NAL treatment program for opioid-dependent adolescents and young adults.
METHODS:: Retrospective chart review was conducted of all opioid-dependent adolescents and young adults (N = 103) who sought treatment from January 12, 2010, to January 9, 2011. Participants were classified as prescription opioid-dependent or combined heroin/prescription opioid-dependent. Opioid abstinence and BUP/NAL compliance were assessed by urine drug screen (UDS) at each visit. A Kaplan-Meier curve was fit to describe patients' retention time over 1 year.
RESULTS:: Mean age was 19.2 ± 1.6 years, 50.5% male, 98.1% white non-Hispanic, and 31.9% prescription opioid-dependent. Overall rates of opioid abstinence and BUP/NAL compliance were high (85.2% and 86.6%, respectively). Seventy-five percent of patients returned for a second visit. Patient retention was 45% at 60 days and 9% at 1 year. Female sex (P < 0.05), negative UDS for opioids (P < 0.001) or tetrahydrocannabinol (P < 0.001), and positive UDS for BUP/NAL (P < 0.001) were associated with longer retention time.
CONCLUSIONS:: Although patient retention was the largest barrier to success, a subset of opioid-dependent adolescents and young adults achieved long-term sobriety in our specific clinic program with continued outpatient BUP/NAL therapy. Retention correlated with UDS negative for opioids, negative for tetrahydrocannabinol, and positive for BUP/NAL.

PMID: 24695018 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Primary care management of opioid dependence: the addition of CBT gives no extra benefit compared to standard physician management alone.

Buprenorphine Research (PubMed) - Fri, 04/04/2014 - 7:30am
Related Articles

Primary care management of opioid dependence: the addition of CBT gives no extra benefit compared to standard physician management alone.

Evid Based Ment Health. 2013 Aug;16(3):76

Authors: Miotto K

PMID: 23616210 [PubMed - indexed for MEDLINE]

Categories: Bup Feeds

75 Percent of Americans See Marijuana Legalization as Inevitable, Survey Finds

Drug and Alcohol News (JoinTogether.com) - Thu, 04/03/2014 - 11:54am

A new survey finds 75 percent of Americans think it is inevitable that recreational marijuana will become legal across the country, ABC News reports. The survey also found a growing number of Americans support ending mandatory minimum prison sentences for non-violent drug offenders.

More Americans are in favor of overturning laws that require jail time for possessing small amounts of marijuana, according to the Pew Research Center survey. “Even people who don’t favor the legalization of marijuana think the possession of small amounts shouldn’t result in jail time,” said Carroll Doherty, Pew’s Director of Political Research.

The survey found increasing support for legalization. Four years ago, 52 percent of survey respondents said they thought marijuana should not be legal and 41 percent said it should. This year, 54 percent of respondents said they favor legalization and 42 percent oppose it.

Many people remain concerned about drug abuse, the survey indicates—32 percent of respondents called it a crisis, and 55 percent said it is a serious national problem. In addition, 54 percent said they thought marijuana legalization would lead to more underage people trying the drug.

The findings were released this week as legislators around the country are considering changes to drug policies, the article notes. At least 30 states have modified penalties for drug crimes since 2009. Many of these states have repealed or reduced mandatory minimum sentences for lower-level drug offenses.

The federal government is also changing its approach to low-level drug crimes. Earlier this month, U.S. Attorney General Eric Holder testified in favor of changing federal guidelines to reduce the average sentence for drug dealers. He told the United States Sentencing Commission the Obama Administration supports changing guidelines to reduce the average drug sentence by about one year, from 62 months to 51 months.

Categories: Bup Feeds

Study Finds Increase in Number of Headache Patients Given Narcotics in the ER

Drug and Alcohol News (JoinTogether.com) - Thu, 04/03/2014 - 11:54am

Contrary to the advice of many medical groups, more emergency departments are giving headache patients prescriptions for powerful narcotic painkillers, according to a new study. Between 2001 and 2010, there was a 65 percent increase in emergency department use of narcotic prescriptions for headaches. Hydromorphone and oxycodone were two of the most frequently prescribed narcotics.

A number of groups, including the American College of Emergency Physicians and the American Academy of Neurology, say narcotics should not be used as a first-line treatment for headaches, HealthDay reports.

During the same period, there was no increase in ER prescriptions for non-narcotic pain relievers such as acetaminophen, nonsteroidal anti-inflammatory medications, or triptans (drugs used to treat migraines).

