The number of hospital admissions among Americans ages 45 and older for medication and drug-related conditions doubled between 1997 and 2008, according to a new report released today by HHS' Agency for Healthcare Research and Quality. Medication and drug-related conditions include effects of both prescription and over-the-counter medications as well as illicit drugs.
Hospital admissions among those 45 years and older were driven by growth in discharges for three types of medication and drug-related conditions - drug-induced delirium; "poisoning" or overdose by codeine, meperidine and other opiate-based pain medicines; and withdrawal from narcotic or non-narcotic drugs.
Admissions for all medication and drug-related conditions grew by 117 percent - from 30,100 to 65,400 - for 45- to 64-year-olds between 1997 and 2008. The rate of admissions for people ages 65 to 84 closely followed, growing by 96 percent, and for people ages 85 and older, the rate grew by 87 percent. By comparison, the number of hospital admissions for these conditions among adults ages 18 to 44 declined slightly by 11 percent.
"This report reveals a disturbing trend, and we need to find out more about why these admissions are increasing," said AHRQ Director Carolyn M. Clancy, M.D. "As the average age of hospital patients continues to increase, so does the need for close monitoring of the types and dosages of drugs given to them."
Drug-induced delirium or dementia can be caused by sleeping pills as well as drugs for urinary incontinence, nausea and other problems common in the elderly, but doctors sometimes cannot identify the cause. Poisoning by pain medicines or other drugs containing codeine, meperidine or other opiates can be caused by accidental overdosing or the failure to recognize the drug's active ingredient. Drug withdrawal occurs when there is an abrupt withdrawal or significant reduction in the dosage of pain or other prescription medicines to which a person can become addicted, as well as of illicit drugs.
HHS' Substance Abuse and Mental Health Services Administration helped support the analysis of the data in the report on hospital care for mental health and substance abuse disorders. "Substance abuse is rising, and drug abuse of all kinds is exploding as a major public health concern for our country," said SAMHSA Administrator Pamela S. Hyde, J.D. "The challenge for our health care practitioners is to see that patients receive medications when there is medical need but also to help prevent the adverse health consequences from drug use."
The new AHRQ report also shows that Medicare and Medicaid were responsible for 57 percent of the $1.1 billion cost to hospitals in 2008 for treating patients with medication and drug-related conditions, private insurance covered 24 percent, and the uninsured accounted for 14 percent. The remaining 5 percent of hospital costs for treating these conditions were borne by other sources such as TRICARE.
AHRQ's report also includes data on other types of medical conditions treated in U.S. community hospitals, surgical and other procedures, and costs in 2008. For more information, see HCUP Facts and Figures: Statistics on Hospital-Based Care in the United States, 2008.
Source:
AHRQ
вторник, 31 мая 2011 г.
понедельник, 30 мая 2011 г.
Link Between Children's Mental Health And Later Substance Abuse Studied At Rutgers-Camden
Research underway at Rutgers University-Camden seeks to examine links between children's mental health problems and alcohol, nicotine, and illegal drug use over time.
The National Institute on Drug Abuse at the National Institutes of Health (NIH) has awarded a highly prestigious Career Development Award to Naomi Marmorstein, an associate professor of psychology at Rutgers-Camden, who will use the $649,503 grant to further her intensive research on how children's anxiety and depression may be associated with substance abuse throughout adulthood. According to the NIH, Marmorstein's award is part of an integrated program designed to foster the development of outstanding scientists and enable them to expand their potential to make important scientific contributions.
"Children can show symptoms of depression and anxiety at very young ages, and some youth smoke, drink, and use drugs as well. A better understanding of the associations between these problems will help us more effectively prevent and treat them. If we can get youth on a trajectory of healthy emotional and behavioral development, they are at reduced risk for psychiatric and substance abuse problems as adults," says Marmorstein.
During the next five years, Marmorstein will receive specialized training on complex statistical techniques; collect her own data with child-appropriate questionnaires; and revaluate existing data with new research methodologies that allow for more fine-grained analyses of developmental trajectories over time. She also will seek to pinpoint crucial differences between types of internalizing disorders, like generalized anxiety and social anxiety, to examine whether these problems relate to substance abuse in different ways.
"We have known for a long time that some people who have depression or anxiety drink alcohol or use drugs to cope with those unpleasant feelings; this is called the 'self-medication' model of substance abuse. However, there is also some evidence that heavy substance use may predict internalizing disorders, rather than the other way around. It is time to apply the advances we have made in research methodologies in order to better understand these associations," says Marmorstein.
The results of the Rutgers-Camden research could be used by those who work with at-risk children to create programs that help these vulnerable young clients as effectively as possible.
