People who are trying to fight the abuse of synthetic drugs need a centralized, national source that collects information about the latest substances, analyzes it and quickly disseminates early alerts, according to a group of experts trying to stay one step ahead of these ever-changing products.
Several sources of information exist, such as poison control centers, the Drug Abuse Warning Network and the Drug Enforcement Administration (DEA), according to Sherry Green, the CEO of the National Alliance for Model State Drug Laws (NAMSDL). The group organized a recent meeting of health officials, law enforcement, doctors, state drug directors and others trying to stop the spread of synthetic drugs.
“The DEA uses a system to gather information from sources about where substances are being used, but it is limited to controlled substances—so if they’re not being controlled or banned yet, the DEA isn’t getting reports about them,” she said. “There’s no one central place that draws on all these sources. We need to gather information from these sources, quickly analyze it and get it back out to people who need it—ER doctors, public health officials and administrators of schools—so they can act.”
Many states have enacted laws banning synthetic drugs, but most ban specific chemical combinations, and drug makers evade these laws by slightly modifying the formula, Green says. “States find they have to play catch-up,” she added. Several states, including Idaho, are trying a different approach, by banning a general class of substances, and then giving specific examples of substances within that class. “If something else in that class is created after the law takes effect, it would already be banned,” she explains. “We’ll be following the success of these statutes, and if they work, we’ll be recommending this type of legislation to other states.”
While there is federal legislation that bans synthetic drugs, signed in 2012, Green said states don’t want to wait for the long process of scheduling and controlling new substances, which can take 18 months or longer. “They want to look at procedures on the state level so they can control new substances on a much more expedited basis,” she said. NAMSDL is also hoping to learn from the experience of Canada and European countries that have passed laws to ban synthetic drugs, also known as novel psychoactive substances.
In addition to new legislation, the group advocated for a much stronger education and prevention campaign. “People need better information about novel psychoactive substances,” Green says. “Everyone from parents to school administrators to ER physicians need better education about what these substances do.” A number of groups, including the National Association of Boards of Pharmacy, the Association of Prosecuting Attorneys and the National Association of Chiefs of Police, agreed there needs to be a coordinated effort on education. NAMSDL is working with the Office of National Drug Control Policy and other federal partners to produce a campaign, Green noted.
NAMSDL will be working with the experts at the meeting to draft model legislation that will be part of a toolbox of legislative options states can use starting early in 2014.
Buprenorphine, a drug used to treat opioid addiction, is increasingly being abused, The New York Times reports. Some for-profit buprenorphine clinics are run by doctors with troubled records, according to the newspaper.
The drug was developed as a safer alternative to methadone for treating addiction to heroin and painkillers. It can be prescribed by doctors in offices, rather than dispensed daily in a clinic. The newspaper tracked patients of two large buprenorphine programs. In one program in suburban Pittsburgh, requirements for obtaining the drug are minimal, and there is a high tolerance for patient missteps, the article notes. Another center at West Virginia University in Morgantown is located in a hospital complex, and run by an addiction medicine specialist.
The doctor who runs the Pittsburgh clinic, Allan W. Clark, is in recovery. He prescribed himself Adderall in the late 1990s, and found his mood improved and he focused better. He took more and more of the drug to get the same effect. In 1999, he checked himself into a rehabilitation program. He lost his Ohio medical license and was put on probation in Pennsylvania for eight years. He now runs a buprenorphine clinic with five doctors working for him, and treats 600 patients.
Dr. Carl R. Sullivan III, who runs the West Virginia University program, primarily treated alcoholism until he saw a “spectacular explosion of prescription opioid drugs” starting around 2000. He saw many patients leave rehab and relapse. Some died. When he started prescribing Suboxone, the brand-name drug whose main ingredient is buprenorphine, he saw a big change. He became a paid treatment advocate for the drug’s maker, Reckitt Benckiser. He noted, “If the company didn’t pay me a nickel, I’d still promote Suboxone because in 2013, it’s the best thing that’s happened for the opioid addict.”