The study authors, who presented their findings at the American College of Medical Toxicology annual meeting, said they are concerned about the findings, in part because of the increasing rates of abuse, overdose and deaths due to narcotics.

“These findings are particularly concerning given the magnitude of increase in [narcotic painkiller] prescribing compared to the other non-addictive medications, whose use remained the same or declined,” lead investigator Dr. Maryann Mazer-Amirshahi of George Washington University said in a news release.

Co-researcher Dr. Jeanmarie Perrone of the University of Pennsylvania said several factors could be contributing to the increased narcotic prescriptions for headaches, including an increased focus on pain management, patient satisfaction, and regulatory requirements.

Categories: Bup Feeds

Bill to Overhaul Mental Health Care Spurs Debate

Drug and Alcohol News (JoinTogether.com) - Thu, 04/03/2014 - 11:53am

A bill designed to overhaul the mental health care system in the United States has spurred debate among advocates for the mentally ill, The New York Times reports. Some groups oppose the measure because it includes provisions for expanded use of involuntary outpatient treatment.

Congress will hear testimony about The Helping Families in Mental Health Crisis Act on Thursday. The act is considered to be the most ambitious overhaul plan in decades, the newspaper notes. Its prospects are not clear.

Several mental health organizations are supporting the bill, which has more than a dozen Democratic co-sponsors in the House. Last week both the House and Senate voted to expand funding for outpatient treatment programs, one of the bill’s central provisions. The House Energy and Commerce Health Subcommittee will hear testimony on the entire bill today.

Parts of the bill have wide support, including provisions to streamline payment for services under Medicaid, and to provide funds for clinics that meet standards for scientifically supported, rigorous care. The bill would fund suicide prevention programs and remote video therapy for rural areas without adequate mental health services. Police officers and emergency medical works would receive increased training in how to identify and treat people with mental disorders.

The bill would provide grants to states for “assisted outpatient treatment programs” for court-ordered treatment for certain people with mental illness and a history of legal or other problems. In most cases, the programs try to ensure these people take their medication—in some cases, against their will.

Gina Nikkel, President and Chief Executive of the Foundation for Excellence in Mental Health Care, told the newspaper, “This becomes a civil rights issue quickly, and it can drive people away from seeking services when they fear treatment will be forced on them or they’ll be locked up.”

Categories: Bup Feeds

Frequency of Energy Drink Use Linked with Risk of Abusing Prescription Drugs

Drug and Alcohol News (JoinTogether.com) - Thu, 04/03/2014 - 11:53am

College students who consume energy drinks are more likely than their peers who don’t use them to abuse prescription drugs, a new study concludes. The more energy drinks a student consumes, the greater their risk.

The study included undergraduate and graduate college students, who completed a web-based survey about their pattern of energy drink and prescription stimulant use. They were asked about medications prescribed to them, as well as drugs they took without a prescription.

The more energy drinks students consumed, the likelier they were to illicitly use prescription stimulants. All students who had a valid prescription for stimulant medications said they mixed energy drinks with their stimulants. This is discouraged, because it can increase side effects, News-Medical.net reports.

The findings are published in Substance Abuse.

“This article includes a needed review of the neurological effects of energy drink ingredients. It also provides practitioners with important information about the dangerous interactions that can occur when energy drinks are mixed with prescription stimulants or other pharmaceutical drugs,” lead author Dr. Conrad Woolsey said in a news release. “Ginseng, for example, should not be mixed with anti-depressant medications or prescription stimulants because this can cause dangerously high levels of serotonin (i.e., serotonin syndrome), which is known for causing rapid irregular heartbeats and even seizures.”

Categories: Bup Feeds

Major League Baseball Charities and The Partnership at Drugfree.org Announce the Fifth Annual Commissioner’s Play Healthy Awards

Drug and Alcohol News (JoinTogether.com) - Thu, 04/03/2014 - 9:10am

New York, NY (April 3, 2014) – The Partnership at Drugfree.org, in conjunction with Major League Baseball Charities (MLB), today announce the fifth annual Commissioner’s Play Healthy Awards to celebrate extraordinary individuals on and off the playing field. The awards are an extension of both organizations’ comprehensive efforts, including the new Play Healthy website, to educate families on the risks of steroids and performance-enhancing substances, and to recognize youth coaches and student athletes who embody the spirit of teamwork and healthy, drug-free competition.