A graduate of Yale University and the University of Minnesota, Marmorstein joined the Rutgers-Camden faculty in 2001 and teaches a range of clinical psychology courses including abnormal psychology, developmental psychopathology, and theories of psychotherapy. She resides in Philadelphia.
Source: Cathy Donovan
Rutgers, the State University of New Jersey
The National Institute on Drug Abuse at the National Institutes of Health (NIH) has awarded a highly prestigious Career Development Award to Naomi Marmorstein, an associate professor of psychology at Rutgers-Camden, who will use the $649,503 grant to further her intensive research on how children's anxiety and depression may be associated with substance abuse throughout adulthood. According to the NIH, Marmorstein's award is part of an integrated program designed to foster the development of outstanding scientists and enable them to expand their potential to make important scientific contributions.
"Children can show symptoms of depression and anxiety at very young ages, and some youth smoke, drink, and use drugs as well. A better understanding of the associations between these problems will help us more effectively prevent and treat them. If we can get youth on a trajectory of healthy emotional and behavioral development, they are at reduced risk for psychiatric and substance abuse problems as adults," says Marmorstein.
During the next five years, Marmorstein will receive specialized training on complex statistical techniques; collect her own data with child-appropriate questionnaires; and revaluate existing data with new research methodologies that allow for more fine-grained analyses of developmental trajectories over time. She also will seek to pinpoint crucial differences between types of internalizing disorders, like generalized anxiety and social anxiety, to examine whether these problems relate to substance abuse in different ways.
"We have known for a long time that some people who have depression or anxiety drink alcohol or use drugs to cope with those unpleasant feelings; this is called the 'self-medication' model of substance abuse. However, there is also some evidence that heavy substance use may predict internalizing disorders, rather than the other way around. It is time to apply the advances we have made in research methodologies in order to better understand these associations," says Marmorstein.
The results of the Rutgers-Camden research could be used by those who work with at-risk children to create programs that help these vulnerable young clients as effectively as possible.
A graduate of Yale University and the University of Minnesota, Marmorstein joined the Rutgers-Camden faculty in 2001 and teaches a range of clinical psychology courses including abnormal psychology, developmental psychopathology, and theories of psychotherapy. She resides in Philadelphia.
Source: Cathy Donovan
Rutgers, the State University of New Jersey
воскресенье, 29 мая 2011 г.
Exercise Helps You Quit Smoking More Successfully
You are more likely to succeed in your attempt to give up smoking if you also do regular exercise, say researchers from Austria. They found that smokers who use nicotine gum or skin patches were much more likely to stay off tobacco if they also did regular exercise, compared to people who just had the nicotine replacement therapy and no exercise.
In this study, 68 volunteers at Otto Wanger and Lainz Hospitals were monitored for three months. Half of them did regular exercise while the other half didn't. All of them received nicotine replacement therapy. 80% of those who exercised were still not smoking at the end of the three months, compared to just 52% of those who didn't exercise.
The researchers also found that the exercisers who failed to stay off tobacco smoked less than the non-exercisers who went back to smoking.
I had my last cigarette on 20th May this year and celebrated 5 months without touching any tobacco products. I have been going to the gym everyday (Monday to Friday) and using the Nicotine Inhaler. I do 45 minutes of cardiovascular exercise and 30 minutes of resistance (weights) training each day.
What really did it for me was the change in my stationary heartbeat (pulse while resting). On my last smoking day it was 78, six weeks later it was 59. I was amazed at the difference.
If you are trying to give up ask someone, a gym instructor or a health professional, to take your 'resting heartbeat/pulse' on the day you give up. Then follow up six weeks later. It is an incredible motivator. The way I see it is that "My heart now gets the same job done with 25% less effort." Whenever I think of cigarettes, I say to myself "You will go back up to 78. Do you want that?"
I am sure the exercise has also helped keep my weight down since I gave up. I have tried to see the whole experience as a liberation, rather than an abstention. Perhaps the term 'giving up' should be replaced by 'liberation' - it is a positive thought, and positive thoughts tend to lead to better success.
American College of Chest Physicians
In this study, 68 volunteers at Otto Wanger and Lainz Hospitals were monitored for three months. Half of them did regular exercise while the other half didn't. All of them received nicotine replacement therapy. 80% of those who exercised were still not smoking at the end of the three months, compared to just 52% of those who didn't exercise.
The researchers also found that the exercisers who failed to stay off tobacco smoked less than the non-exercisers who went back to smoking.
I had my last cigarette on 20th May this year and celebrated 5 months without touching any tobacco products. I have been going to the gym everyday (Monday to Friday) and using the Nicotine Inhaler. I do 45 minutes of cardiovascular exercise and 30 minutes of resistance (weights) training each day.
What really did it for me was the change in my stationary heartbeat (pulse while resting). On my last smoking day it was 78, six weeks later it was 59. I was amazed at the difference.