Prescription drug abuse continues to be the nation’s fastest growing drug problem, according to a new report by the Drug Enforcement Administration (DEA). Americans are abusing prescription drugs at a higher prevalence rate than any illicit drug except marijuana.
Pain relievers are the most commonly abused prescription drugs, and are most likely to be involved in overdose incidents, the article notes. Last year, 28 percent of law enforcement officials said prescription drugs are their biggest drug problem, up from 9 percent in 2009.
Heroin was easier to obtain in the United States last year, likely due to high levels of heroin production in Mexico, and Mexican traffickers expanding into white powder heroin markets in the eastern and Midwestern United States, the DEA said. Many prescription opioid users have turned to heroin because it is cheaper and/or easier to obtain, law enforcement and treatment officials around the country report.
Cocaine was less available in some parts of the country, the Miami Herald reports. Several major cities, including Chicago, Houston, St. Louis, Phoenix and Baltimore, reported sporadic interruptions in cocaine availability in the spring of 2012. These interruptions may have been due to counterdrug efforts, conflict within and between drug cartels in Mexico, and continued reductions in cocaine production rates in Colombia.
The availability of methamphetamine and marijuana is likely on the rise because of increased production in Mexico, and ongoing domestic production, the DEA noted. The agency is also concerned with the abuse of synthetic drugs, such as K2, Spice and bath salts.
Alcohol affects people more in middle age due to physical and lifestyle changes, according to The Wall Street Journal. As people start to take more medication in their 40s and 50s, the risk of alcohol and drug interactions also increases.
As people reach middle age, they experience changes in body composition, brain sensitivity and liver functioning, the article notes. “All of the effects of alcohol are sort of amplified with age,” David W. Oslin, a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania, told the newspaper. “Withdrawal is a little bit more complicated. Hangovers are a little bit more complicated.”
Changes in body composition during middle age result in more alcohol circulating in the bloodstream. In addition, the liver, which metabolizes alcohol, gets less efficient as people age. The level of certain enzymes that break down alcohol decreases. Hormonal changes that women experience during menopause can increase their sensitivity to alcohol.
In middle age, people tend to drink less than they did when they were younger, notes Robert Pandina, director of the Center of Alcohol Studies at Rutgers University. So when you do drink “you might have a more sensitive response to alcohol because you’ve lowered your exposure to alcohol over all,” he said.
Drugs that can interact with alcohol include heartburn drugs such as Zantac, acetaminophen, and blood thinners like Coumadin. Mixing blood thinners with alcohol can cause bleeding. “People on Coumadin shouldn’t really drink at all,” Dr. Oslin noted. Combining alcohol with some pain medications and benzodiazepines can make a person “more prone to sedation, more prone to cardiovascular risk and more prone to overdose,” he added.
According to the Centers for Diseases Control and Prevention, about 52 percent of people ages 45 to 64 had at least 12 drinks in the previous year.
The attorneys general of 24 states are urging the Food and Drug Administration (FDA) to ban the sale of menthol cigarettes, CSPnet.com reports.
In a letter to the FDA, the attorneys general said “there are numerous law enforcement tools that can be used to combat production or importation of unlawful tobacco products. Moreover, the quantity of menthol cigarettes that could be made available on the black market would be far less than the quantity that will be available if menthol remains legal. Therefore, a ban on menthol would dramatically decrease public access to menthol cigarettes.”
“Menthol cigarettes are attractive to youth and have been marketed in ways that promote youth smoking. We hope the FDA will ban them completely,” Vermont Attorney General Sorrell said in a news release. Menthol cigarettes are the only flavored cigarettes currently legal for sale in the United States. The FDA is seeking public comment before it makes a decision about what action to take regarding menthol cigarettes.