One winning youth coach and one student athlete will receive prizes, including a trip for themselves and one special guest to New York City. The winning coach and athlete will also receive two tickets each to The Partnership at Drugfree.org’s annual gala at Gotham Hall on November 20, 2014, where they will be honored. Additional prizes will consist of a $500 gift card to a sporting goods store, a commemorative plaque presented at the gala and the opportunity to be featured prominently on drugfree.org.

A panel of judges will determine the winners by reviewing all nominees who demonstrate their commitment to fair, drug-free play and an overall healthy lifestyle. Additionally, the judges will evaluate the nominee’s commitment to leadership, sportsmanship and encouragement of others on and off the field. The applications consist of general information about the athlete or coach and a short essay.

“Major League Baseball continues to proudly support the efforts of The Partnership at Drugfree.org,” said Baseball Commissioner Allan H. (Bud) Selig. “It is imperative that everyone involved with youth sports understands the significance and benefits of fair and healthy competition, and The Partnership does a wonderful job of educating coaches, parents and young people of these important virtues, especially through initiatives like the Play Healthy Awards. We are looking forward to joining them in recognizing exceptional individuals who embrace the concept of fair play and puts these ideals into action.”

“Athletes face enormous pressure to excel in competition, and despite a small number opting to make the unhealthy choice to use performance-enhancing substances, the vast majority of student athletes and youth coaches lead their teams and communities in healthy play,” said Steve Pasierb, President of The Partnership at Drugfree.org. “Through our ongoing partnership with MLB, we are honored to recognize these elite individuals with the Commissioner’s Play Healthy Award for their work to promote healthy living and the positive influence sports can have on a teen’s life.  This is an award that every parent, every coach, every family with an exemplary student athlete in their life should enter.”

Steve Carter, a youth coach and Parks Foundation Director from Beltsville, Maryland and Garrett Burk, a teen athlete from Laguna Beach, California, were the recipients of the fourth annual Commissioner’s Play Healthy Awards last year.

Nominations may be submitted online at drugfree.org/playhealthy from Thursday, April 3, 2014 to Friday, October 31, 2014. Nominees for the student athlete award must be between 13 and 18 years old and nominees for the youth coach award must coach teams of students who are between the ages of 13 to 18. If qualified, individuals can nominate themselves or the nomination can be made by someone other than the person being nominated. Winners of the Commissioner’s Play Healthy Award will be notified on Friday, November 7, 2014, and announced on Friday, November 21, 2014. Please visit drugfree.org/playhealthy for additional contest rules and regulations. Use #playhealthy to follow the conversation on social media.

# # # #

About The Partnership at Drugfree.org 

Ninety percent of addictions start in the teenage years. The Partnership at Drugfree.org is dedicated to solving the problem of teen substance abuse. Together with experts in science, parenting and communications, the nonprofit translates research on teen behavior, addiction and treatment into useful and effective resources for both individuals and communities. Working toward a vision where all young people will be able to live their lives free of drug and alcohol abuse, The Partnership at Drugfree.org works with parents and other influencers to help them prevent and get help for drug and alcohol abuse by teens and young adults. The organization depends on donations from individuals, corporations, foundations and the public sector and is thankful to SAG-AFTRA and the advertising and media industries for their ongoing generosity. If you or someone you know is struggling with drug or alcohol abuse, please call The Parents Toll-Free Helpline at 1-855-DRUGFREE.

Categories: Bup Feeds

US Practitioner Prescribing Practices and Patient Characteristics of those Newly Treated with a Buprenorphine Transdermal Patch System.

Buprenorphine Research (PubMed) - Thu, 04/03/2014 - 6:00am

US Practitioner Prescribing Practices and Patient Characteristics of those Newly Treated with a Buprenorphine Transdermal Patch System.

Curr Med Res Opin. 2014 Apr 1;