If you are trying to give up ask someone, a gym instructor or a health professional, to take your 'resting heartbeat/pulse' on the day you give up. Then follow up six weeks later. It is an incredible motivator. The way I see it is that "My heart now gets the same job done with 25% less effort." Whenever I think of cigarettes, I say to myself "You will go back up to 78. Do you want that?"
I am sure the exercise has also helped keep my weight down since I gave up. I have tried to see the whole experience as a liberation, rather than an abstention. Perhaps the term 'giving up' should be replaced by 'liberation' - it is a positive thought, and positive thoughts tend to lead to better success.
American College of Chest Physicians
суббота, 28 мая 2011 г.
How To Save $1 Billion And 800 Lives In Canada
The economic burden of alcohol abuse costs each Canadian $463 per year. In fact, the direct health care costs for alcohol abuse in Canada exceed those of cancer. Released by the Centre for Addiction and Mental Health (CAMH), the Avoidable Cost of Alcohol Abuse in Canada 2002 report estimates that, even under very conservative assumptions, implementing six reviewed interventions would result in cost savings of about $1 billion per year and a savings of about 800 lives, close to 26,000 years of life lost to premature death and more than 88,000 acute care hospital days in Canada per year. This pioneering study is Canada's first systematic estimate of the avoidable costs of alcohol abuse, and the first study of its kind worldwide.
To calculate the avoidable burden and avoidable costs of alcohol abuse in Canada for 2002, CAMH Senior Scientist Dr. Jurgen Rehm and his team estimated the potential economic impact of increasing alcohol taxation, lowering the blood alcohol concentration (BAC) legal limit from 0.08 per cent to 0.05 percent, zero tolerance BAC for all drivers under age 21, increasing the legal minimum drinking age from 19 to 21 years of age, a Safer Bars intervention, and brief interventions (routine screening with concise advice for problematic alcohol users by primary care physicians or other health professionals).
The data revealed that:
Implementing all six interventions would decrease productivity losses by more than $561 million or 58 per cent of the total avoidable cost due to alcohol, decrease health care costs (saving almost $230 million or 24 per cent), and lower criminality costs by almost $178 million or 18 per cent.
The most effective intervention to reduce avoidable costs in health care, criminality and productivity losses was the brief interventions (saving almost $602 million per year, 62 per cent of total savings), followed by increasing alcohol taxes (saving more than $211 million per year, 22 per cent of total savings).
The most effective intervention for preventing drinking and driving incidents in Canada was lowering the BAC level, which would result in a 19 per cent reduction.
The Safer Bars program was the most effective measure to avoid homicide and other violent crimes (more than 3 per cent reductions were estimated).
Brief interventions were the most effective measure to avoid other alcohol-attributable criminal activities (e.g., property crime), resulting in an almost 3 per cent reduction in these types of crimes.
"It's clear that the largest impact would come from interventions affecting the level of drinking in general such as brief interventions and increasing alcohol taxation," says Dr. Rehm. "However, the greatest overall cost avoidance would be achieved when multiple rather than single effective and cost-effective alcohol interventions are implemented as part of a comprehensive alcohol policy."
The scientists also estimated the potential impact of privatizing alcohol sales in those provinces that sell alcohol through a government monopoly. The analysis showed that substantial increases in direct and indirect costs would occur if Canadian provinces were to privatize alcohol sales. Productivity losses would increase by more than $468 million (7 per cent), health care costs would increase by more than $258 million (8 per cent), and costs related to criminality would increase by about $102 million (3 per cent).
While studies that investigate the cost of illness are a valuable indicator of the overall economic burden due to substance abuse in Canada, they do not offer potential solutions to reduce the burden. As Dr. Rehm explains, "this study shows the benefits potentially available to the community as a whole by directing public resources to specific policies, strategies and programs. It also helps identify information gaps, target problems, and identify potential solutions."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
Source: Michael Torres
Centre for Addiction and Mental Health
To calculate the avoidable burden and avoidable costs of alcohol abuse in Canada for 2002, CAMH Senior Scientist Dr. Jurgen Rehm and his team estimated the potential economic impact of increasing alcohol taxation, lowering the blood alcohol concentration (BAC) legal limit from 0.08 per cent to 0.05 percent, zero tolerance BAC for all drivers under age 21, increasing the legal minimum drinking age from 19 to 21 years of age, a Safer Bars intervention, and brief interventions (routine screening with concise advice for problematic alcohol users by primary care physicians or other health professionals).
The data revealed that:
Implementing all six interventions would decrease productivity losses by more than $561 million or 58 per cent of the total avoidable cost due to alcohol, decrease health care costs (saving almost $230 million or 24 per cent), and lower criminality costs by almost $178 million or 18 per cent.