The attorneys general represent the states of Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Idaho, Illinois, Indiana, Iowa, Maine, Maryland, Mississippi, Montana, New Hampshire, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont and Washington.
In July, the FDA issued a report that stated menthol-flavored cigarettes raise critical public health questions, and likely pose a greater risk to the health of smokers than non-menthol cigarettes. The agency said it is considering taking action that would result in restricted sales of menthol cigarettes. While the FDA said current research does not indicate menthol cigarettes increase the risk of smoking-related disease compared with regular cigarettes, it noted “adequate data suggest that menthol use is likely associated with increased smoking initiation by youth and young adults. Further, the data indicate that menthol in cigarettes is likely associated with greater addiction. Menthol smokers show greater signs of nicotine dependence and are less likely to successfully quit smoking.”
Positive workplace tests for marijuana and cocaine have dropped sharply since 1988, while tests revealing prescription drug abuse are increasing, according to a study by the medical-testing company Quest Diagnostics Inc.
The findings come from a review of more than 125 million urine drug tests conducted from 1988 through 2012. Last year, 3.5 percent of samples were positive, down from 13.6 percent in 1988. About three-quarters of tests were conducted for pre-employment screening.
Between 2002 and 2012, positive tests for amphetamines, including prescription drugs such as Adderall, more than doubled. From 2005 to 2012, positive tests for Vicodin increased 172 percent, while those positive for OxyContin increased 71 percent. Workers tested after they have been involved in an accident on the job show higher levels of painkiller use.
“Even when used under prescription, these drugs can have an impact on workplace safety,” Barry Sample, director of drug-testing technology for Quest, told The Wall Street Journal.
The decrease in positive marijuana tests may be due in part to workers becoming better at passing drug tests, according to the article. Labs are trying to reduce the number of people who use other people’s urine to pass drug tests, by experimenting with oral swabs and hair tests.
The study found positive tests for methamphetamine decreased after 2005, but have begun to increase again, particularly in safety-sensitive industries including railroads and trucking.
Last year, a report from Amtrak found a growing number of their employees have been testing positive for drugs and alcohol, increasing the risk of a serious railroad accident. The report found drug and alcohol use by conductors, mechanics and engineers who operate the trains greatly exceeds the national average for the railroad industry. Amtrak’s signal operators and mechanics tested positive for drugs four times as frequently as those working for other railroads. Cocaine and marijuana are the most frequently used drugs.
The newly approved pure hydrocodone product, Zohydro ER (extended release), will be made by the same company that manufactures Vivitrol, a drug used to treat patients addicted to opioids or alcohol, The New York Times reports.
The Food and Drug Administration (FDA) approved Zohydro ER last month for patients with pain that requires daily, around-the-clock, long-term treatment that cannot be treated with other drugs. Drugs such as Vicodin contain a combination of hydrocodone and other painkillers such as acetaminophen. Zohydro is expected to reach the market in early 2014.
In December 2012, a panel of experts assembled by the 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 the drug’s maker, Zogenix, had met narrow targets for safety and efficacy, the painkiller could be used by people addicted to other opioids, including oxycodone.
In 2010, Zogenix bought the right to market Zohydro in the United States from another company, Elan, the article notes. The following year, a company named Alkermes, which makes Vivitrol, bought a unit of Elan that included Zohydro. The deal included the existing agreement with Zogenix.
Alkermes provides financial support to the American Society of Addiction Medicine, a leading professional group representing substance abuse experts, according to the newspaper. Dr. Stuart Gitlow, president of the group, told The New York Times he had been unaware of Alkermes’s involvement with Zohydro, adding the group would ask for more information from the company and then decide what, if anything, it will do about the situation.
Some law enforcement agencies and addiction experts have voiced concern that approval of a pure hydrocodone drug will lead to an increase in overdoses.