Authors: Pergolizzi JV, Ben-Joseph R, Chang CL, Hess G

Abstract
Abstract Objectives: Medication prescribing information provides guidance to healthcare providers on how to prescribe a drug properly. Oftentimes patient factors in addition to the prescribing information are considered when selecting medications. Utilizing real-world pharmacy and medical claims data, this study assessed US practitioner prescribing practices of US approved transdermal buprenorphine system (BTDS) in relation to BTDS's full prescribing information (FPI) as well as the relationship between patient factors and initial BTDS dose. Research Design and Methods: Patients aged ≥18 years initiating BTDS during 1/1/2011-11/30/2011 were identified in the IMS Pharmacy and Private Practitioner Medical Claims databases. The index date was defined as the first filled BTDS prescription. Demographics, chronic pain related medical conditions in 12 months pre-index and prior medication use in 6 months pre-index was assessed. Initial BTDS dosing strength, receipt of approved initial BTDS dose per the FPI, and concomitant medications was assessed in the post-index 6-month period. Results: The study included 10,457 patients newly treated with BTDS. Majority of patients were female (69.9%) with a mean (±SD) age of 54.5(±15.2) years. Within 6 months prior to the index BTDS prescription, 91.7% of the patients used opioids. Overall, 48.9% of patients were prescribed the FPI approved BTDS dose. When stratified, 73.5% of opioid naïve patients received the FPI approved initial dose compared to 46.0% of those with prior opioid experience of ≤ 80 mg morphine-equivalent daily dose. Patients on BTDS alone (i.e. mono-therapy) had a higher rate of receiving the FPI approved initial BTDS dose compared to patients on BTDS concomitant regimens (p < 0.05). Conclusions: Practitioners demonstrated that they prescribe in accordance with BTDS's prescribing information in the majority of opioid naïve patients and in approximately half of opioid experienced patients. The initial opioid dose is a critical step in treatment, setting the stage for preventing side effects and improving treatment effectiveness. Understanding practitioner prescribing practices in regards to the initial dose selection of BTDS may provide insight on how to improve outcomes of care and reduce healthcare resource utilization and costs associated with pain management. Limitations: Data obtained from prescription claims reflect only the activities of prescriptions filled, not medication use or other clinical characteristics observed by physicians when treating patients.

PMID: 24689806 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Commentary: From Lemons to Lemonade and Defense to Offense: An Activist’s Journey on the Road to Parity

Drug and Alcohol News (JoinTogether.com) - Wed, 04/02/2014 - 11:46am

In my recovery story, I often speak about making lemonade out of lemons. From my greatest personal struggle with addiction came my greatest professional passion and strength – being an activist, lobbyist and champion for those needing or seeking recovery from addiction and mental illness like me. My 18-year recovery journey to get parity passed and implemented is not over, but it’s important to share some lessons learned along the way.

The Early Years
In 1996, I began working on parity. Addiction was left out of the first mental health parity bill that was signed into law in 1996. From that point forward, my challenge was laid before me: get a parity bill that included addiction signed into law and implemented.

I brought lived experienced with addiction, anger, passion; Washington know-how; and staff that was consistently smarter than me to the table. I lacked a lot of technical knowledge initially, and it showed. I have learned about the clinical aspects of addiction, and later, mental illness from my clients, including addiction physicians, residential addiction treatment facilities, psychiatrists and psychiatric health systems. I learned about the very real tragedies that happen every day to families who lose loved ones, or worse, lose them behind the walls of prisons and jails through my work with Faces and Voices, the National Alliance on Mental Illness and Mental Health America. I began to carry around the picture of a 16-year-old girl who died from a heroin overdose to remind myself what I am fighting for on the days when I was discouraged and felt like parity would never pass. For good luck, I wore my lucky Irish clover necklace on the days of big votes and the day the Supreme Court upheld the Affordable Care Act (ACA).

Collaboration with Mental Health Advocates
To succeed, bridging the gaps between addiction and mental illness advocacy groups was going to be a necessity. I was an unlikely candidate as I had been a flag waving, card-carrying purist addiction advocate steeled against the discrimination I felt even among mental health advocates. To get the bill passed, former Congressman Patrick Kennedy issued an edict that I would work with another mental health advocate and establish a joint parity coalition. There were some awkward first meetings, but we made it work. Later, I had to go to a colleague who was negotiating the Senate version of parity. We compromised. The bill sponsors compromised. The bill passed, and the addiction and mental health communities have worked together on the broader health policy agenda ever since. Success has a thousand fathers and we all shared in it. We built on that shared success in the provisions we secured in the Affordable Care Act. The addiction and mental health communities had their own agendas as they should but my purist days are done. Politics is not about purity, especially when working highly stigmatized, under-funded advocacy campaigns. The goal is to find winning strategies, build coalitions and run plays that advance strategic objectives; sometimes with big sexy wins and others with baby steps that no one notices. The trick is to stay in the game, head down and work to build forward momentum.