The most effective intervention to reduce avoidable costs in health care, criminality and productivity losses was the brief interventions (saving almost $602 million per year, 62 per cent of total savings), followed by increasing alcohol taxes (saving more than $211 million per year, 22 per cent of total savings).
The most effective intervention for preventing drinking and driving incidents in Canada was lowering the BAC level, which would result in a 19 per cent reduction.
The Safer Bars program was the most effective measure to avoid homicide and other violent crimes (more than 3 per cent reductions were estimated).
Brief interventions were the most effective measure to avoid other alcohol-attributable criminal activities (e.g., property crime), resulting in an almost 3 per cent reduction in these types of crimes.
"It's clear that the largest impact would come from interventions affecting the level of drinking in general such as brief interventions and increasing alcohol taxation," says Dr. Rehm. "However, the greatest overall cost avoidance would be achieved when multiple rather than single effective and cost-effective alcohol interventions are implemented as part of a comprehensive alcohol policy."
The scientists also estimated the potential impact of privatizing alcohol sales in those provinces that sell alcohol through a government monopoly. The analysis showed that substantial increases in direct and indirect costs would occur if Canadian provinces were to privatize alcohol sales. Productivity losses would increase by more than $468 million (7 per cent), health care costs would increase by more than $258 million (8 per cent), and costs related to criminality would increase by about $102 million (3 per cent).
While studies that investigate the cost of illness are a valuable indicator of the overall economic burden due to substance abuse in Canada, they do not offer potential solutions to reduce the burden. As Dr. Rehm explains, "this study shows the benefits potentially available to the community as a whole by directing public resources to specific policies, strategies and programs. It also helps identify information gaps, target problems, and identify potential solutions."
The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centres in the area of addiction and mental health. CAMH combines clinical care, research, education, policy development and health promotion to transform the lives of people affected by mental health and addiction issues.
CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre.
Source: Michael Torres
Centre for Addiction and Mental Health
пятница, 27 мая 2011 г.
Students who get drunk weekly have higher risk of injuries
College students who get drunk at least once a week are significantly more likely to be hurt or injured than other
student drinkers, according to new research from Wake Forest University School of Medicine.
The research suggests that a simple screening question - "In a typical week, how many days do you get drunk?" - may help
identify at-risk students.
"Each year approximately 1,700 college students die from alcohol-related injuries," said Mary Claire O'Brien, M.D., assistant
professor of emergency medicine and public health sciences at Wake Forest's School of Medicine, which is part of Wake Forest
University Baptist Medical Center. "Our goal was to develop a simple tool to tell which student drinkers are at highest risk
of getting hurt, as a result of their own drinking and the drinking of others."
The results, part of an ongoing, five-year research project to develop effective strategies for reducing problem drinking on
college campuses, were reported today at the annual meeting of the Society for Academic Emergency Medicine in New York City.
Wake Forest researchers found that students who got drunk at least once weekly were three times more likely to be hurt or
injured due to their own drinking than student drinkers who do not report getting drunk at least once a week. They were twice
as likely to fall from a height and need medical care, and 75 percent more likely to be sexually victimized. Getting drunk
was defined as being unsteady, dizzy or sick to your stomach.
"When you drink, you're also at risk because of other people's drinking," O'Brien said.
For example, students who got drunk at least once weekly were three times more likely to be in an automobile accident caused
by someone else's drinking and twice as likely to be taken advantage of sexually by someone who was drinking.
O'Brien's goal was to identify a one-question screening tool that could be used in busy hospital emergency departments. She
said the Wake Forest "single question" was designed specifically for college students.
"The emergency department presents a teachable moment," she said. "Research has shown that a brief intervention, such as
simple advice, can change drinking patterns."
O'Brien said that current screening tools define problem drinking as having four or five drinks in a row.
"In my experience, patients lie about how much they drink, and screening tests based on quantity don't account for
differences in weight, gender, alcohol tolerance, body metabolism, medications and other variables," she said. "What it takes
to make someone drunk varies from individual to individual."
The overall goal of the $3.2 million Study to Prevent Alcohol-Related Consequences (SPARC) is to reduce the availability of
alcohol to students and to help change campus cultures that promote drinking. The study uses such strategies as restricting
alcohol at campus events, increasing enforcement, constraining marketing and educating alcohol sellers and servers,
landlords, students and parents.
Ten North Carolina universities are participating in the Wake Forest study. Students are surveyed once a year on their
alcohol consumption, availability of alcohol, attitudes and perceptions, and consequences experienced from drinking.
Strategies to reduce problem drinking are being implemented at half of the campuses, with emphasis on forming
campus-community coalitions that address issues specific to each school. The web-based student surveys are one of several
measures of the project's effectiveness.