PCP-related emergency room visits jumped 400 percent between 2005 and 2011, according to a new report by the Substance Abuse and Mental Health Services Administration (SAMHSA). PCP (phencyclidine), also known as “angel dust,” can cause hallucinations when taken at high doses.
The number of PCP-related visits to hospital emergency rooms jumped from 14,825 in 2005, to 75,538 in 2011, Medical News Today reports. The largest increase was seen among patients ages 25 to 34. In 2011, about two-thirds of PCP-related visits were made by males, and almost half were made by people ages 25 to 34. Other illegal drugs, including marijuana, cocaine and heroin, were involved in about half of PCP-related emergency room visits in 2011.
PCP can be snorted, smoked, injected, or swallowed and is most commonly sold as a powder or liquid and applied to a leafy material such as mint, parsley, oregano, tobacco, or marijuana. Many people who use PCP may do it unknowingly because it is often used as an additive and can be found in marijuana, LSD, or methamphetamine. In a hospital or detention setting, a person on PCP may become violent or suicidal, and can become very dangerous to themselves and to others.
“This report is a wake-up call that this dangerous drug may be making a comeback in communities throughout the nation,” Dr. Peter Delany, Director of SAMHSA’s Center for Behavioral Health Statistics and Quality, said in a news release. “PCP is a potentially deadly drug and can have devastating consequences not only for individuals, but also for families, friends and communities. We must take steps at every level to combat the spread of this public health threat.”
The Drug Enforcement Administration (DEA) has made three synthetic drugs, known as NBOMe compounds, illegal for the next two years. The compounds, also known as “N-Bomb,” have been responsible for the deaths of at least 19 people in the United States in the past year.
The compounds can be harmful to kidneys, and can trigger mental health issues.
The DEA made the synthetic compounds 25I-NBOMe, 25C-NBOMe, and 25B-NBOMe Schedule I, illegal drugs under the Controlled Substances Act for the next two years, UPI reports. These drugs are marketed online and through illegal channels as illicit hallucinogens such as LSD, according to a DEA news release. They are sold as powders, liquid solutions, soaked onto blotter paper, and laced on edible items.
“There is no approved medical use for these particular synthetic drugs, nor has the Food and Drug Administration approved them for human consumption,” the DEA notes, adding “data suggest that extremely small amounts of these drugs can cause seizures, cardiac and respiratory arrest, and death.”
The DEA warns synthetic drugs such as the NBOMe compounds have no consistent manufacturing and packaging processes and may contain drastically differing dosage amounts, a mix of several drugs, and unknown adulterants. “Users are playing Russian roulette when they abuse them,” the agency states.
During the next two years, the DEA will work with the Department of Health and Human Services to determine if these compounds should be made permanently illegal.
A double-blind, within subject comparison of spontaneous opioid withdrawal from buprenorphine versus morphine.
A double-blind, within subject comparison of spontaneous opioid withdrawal from buprenorphine versus morphine.
J Pharmacol Exp Ther. 2013 Nov 13;
Authors: Tompkins DA, Smith MT, Mintzer MZ, Campbell CM, Strain EC
Preliminary evidence suggests there is minimal withdrawal following cessation of chronically administered buprenorphine and that opioid withdrawal symptoms are delayed compared to other opioids. The present study compared the time course and magnitude of buprenorphine withdrawal versus a prototypical mu opioid agonist, morphine. Healthy, out-of-treatment opioid dependent residential volunteers (N=7) were stabilized either on intramuscular buprenorphine (32 mg/day) or morphine (120 mg/day) administered in four divided doses for nine days. They then underwent an 18-day period of spontaneous withdrawal during which four double-blind IM placebo injections were administered daily. Stabilization and spontaneous withdrawal were assessed for the second opioid using the same time course. Opioid withdrawal measures were collected eight times daily. Morphine withdrawal was significantly (p<0.05) greater than buprenorphine withdrawal as measured by mean peak ratings of: clinical opiate withdrawal scale (COWS); subjective opiate withdrawal scale (SOWS); all subscales of the Profile of Mood States (POMS); sick and pain (0-100) visual analog scales; systolic and diastolic blood pressure; heart rate; respiratory rate; and pupil dilation. Peak ratings on COWS and SOWS occurred on day two of morphine withdrawal and were significantly greater than day two of buprenorphine withdrawal. Subjective reports of morphine withdrawal resolved on average by day seven. There was minimal evidence of buprenorphine withdrawal on any measure. In conclusion, spontaneous withdrawal from high-dose buprenorphine appears subjectively and objectively milder as compared to morphine for at least 18 days after drug cessation.