Using “Luck” and Tragedy
Turning tragedies into lucky breaks and then forward momentum on issues is something that advocates in our field know all about. The trick is to feel and then afford the tragic situation the dignity, respect and healing time it deserves while planning strategies aimed at ensuring the tragedy never happens again. Sadly, overdose deaths and suicides are an all too familiar reality to recovery advocates. Sometimes the scale of these tragedies creates issue openings.The tragic shootings at Newtown resulted in a Presidential Executive Order that required that a final parity rule be out by the end of last year. Once that executive order was issued, it was just a matter of persistent, but polite pushing.

Other times electoral outcomes provided the luck needed to move meaningful parity bills. In 2006, when Democrats took control of the House and Senate, we had the opportunity to work on the introduction of strong parity bills that were championed by a bipartisan team of legislators, then Reps. Patrick Kennedy (D-RI) and Jim Ramstad (R-MN), former Senator Pete Domenici (R-NM) and the late Senator Kennedy (D-MA), all who had been touched personally by mental illness and/or addiction. Planning on these bills literally started the Wednesday after the elections when it was clear Democrats would control the House and the Senate. Struggling as we had to even get a hearing on parity legislation in the 1990s through early 2000s, when opportunity knocked in 2006, we opened the door and got busy. When these strategies worked and a compromise bill was reached, luck and Senate legislative acumen and tenacity were able to get our parity bill attached to the 2008 Bank Bailout Bill. Once President Bush signed the bill into law on October 3, 2008, we began planning a big celebration honoring the work of our House and Senate champions and allowing advocates, many who had worked on the law’s passage for more than a decade, to celebrate their hard-won victory.

Regulations Matter
I remember standing at the back of that party with a mental health lobbyist planning our attack on advancing the regulations to make the law mean something. That didn’t feel anti-social to me at the time – that’s just what advocates do, I told myself. We planned a lunch for the following week at a well-known DC restaurant and wrote out the regulatory strategy on scraps of paper and business cards. We were lucky enough to find committed addiction and mental health provider and consumer groups to fund the effort.

We stuck to the strategy and ran these plays for five years until we got the final rule last November. The work to implement the laws is ongoing and cannot be done just by advocates like me. Persistence in Washington is something that is not for the faint of heart. Most people can’t endure it and that keeps people like me in business. It can be frustrating, agonizingly slow and heartbreaking as lives are lost while it appears DC is doing nothing. Keeping clients to fund the advocacy work during the late 1990s to early 2000s when nothing moved was also challenging. A couple of years it was tough to distinguish whether I was a volunteer or a hired gun. I can remember going to conferences and meetings during that time and I could tell my colleagues and friends pitied me; a woman obsessed with an unwinnable cause.

Working to get regulations implemented is an “inside the Beltway” technician’s task but it is deadly important. Often well-funded opponents will rewrite a law through regulations and we worked really hard to make sure the parity law did not fall prey to that type of attack.

Burnout is a Reality
Two years into the regulatory process and 14 years in on parity, I had to face that I was burnt out, had let my health go and had neglected my marriage and my social life. It happened ever so slowly by working nights and weekends, traveling to shore up clients and pleading with the advocacy community that parity will make a difference, while fighting with payers every day and regulators about how the law is being improperly implemented. The intensely personal nature of parity to me has been my greatest strength and biggest weakness, but it remains an honor to work on something so important to me and the lives of so many. Always being on the defense, slaying dragons and fighting for the little guy is exhausting. I had to find a new positive way of looking at the pursuit of parity to allow myself to actually be balanced and well – what recovery is all about.

From Defense to Offense
I am not sure why it took me so long to realize why we should start playing offense instead of defense. It is a lot less draining and has given me a fresh perspective. Parity and the ACA have passed, the regulations are written and now we must offensively use the laws, the regulations, our grassroots and grasstops advocates to implement that which we have earned. We are not sitting at the kids table anymore begging for scraps from the adult table. We have a shiny new cost savings solution to provide public and private payers and that proves they are more efficient with us than without us.

While you can bet you will still hear me at a conference near you asking for your documentation of parity and ACA violations and why it is everyone’s job to see these laws succeed, I know now we are doing it with the wind at our back and not in our face. I take time out to enjoy some really good lemonade along the way.

Carol McDaid

 

 

 

 

Categories: Bup Feeds

Parents Influence Teens’ Drinking Decisions: Survey

Drug and Alcohol News (JoinTogether.com) - Wed, 04/02/2014 - 11:46am

Parents do have an influence on teens’ decisions about drinking, according to a new survey by Mothers Against Drunk Driving (MADD). Teens are much less likely to drink if their parents tell them underage drinking is completely unacceptable, the survey found.