The multidisciplinary study team is led by Robert H. DuRant, Ph.D., professor of pediatrics and public health sciences at
Wake Forest Baptist. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
O'Brien's research is based on the first student web survey (fall 2003), which found that 63 percent of students under age 21
drink and that 20 percent of the drinkers usually have seven or more drinks. More than half (54 percent) of the drinkers said
they get drunk at least weekly.
According to the NIAAA, about four out of five students drink and about half of the drinkers engage in heaving episodic
consumption. It is estimated that that 97,000 students each year are victims of alcohol-related sexual assault or date rape,
that almost a third (31 percent) of college students meet the criteria for a diagnosis of alcohol abuse and that 2.8 million
college students drove under the influence of alcohol last year.
The 10 universities involved in the study are Appalachian State, Duke, High Point, Western Carolina and the Asheville, Chapel
Hill, Charlotte, Wilmington and Pembroke campuses of the University of North Carolina.
Other members of the SPARC research team are Barbara Alvarez-Martin, M.P.H., Heather Champion, Ph.D., Gail Cohen, M.D., Ralph
B. D'Agostino Jr., Ph.D., Sheryl Hulme, Thomas McCoy, M.S., Cindy Miller, A.A.S., Ananda Mitra, Ph.D., Morrow Omli, M.A. Ed.,
Scott Rhodes, Ph.D., Adrienne Robbins, B.A., Lisa Sobieski, B.A., Hoa Teuschlser, B.S., Leslie Tuttle, Kim Wagoner, M.S., and
Mark Wolfson, Ph.D, all from Wake Forest.
Media Contacts: Karen Richardson, krchrdsnwfubmc; Shannon Koontz, shkoontzwfubmc; at 336-716-4587
About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North
Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The
system comprises 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of
"America's Best Hospitals" by U.S. News & World Report.
Contact: Karen Richardson
krchrdsnwfubmc
336-716-4453
Wake Forest University Baptist Medical Center
wfubmc
student drinkers, according to new research from Wake Forest University School of Medicine.
The research suggests that a simple screening question - "In a typical week, how many days do you get drunk?" - may help
identify at-risk students.
"Each year approximately 1,700 college students die from alcohol-related injuries," said Mary Claire O'Brien, M.D., assistant
professor of emergency medicine and public health sciences at Wake Forest's School of Medicine, which is part of Wake Forest
University Baptist Medical Center. "Our goal was to develop a simple tool to tell which student drinkers are at highest risk
of getting hurt, as a result of their own drinking and the drinking of others."
The results, part of an ongoing, five-year research project to develop effective strategies for reducing problem drinking on
college campuses, were reported today at the annual meeting of the Society for Academic Emergency Medicine in New York City.
Wake Forest researchers found that students who got drunk at least once weekly were three times more likely to be hurt or
injured due to their own drinking than student drinkers who do not report getting drunk at least once a week. They were twice
as likely to fall from a height and need medical care, and 75 percent more likely to be sexually victimized. Getting drunk
was defined as being unsteady, dizzy or sick to your stomach.
"When you drink, you're also at risk because of other people's drinking," O'Brien said.
For example, students who got drunk at least once weekly were three times more likely to be in an automobile accident caused
by someone else's drinking and twice as likely to be taken advantage of sexually by someone who was drinking.
O'Brien's goal was to identify a one-question screening tool that could be used in busy hospital emergency departments. She
said the Wake Forest "single question" was designed specifically for college students.
"The emergency department presents a teachable moment," she said. "Research has shown that a brief intervention, such as
simple advice, can change drinking patterns."
O'Brien said that current screening tools define problem drinking as having four or five drinks in a row.
"In my experience, patients lie about how much they drink, and screening tests based on quantity don't account for
differences in weight, gender, alcohol tolerance, body metabolism, medications and other variables," she said. "What it takes
to make someone drunk varies from individual to individual."
The overall goal of the $3.2 million Study to Prevent Alcohol-Related Consequences (SPARC) is to reduce the availability of
alcohol to students and to help change campus cultures that promote drinking. The study uses such strategies as restricting
alcohol at campus events, increasing enforcement, constraining marketing and educating alcohol sellers and servers,
landlords, students and parents.
Ten North Carolina universities are participating in the Wake Forest study. Students are surveyed once a year on their
alcohol consumption, availability of alcohol, attitudes and perceptions, and consequences experienced from drinking.
Strategies to reduce problem drinking are being implemented at half of the campuses, with emphasis on forming
campus-community coalitions that address issues specific to each school. The web-based student surveys are one of several
measures of the project's effectiveness.
The multidisciplinary study team is led by Robert H. DuRant, Ph.D., professor of pediatrics and public health sciences at
Wake Forest Baptist. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
O'Brien's research is based on the first student web survey (fall 2003), which found that 63 percent of students under age 21
drink and that 20 percent of the drinkers usually have seven or more drinks. More than half (54 percent) of the drinkers said
they get drunk at least weekly.