PMID: 24227768 [PubMed - as supplied by publisher]
Phantom Limb Pain: A Systematic Neuroanatomical-Based Review of Pharmacologic Treatment.
Pain Med. 2013 Nov 13;
Authors: McCormick Z, Chang-Chien G, Marshall B, Huang M, Harden RN
OBJECTIVE: Review the current evidence-based pharmacotherapy for phantom limb pain (PLP) in the context of the current understanding of the pathophysiology of this condition.
DESIGN: We conducted a systematic review of original research papers specifically investigating the pharmacologic treatment of PLP. Literature was sourced from PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies with animals, "neuropathic" but not "phantom limb" pain, or without pain scores and/or functional measures as primary outcomes were excluded. A level of evidence 1-4 was ascribed to individual treatments. These levels included meta-analysis or systematic reviews (level 1), one or more well-powered randomized, controlled trials (level 2), retrospective studies, open-label trials, pilot studies (level 3), and anecdotes, case reports, or clinical experience (level 4).
RESULTS: We found level 2 evidence for gabapentin, both oral (PO) and intravenous (IV) morphine, tramadol, intramuscular (IM) botulinum toxin, IV and epidural Ketamine, level 3 evidence for amitriptyline, dextromethorphan, topiramate, IV calcitonin, PO memantine, continuous perineural catheter analgesia with ropivacaine, and level 4 evidence for methadone, intrathecal (IT) buprenorphine, IT and epidural fentanyl, duloxetine, fluoxetine, mirtazapine, clonazepam, milnacipran, capsaicin, and pregabalin.
CONCLUSIONS: Currently, the best evidence (level 2) exists for the use of IV ketamine and IV morphine for the short-term perioperative treatment of PLP and PO morphine for an intermediate to long-term treatment effect (8 weeks to 1 year). Level 2 evidence is mixed for the efficacy of perioperative epidural anesthesia with morphine and bupivacaine for short to long-term pain relief (perioperatively up to 1 year) as well as for the use of gabapentin for pain relief of intermediate duration (6 weeks).
PMID: 24224475 [PubMed - as supplied by publisher]
[Study on the distribution of buprenorphione in the bodies of the rabbits].
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Mar;37(3):296-9
Authors: Liu D, He J
OBJECTIVE: To investigate the distribution of buprenorphione in the bodies of rabbits.
METHODS: Buprenorphione was administrated to rabbits orally or by intravenous injection (0.04 mg/kg buprenorphione). Two hours after administration, rabbits were killed and their blood, urine, liver, kidney, lung, stomach, brain, heart, stomach content and feces were collected. The concentrations of buprenorphione in these body fluids and tissues were determined by liquid chromatography-mass spectrometry (LC-MS).
RESULTS: The results show the distribution of buprenorphione in rabbit's body: urine>stomach content>brain >heart >stomach>lung> kidney > liver > blood> feces.
CONCLUSION: The method developed can be used for the detection of buprenorphione in biological fluids and tissues in forensic practice. Urine is the preferred sample for screening for buprenorphione abuse.