The online survey of 663 U.S. high school students found only 8 percent of teens who said their parents thought underage drinking was unacceptable were drinkers themselves, HealthDay reports. In contrast, 42 percent of teens who said their parents believed underage drinking was somewhat unacceptable, or completely acceptable, were drinkers.

Teens whose parents told them underage drinking is completely unacceptable are 80 percent less likely to drink, compared with those whose parents give their teens’ other messages about drinking, the survey found.

“Decades of research show that there is no safe way to ‘teach’ teens how to drink responsibly,” Robert Turrisi, a professor and researcher at Pennsylvania State University, said in a MADD news release. “A clear no-use message is the most effective way for parents to help keep teens safe from the many dangers associated with underage alcohol use. This issue is too important to leave to chance and hope for the best.”

In conjunction with the survey, MADD launched a new campaign that encourages parents to tell their teens not to drink if they are under 21. Not everyone agrees with MADD’s message, including John McCardell, former president of Middlebury College. In 2008, McCardell joined with more than 100 other college presidents to demand reconsideration of the national drinking age in 2008, U.S. News & World Report notes.

“Are they saying that drinking on the day one turns 21 is OK? Are they saying that they expect everyone under 21 to abstain and to wake up on their 21st birthday prepared to make responsible decisions about alcohol consumption?” McCardell said. “Do they really believe it is that simple? Many of those who turn 21 will no longer be at home or under parental influence. To whom, then, do they turn, to learn about responsible alcohol consumption?”

Categories: Bup Feeds

New Test Developed to Detect Date-Rape Drug, GHB, in Drinks

Drug and Alcohol News (JoinTogether.com) - Wed, 04/02/2014 - 11:45am

Researchers in Singapore announced they have developed a new test that can detect the date-rape drug GHB in drinks, according to HealthDay.

GHB is predominantly a central nervous system depressant. It can be produced in clear liquid, white powder, tablet, and capsule forms. Because GHB is odorless and tasteless, it can be slipped into someone’s drink without detection. The drug incapacitates people who ingest it, making them vulnerable to sexual assault, the article notes.

The researchers mixed a fluorescent compound with a sample of drink containing GHB and found the mixture changed color in less than 30 seconds. They reported their findings in the journal Chemical Communications. They said the color change was seen in clear and light-colored drinks, including water and vodka. Better lighting was needed to see the change in darker drinks, such as cola and whiskey.

“We wanted to develop something that would give results within several seconds, so you can check whether it is a safe drink or whether you should stop and think again,” researcher Chang Young-Tae said in a news release. The researchers said GHB takes effect within 15 to 30 minutes, and can last for three to six hours. They are working with product designers to come up with a portable detection kit within a year.

Categories: Bup Feeds

Drug Used to Prevent Spasms May Help Prevent Cocaine Relapse

Drug and Alcohol News (JoinTogether.com) - Wed, 04/02/2014 - 11:44am

The drug baclofen, used to prevent spasms in patients with spinal cord injuries and neurological disorders, may be able to help prevent relapses in people treated for cocaine addiction, a new study suggests.

Baclofen can help block the impact of the brain’s response to “unconscious” drug triggers, even before a person begins craving cocaine, according to the researchers from the University of Pennsylvania. This mechanism has the potential to prevent a relapse of cocaine addiction, MedicalXpress reports.

The findings will be published in the Journal of Neuroscience.

“The study was inspired by patients who had experienced moments of ‘volcanic craving,’ being suddenly overcome by the extreme desire for cocaine, but without a trigger that they could put their finger on,” researcher Anna Rose Childress, PhD said in a news release.

The study included 23 cocaine-dependent men, who had used cocaine on at least eight of 30 days before screening. They stayed for up to 10 days in a supervised inpatient drug treatment facility. Twelve men received baclofen, and 11 received a placebo. They were shown images, including pictures of cocaine, for very brief periods while their brains were scanned. They were also shown pictures of non-drug objects and scenes for longer periods. The subjects were aware of seeing the non-drug pictures, but not the “ultra-brief” pictures of cocaine.

The cocaine pictures were shown so quickly that the brain could not consciously process them, but the scan could still measure the earliest, subconscious effects of the pictures on the brain, the researchers said.

Participants who were treated with baclofen showed a significantly lower response in the reward and motivational circuits of the brain when they were shown the cocaine pictures versus the non-cocaine pictures, compared with participants in the placebo-treated group.