According to the NIAAA, about four out of five students drink and about half of the drinkers engage in heaving episodic
consumption. It is estimated that that 97,000 students each year are victims of alcohol-related sexual assault or date rape,
that almost a third (31 percent) of college students meet the criteria for a diagnosis of alcohol abuse and that 2.8 million
college students drove under the influence of alcohol last year.
The 10 universities involved in the study are Appalachian State, Duke, High Point, Western Carolina and the Asheville, Chapel
Hill, Charlotte, Wilmington and Pembroke campuses of the University of North Carolina.
Other members of the SPARC research team are Barbara Alvarez-Martin, M.P.H., Heather Champion, Ph.D., Gail Cohen, M.D., Ralph
B. D'Agostino Jr., Ph.D., Sheryl Hulme, Thomas McCoy, M.S., Cindy Miller, A.A.S., Ananda Mitra, Ph.D., Morrow Omli, M.A. Ed.,
Scott Rhodes, Ph.D., Adrienne Robbins, B.A., Lisa Sobieski, B.A., Hoa Teuschlser, B.S., Leslie Tuttle, Kim Wagoner, M.S., and
Mark Wolfson, Ph.D, all from Wake Forest.
Media Contacts: Karen Richardson, krchrdsnwfubmc; Shannon Koontz, shkoontzwfubmc; at 336-716-4587
About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North
Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The
system comprises 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of
"America's Best Hospitals" by U.S. News & World Report.
Contact: Karen Richardson
krchrdsnwfubmc
336-716-4453
Wake Forest University Baptist Medical Center
wfubmc
четверг, 26 мая 2011 г.
Fewer Young Adults Seek Help For Cocaine And Crack Use
New figures from the National Treatment Agency for Substance Misuse (NTA) show a sharp drop for the first time in the numbers of drug users seeking treatment for addiction to cocaine and crack.
The fall affects all age groups but is particularly marked among young adults aged 18-24, and reverses the recent trend of steadily increasing treatment demand from users of these Class A drugs.
According to an NTA report, Drug Treatment in 2009-10 which is published today, the reduction disclosed by annual treatment statistics reflects recent evidence of a decline in popularity of cocaine as scarce street supplies are cut and adulterated by dealers.
The NTA report is published alongside independent research that estimates the number of heroin addicts in England has fallen by almost 11,000 in recent years. A study by Glasgow University, commissioned by the NTA, also found the numbers of heroin and crack addicts falling fastest among young adults.
A year ago the NTA discovered a dramatic drop in demand nationally for heroin treatment among young adults aged 18-24. That fall has continued this year, and now affects the 25-29 age-group as well.
NTA Chief Executive, Paul Hayes said:
"These statistics are more than just an annual snapshot for one year, 2009-10. We now have five years' worth of robust data from the National Drug Treatment Monitoring System, so we can show some reliable trends.
"This year's figures confirm the NTA's claim that the 'trainspotting generation' that got hooked in the 1980s is growing older, fewer young people are risking getting addicted to heroin, and treatment is beginning to show an impact on drug use.
"Our priority now is to refocus the drug treatment system in England to deliver sustained recovery from addiction so that users can get off drugs altogether, start re-living their lives and contribute to their families, communities and society."
However, just as young adults are shunning heroin, there is a small rise in treatment demand among the over-40s. As the heroin-using population gets older, some entrenched users are beginning to come into treatment for the first time.
Notes
Drug Treatment 2009-10 (see here) draws on information from:
- A Long Term Study of the Outcomes of Drug Users Leaving Treatment September 2010 (see here)
- National Drug Treatment Monitoring System (NDTMS) Statistical report for 2009/10 (see here)
- Prevalence estimates for England 2008/09 (Glasgow University) (see here )
Source:
National Treatment Agency for Substance Misuse (NTA)
The fall affects all age groups but is particularly marked among young adults aged 18-24, and reverses the recent trend of steadily increasing treatment demand from users of these Class A drugs.
According to an NTA report, Drug Treatment in 2009-10 which is published today, the reduction disclosed by annual treatment statistics reflects recent evidence of a decline in popularity of cocaine as scarce street supplies are cut and adulterated by dealers.
The NTA report is published alongside independent research that estimates the number of heroin addicts in England has fallen by almost 11,000 in recent years. A study by Glasgow University, commissioned by the NTA, also found the numbers of heroin and crack addicts falling fastest among young adults.
A year ago the NTA discovered a dramatic drop in demand nationally for heroin treatment among young adults aged 18-24. That fall has continued this year, and now affects the 25-29 age-group as well.
NTA Chief Executive, Paul Hayes said:
"These statistics are more than just an annual snapshot for one year, 2009-10. We now have five years' worth of robust data from the National Drug Treatment Monitoring System, so we can show some reliable trends.