PMID: 22561499 [PubMed - indexed for MEDLINE]
Two patients wait in the reception area of a busy urban medical clinic. They don’t know each other, but they are about to embark on very similar journeys. In the exam room, Bill receives the diagnosis that he is pre-diabetic and is encouraged to make some lifestyle changes, including reducing his alcohol intake, as his provider has determined that his drinking is at a risky level. Maria meets with her provider and is asked to break a tough habit. Maria is struggling with continuous asthma complications and although she quit smoking cigarettes, she still smokes marijuana every day to cope with stress. Maria’s provider challenges her to quit smoking marijuana for one month to see if it helps improve her condition. Both patients are uncertain if they can break these habits or if they even want to try.
While these patients will sound familiar to medical providers across the spectrum of health care, they are actually the fictional starring characters of a new health education graphic novel being tested by the Treatment Research Institute (TRI). In Keep it Moving: A Guide to Breaking Habits, both Bill and Maria have to resolve their own ambivalence about whether to make an effort to reduce or quit their alcohol and drug use. They model how to deal with stressors, temptations, obstacles and personal triggers that influence their habits.
These relatable characters are part of a greater goal to integrating models of behavioral health care directly into primary care; and to help individuals combat their own personal habits and make the decision to seek further alcohol or substance use treatment. Our clinical research team received a grant from the Pennsylvania Department of Health to conduct a clinical trial of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for the reduction of illicit drug use in three federally qualified health care centers (FQHCs) in Philadelphia. We wanted to be able to provide patients with an educational resource akin to Rethinking Drinking, the excellent patient resource developed and distributed by NIAAA. However, we wanted to be able to address both habitual alcohol and drug use, and we also felt that including more interactive activities and models that were within the grasp of populations with various literacy rates was important. A community advisory board consisting of medical patients in recovery from substance use issues reviewed numerous health education strategies for alcohol and nicotine cessation, and concluded that our team might best reach our target population by developing our material in a graphic novel format.
The use of graphic novels for health education is not new. SAMHSA’s People Recover about a young couple who enter treatment for addiction is an excellent example. We wanted to equip the behavioral health consultants at the participating FQHCs with a resource that that would help patients begin the process of self-change. Our consultants reminded us that they typically had limited time to meet with patients in a primary care setting, so finding strategies that could help patients remember advice on why and how to make habit change was critical.
The characters model self change using time-tested, habit-breaking strategies. Throughout the narrative, as Bill and Maria exemplify effectively putting change strategies into place, the narrative halts and the reader is invited to complete interactive journaling exercises that allow them to parallel the change process the characters are engaging in.
Our team is currently piloting Keep It Moving in the context of a clinical trial; and while we do not have effectiveness data to share, the early reviews from patients are very positive. Behavioral health consultants have shared with us anecdotal stories of patients returning for second intervention sessions who have completed every exercise in the book, and who have shared content with other family members. So far, more than 70 patients have participated in this the pilot launch of the novel. Our team will monitor results from the pilot through 2014.
Keep it Moving is an example of TRI’s work in counseling tool development, an effort largely intended to encourage counselors to use evidence-based practices. If counselors have the tools necessary to deliver productive and effective interventions that are centered on evidence-based content, they will be more likely to adhere to evidence-based strategies and insist on being properly equipped to do so. Additionally, motivated patients who have been provided with the tools to jump-start self change can surprise providers by moving the change process forward on their own.
Adam C. Brooks, PhD is a Senior Research Scientist working on continuous care and adaptive treatment protocols, along with performance-based contracting strategies at Treatment Research Institute. Dr. Brooks has a PhD in clinical psychology with a specialization in marital and family therapy from St. John’s University.
A new Pew Research Center survey finds only 16 percent of Americans think the nation is making progress on prescription drug abuse, and 19 percent see progress in dealing with mental illness.
In contrast, 54 percent of Americans say the nation is making progress on cancer.
The survey found 35 percent of Americans say the nation is losing ground on mental illness, and 37 percent on prescription drug abuse. The public’s perception of progress against alcohol abuse is similarly gloomy. The survey found 17 percent see improvement in addressing alcohol abuse, while 23 percent say ground is being lost, and 58 percent say the problem is staying about the same.