Categories: Bup Feeds

The Way a Person Smokes Marijuana May Predict Future Dependence on the Drug

Drug and Alcohol News (JoinTogether.com) - Wed, 04/02/2014 - 11:44am

The way a person smokes marijuana is more important than how potent the drug is, or how much of the active ingredient THC it contains, in predicting whether the person will become dependent on the drug, a new study suggests.

While people who smoke potent marijuana do get more THC than those who smoke traditional varieties, their style of marijuana smoking is more important in predicting dependence, the researchers report in the journal Addiction.

Previous research on marijuana dependence has focused on how often a person uses the drug, lead researcher Peggy van der Pol of the Netherlands Institute of Mental Health and Addiction told Reuters. She studied 98 young adults who smoked marijuana at least three days a week for more than a year.

At the start of the study, one-third of participants met the criteria for marijuana dependence. All participants were interviewed a year-and-a-half after being recruited into the study, and then again a year-and-a-half after that. At both sessions, they were asked to smoke marijuana, while researchers observed. The researchers found people who smoked more potent marijuana inhaled less smoke, and smoked at a slower pace than their peers.

Smoking behaviors, such as how much of a marijuana joint they smoked, or how frequently they puffed, predicted dependence at the three-year mark, regardless of how much THC they were exposed to, or whether they were marijuana-dependent at the start of the study.

Categories: Bup Feeds

Comparative pharmacokinetics of intravenous fentanyl and buprenorphine in healthy greyhound dogs.

Buprenorphine Research (PubMed) - Wed, 04/02/2014 - 8:15am

Comparative pharmacokinetics of intravenous fentanyl and buprenorphine in healthy greyhound dogs.

J Vet Pharmacol Ther. 2014 Mar 29;

Authors: Kukanich B, Allen P

Abstract
The purpose of this study was to compare the pharmacokinetics of two highly protein-bound, lipophilic opioid drugs. Fentanyl (10 μg/kg) and buprenorphine (20 μg/kg) were administered intravenously (IV) to six healthy greyhound dogs (three males and three females). The doses were based on clinically administered doses for dogs. Plasma drug concentrations were determined using liquid chromatography with mass spectrometry, and noncompartmental pharmacokinetics were estimated with computer software. The volume of distribution (area) was larger for fentanyl (7.42 L/kg) compared to buprenorphine (3.54 L/kg). The plasma clearance of fentanyl (38.6 mL·min/kg) was faster than buprenorphine (10.3 mL·min/kg). The terminal half-life of fentanyl (2.22 h) was shorter than buprenorphine (3.96 h). Despite similar physicochemical properties including octanol-water partition coefficient and pKa, the pharmacokinetics of fentanyl and buprenorphine were not similar. Both fentanyl (84%) and buprenorphine (95-98%) are considered highly protein bound, but the differences in protein binding may contribute to the lack of similarity of pharmacokinetics in healthy dogs.

PMID: 24684621 [PubMed - as supplied by publisher]

Categories: Bup Feeds

Kids, Marijuana and Mad Men

Drug and Alcohol News (JoinTogether.com) - Tue, 04/01/2014 - 12:56pm

Love it or hate it – advertising works. Proof comes in the form of the annual $70 billion U.S. advertising industry. Everything from potato chips to cell phones to banking and even cancer care is bolstered by a healthy marketing budget.

The truth is that we are all influenced by advertising. Even when we don’t realize it or are unwilling to admit it, effective advertising seeps into our thoughts and influences our behavior as consumers. Advertising drives sales and grows businesses. Especially susceptible to advertising’s wills are the young, open and less cynical minds of kids.

They, along with their moms and dads, are arguably America’s most sought-after consumer base. Young people are both directly targeted and unintentionally exposed to the whirlwind of ads that surround their daily existence. Too often, they sit too closely on the periphery of messages not intended for them, like those for beer, distilled spirits, tobacco and unhealthy food choices. These now include advertising designed to increase sales of medical and recreational marijuana.

Ads for marijuana have already surfaced in states that have passed these initiatives. What we see – as a public health nonprofit with roots in the advertising industry – is the potential for significant childhood exposure to marketing of an alluring, newly legal drug. Advertising that will have the net communication that it’s okay to use marijuana.