"This year's figures confirm the NTA's claim that the 'trainspotting generation' that got hooked in the 1980s is growing older, fewer young people are risking getting addicted to heroin, and treatment is beginning to show an impact on drug use.
"Our priority now is to refocus the drug treatment system in England to deliver sustained recovery from addiction so that users can get off drugs altogether, start re-living their lives and contribute to their families, communities and society."
However, just as young adults are shunning heroin, there is a small rise in treatment demand among the over-40s. As the heroin-using population gets older, some entrenched users are beginning to come into treatment for the first time.
Notes
Drug Treatment 2009-10 (see here) draws on information from:
- A Long Term Study of the Outcomes of Drug Users Leaving Treatment September 2010 (see here)
- National Drug Treatment Monitoring System (NDTMS) Statistical report for 2009/10 (see here)
- Prevalence estimates for England 2008/09 (Glasgow University) (see here )
Source:
National Treatment Agency for Substance Misuse (NTA)
среда, 25 мая 2011 г.
Increasing Taxes On Alcoholic Beverages Reduces Disease, Injury, Crime And Death Rates
Increasing the costs to consumers of beer, wine, and hard liquor significantly reduces the rates of a wide range of alcohol-related deaths, diseases, injuries, and other problems, according to a new study published in the online edition of the American Journal of Public Health and scheduled for inclusion in the November print edition. Researchers at the University of Florida (UF) report that public policies that increase the price of alcoholic beverages, such as increases in alcohol excise taxes, not only reduce drinking but also significantly reduce most of the negative and costly outcomes associated with alcohol.
According to the researchers, alcohol taxes have considerably larger effects than prevention programs on a state's burden of alcohol-related problems. The results suggest that doubling the average state tax on alcohol would be associated, on average, with a 35 percent reduction in alcohol-related mortality, an 11 percent reduction in traffic crash deaths, a 6 percent reduction in STDs, a 2 percent reduction in violence, and a 1.4 percent reduction in crime.
"Our meta-analysis cumulated information from all the published scientific research on this topic over the past half century, and results clearly show increasing the price of alcohol will result in significant reductions in many of the undesirable outcomes associated with drinking," said Alexander C. Wagenaar, PhD, professor of health outcomes and policy at UF College of Medicine and lead author of the study. "Simply adjusting decades-old tax rates to account for inflation could save thousands of lives and billions of dollars in law enforcement and health care costs."
For this meta-analysis study, the researchers identified 50 published research papers containing 340 estimates of the effects of alcohol taxes or prices on the rates of a variety of outcomes, including: all-cause morbidity and mortality, alcohol-related diseases or injuries, violence, suicide, traffic safety outcomes, STDs and risky sexual behaviors, other drug use, and crimes and misbehaviors. Through a meta-analysis of the aggregate data from all those studies, the researchers found that alcohol prices and taxes are significantly and inversely related to all outcome categories examined except suicide, for which data were too sparse to draw a firm conclusion.
"Results are surprisingly consistent," said Wagenaar. "With the sole exception of suicide rates, every category of outcome examined shows a significant effect of alcohol taxes and prices."
Today's study follows a previous meta-analysis study through which these researchers found that a 10 percent increase in alcohol price results in about a 5 percent reduction in alcohol consumption. That study examined 112 research papers containing 1,004 estimates of the effects of alcohol prices on alcohol sales and drinking behaviors.
"Taken together, these two studies establish beyond any reasonable doubt that, as the price of alcohol goes up, alcohol consumption and the rates of adverse outcomes related to consumption go down," said Wagenaar. "The strength of these findings suggests that tax increases may be the most effective way we have to prevent excessive drinking - and also have drinkers pay more of their fair share for the damages caused and costs incurred."
Wagenaar's study, Effects of Alcohol Tax and Price Policies on Morbidity and Mortality: A Systematic Review, was funded by the Robert Wood Johnson Foundation.
Source:
Becky Wexler
Burness Communications
According to the researchers, alcohol taxes have considerably larger effects than prevention programs on a state's burden of alcohol-related problems. The results suggest that doubling the average state tax on alcohol would be associated, on average, with a 35 percent reduction in alcohol-related mortality, an 11 percent reduction in traffic crash deaths, a 6 percent reduction in STDs, a 2 percent reduction in violence, and a 1.4 percent reduction in crime.
"Our meta-analysis cumulated information from all the published scientific research on this topic over the past half century, and results clearly show increasing the price of alcohol will result in significant reductions in many of the undesirable outcomes associated with drinking," said Alexander C. Wagenaar, PhD, professor of health outcomes and policy at UF College of Medicine and lead author of the study. "Simply adjusting decades-old tax rates to account for inflation could save thousands of lives and billions of dollars in law enforcement and health care costs."