The public’s outlook on smoking is more positive—45 percent of adults surveyed see progress in this area, and 13 percent think the nation is losing ground.
The findings are based on telephone interviews conducted among a national sample of 2,003 adults in all 50 states and the District of Columbia.
A review of medical groups’ guidelines on prescribing opioids for chronic pain finds most of the organizations are in are agreement, Reuters reports.
“There is widespread agreement about some basic ways of mitigating the risks associated with prescribing opioids for chronic pain,” said lead researcher Dr. Teryl Nuckols at the David Geffen School of Medicine at the University of California, Los Angeles.
Nuckols reviewed recommendations for doctors about prescribing opioids to patients with non-cancer pain lasting for more than three months. Most of the guidelines recommend doctors not prescribe doses greater than 90 to 200 milligrams of “morphine equivalents” daily, and that they have additional knowledge to prescribe methadone.
The guidelines agreed doctors should increase dosages slowly, and monitor patients for side effects when they first prescribe opioids. They advise reducing doses by at least 25 to 50 percent when switching opioids. The guidelines also recommend opioid risk assessment tools, written treatment agreements and urine drug testing to help manage the risk of overdose and misuse.
The findings are published in the Annals of Internal Medicine.
The study did not address how closely doctors are following the guidelines, the article notes. “Unfortunately, guidelines are not followed as often as they should be,” Nuckols said.
An increasing number of students in middle school and high school are smoking e-cigarettes, hookahs and cigars, a new government report concludes.
The Centers for Disease Control and Prevention (CDC) found overall youth smoking rates have not declined. “We need effective action to protect our kids from addiction to nicotine,” Dr. Tom Frieden, Director of the CDC, said in a news release.
The findings come from the 2012 National Youth Tobacco Survey, which includes 25,000 students in grades 6 through 12. Among high school students, e-cigarette use increased to 2.8 percent in 2012, from 1.5 percent in 2011. Among middle school students, e-cigarette use increased to 1.1 percent, from 0.6 percent the previous year.
Hookah smoking rose from 4.1 percent of high school students in 2011, to 5.4 percent in 2012, CBS News reports.
The report found cigar use among black high school students jumped from 11.7 percent in 2011, to 16.7 percent in 2012. The survey included flavored little cigars, or cigarillos, which contain candy or fruit flavorings and look similar to cigarettes.
According to the CDC, the rise in the use of e-cigarettes and hookahs may be due to an increase in marketing, availability and visibility of these products, and the perception they may be safer than regular cigarettes. E-cigarettes, hookahs and cigars are not subject to regulation by the Food and Drug Administration. The agency is expected to issue rules to tighten regulation of e-cigarettes and other non-cigarette nicotine products.
The CDC researchers recommend additional measures, such as increasing the products’ price, using media campaigns to discourage smoking, increasing access to services to help people quit, and enforcing restrictions on promotion and advertising.
“This report raises a red flag about newer tobacco products,” Dr. Frieden said. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”
A licensed smell investigator in Denver is using a device called a “Nasal Ranger” to sniff out marijuana. Ben Siller is using the device to help enforce an ordinance designed to protect the purity of the city’s air.
Although recreational marijuana use is now legal in Colorado, the Denver ordinance allows for possible fines when marijuana odors are very strong—exceeding a level of detection when one volume of scented air is combined with seven volumes of clean air, according to NPR. It has been almost 20 years since anyone has broken that threshold, Siller said. A violation of the ordinance could result in a fine of up to $2,000.
Siller, a member of Denver’s Department of Environmental Health, is receiving a growing number of complaints as the number of facilities used to cultivate marijuana increase. The Nasal Ranger is a cone-shaped device that looks like a megaphone. It samples the air to detect the presence and strength of odors.