And some might argue that the future pool of customers for the legal marijuana industry will be kids and teens since past-month marijuana use – particularly heavy use – has increased significantly among U.S. high school students since 2008. Kids are still more likely to smoke marijuana than adults and even twentysomethings, presenting a real marketing conundrum for marijuana retailers who seek to increase their business and expand their markets, while also claiming they are only targeting consenting adults. The ongoing roll-out of marijuana-infused candies, sodas, and edible products that appeal to younger cohorts is just one example of quickly increasing marketing and merchandising to make this product more appealing and accessible.

In the complicated debates around marijuana legalization, many are talking about new tax revenues and adults’ ability to choose, but precious few of us are talking with families about what this means for them – or considering how all this affects the healthy development of their kids.

Our recent research reports that roughly 50 percent of all parents have used marijuana and that 40 percent of adults believe marijuana should be legal. However, parents have serious expectations that legal marijuana will be heavily regulated to protect kids.

More than 80 percent of parents surveyed in Colorado and Washington, two states where recreational marijuana is now legal, believe “marijuana advertising should still be banned.” When forced to choose, a majority of parents identify the number one place where it should be permissible to advertise marijuana as “nowhere.” But those expectations from parents far exceed how legal marijuana is actually being implemented. The advertising limitations that are in place in these states will be subject to future court challenges over first amendment protected speech.

While there’s an urgency to discuss taxing marijuana, how to deal with banking the profits of retailers and in what ways a lucrative new industry will grow its sales, there’s also a contradictory “we’ll think about it tomorrow” attitude on how to go about effectively communicating the health risks of use to families and kids. Our nation’s past experiences with alcohol and tobacco regulation suggests we’re destined to fail at banning the mass marketing  of a growing, profitable and legal industry, contradicting parents’ desires to protect their kids from such ads.

So, what are we to do? For starters, let’s keep talking with parents and families specifically about the health risks of pre-teens and teenagers using marijuana. Let’s guide them to have effective conversations with their kids about why marijuana is not a good choice for their developing brains – even if mom or dad used it back in the days when they were teenagers.

We certainly don’t have all of the answers, but we do know from calls to our parents toll-free helpline and from posts on our website and in social media that families want sensible, health-based guidance on how to navigate this new, legalized landscape on behalf of their kids. While we can and do provide that, much more is needed across society.

There is inherent power in advertising and delivering persuasive messages. Messages that help young consumers form personal opinions and beliefs about a product ultimately drive their individual behavior. Yet the most important messengers – the most powerful influencers – in the lives of kids are their parents.

The time is now to start talking about this new world of marijuana and children’s health at home before our kids get the wrong messages somewhere else.

 

Categories: Bup Feeds

Zohydro Sales Banned in Massachusetts

Drug and Alcohol News (JoinTogether.com) - Tue, 04/01/2014 - 11:02am

The pure hydrocodone drug Zohydro ER (extended release) will be banned in Massachusetts, Governor Deval Patrick has announced. He cited a public health emergency stemming from opioid abuse, Reuters reports.

“The introduction of this new painkiller into the market poses a significant risk to individuals already addicted to opiates and to the public at large,” Governor Patrick said in a news release.

Zohydro is designed to be released over time, and can be crushed and snorted by people seeking a strong, quick high. It was approved for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Other hydrocodone drugs on the market, such as Vicodin, also contain acetaminophen.

In a statement, Zogenix said, “We believe Governor Patrick’s ban on Zohydro ER only serves to unfairly restrict patient access to the only hydrocodone pain reliever available for long-term, daily, severe chronic pain patients who are obtaining relief with short-acting hydrocodone combination products, but who are at risk for potentially fatal liver toxicity due to their daily intake of acetaminophen. Ultimately, the ban on the prescription medication will add to patient suffering in the state.”

In December 2012, a panel of experts assembled by the Food and Drug Administration (FDA) voted against recommending approval of Zohydro ER. The panel cited concerns over the potential for addiction. In the 11-2 vote against approval, the panel said that while Zogenix had met narrow targets for safety and efficacy, the painkiller could be used by people addicted to other opioids, including oxycodone.

Last week, Zohydro’s manufacturer, Zogenix, announced it will assemble an oversight board designed to spot misuse of the drug.

The FDA’s decision to approve Zohydro has been criticized by some legislators and public health groups. FDA Commissioner Margaret Hamburg has received letters protesting the decision from 28 state attorneys general and four senators, among others. Law enforcement agencies and addiction experts predict approval of the drug will lead to an increase in overdose deaths.

Categories: Bup Feeds

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