For this meta-analysis study, the researchers identified 50 published research papers containing 340 estimates of the effects of alcohol taxes or prices on the rates of a variety of outcomes, including: all-cause morbidity and mortality, alcohol-related diseases or injuries, violence, suicide, traffic safety outcomes, STDs and risky sexual behaviors, other drug use, and crimes and misbehaviors. Through a meta-analysis of the aggregate data from all those studies, the researchers found that alcohol prices and taxes are significantly and inversely related to all outcome categories examined except suicide, for which data were too sparse to draw a firm conclusion.
"Results are surprisingly consistent," said Wagenaar. "With the sole exception of suicide rates, every category of outcome examined shows a significant effect of alcohol taxes and prices."
Today's study follows a previous meta-analysis study through which these researchers found that a 10 percent increase in alcohol price results in about a 5 percent reduction in alcohol consumption. That study examined 112 research papers containing 1,004 estimates of the effects of alcohol prices on alcohol sales and drinking behaviors.
"Taken together, these two studies establish beyond any reasonable doubt that, as the price of alcohol goes up, alcohol consumption and the rates of adverse outcomes related to consumption go down," said Wagenaar. "The strength of these findings suggests that tax increases may be the most effective way we have to prevent excessive drinking - and also have drinkers pay more of their fair share for the damages caused and costs incurred."
Wagenaar's study, Effects of Alcohol Tax and Price Policies on Morbidity and Mortality: A Systematic Review, was funded by the Robert Wood Johnson Foundation.
Source:
Becky Wexler
Burness Communications
Report Recommends Five-Point Plan To Reduce Spread Of HIV Among U.S. Blacks
The National Minority AIDS Council on Thursday released a report calling for U.S. policymakers to implement a five-point strategy aimed at combating HIV/AIDS among blacks in the country, the San Francisco Chronicle reports (Fulbright, San Francisco Chronicle, 11/16). Blacks account for 13% of the U.S. population but make up more than half of new HIV cases in the country, according to CDC (Dunham, Reuters Health, 11/16). The 27-page report -- titled, "African Americans, Health Disparities and HIV/AIDS: Recommendations for Confronting the Epidemic in Black America" -- was released as part of events leading up to World AIDS Day, which will be held on Dec. 1 (Taylor, Long Island Newsday, 11/16). For the report, NMAC examined the social, economic and personal factors that are the basis for the HIV/AIDS epidemic among U.S. blacks (Reuters Health, 11/16). The report calls on advocates to strengthen black communities by addressing the issue of affordable housing; eliminating marginalization, stigma and discrimination against black men who have sex with men; reducing the impact of incarceration on the spread of HIV among blacks; broadening HIV education programs and promote early detection through voluntary, routine testing; and expanding substance abuse prevention programs, drug treatment and recovery services, and needle-exchange programs (NMAC
вторник, 24 мая 2011 г.
Teen's Addiction Leads Family To Unique Wilderness Therapy Program
At age 12, straight-A student James
turned to methamphetamines to help him cope with his mother's near-fatal
illness and to be accepted by peers. Little did he know the drug would
later place him in his own life-or-death struggle to overcome addiction.
James' journey to overcome addiction at Passages to Recovery, a unique
wilderness-based substance recovery program, was featured on the July 30,
2006, episode of A&E Television Network's documentary series
"INTERVENTION(TM)."
"With the help of A&E Television, James' mother was introduced to
Passages to Recovery for the treatment of her son," said Trilby Hoover,
executive director of Passages to Recovery. "Passages to Recovery
incorporates individual, group and family therapy, proven treatment
methods, and a 12-step philosophy to create a successful 'wilderness rehab'
experience for young adults."
Based in southern Utah, Passages to Recovery is a program of Aspen
Education Group, the nation's private-sector leader in providing
therapeutic education to under-achieving or struggling young people.
"Passages to Recovery is an incredible program that brought hope, joy
and love back into our lives," said mom Marybeth. "The tools and knowledge
they taught at Passages to Recovery were unbelievable," James' father,
James, Sr., noted. "James' outlook on life has done a complete turnaround."
"During my therapy in the wilderness, I learned self-reliance and
self-confidence, and most importantly I learned how to face my fears
without drugs," said James. "I hope my experience can help others
understand that they can overcome addiction at programs like Passages to
Recovery."
According to Hoover, students like James benefit from the
individualized clinical care and therapy they receive from the program's
professional therapists and wilderness guides. "The Passages to Recovery
wilderness rehab program is designed specifically for young adults who are
18-30 years old; and it allows them to experience success and develop
self-esteem by overcoming the physical, mental and emotional challenges of
living in the wilderness," added Hoover. "Students experience firsthand the
transformational power of nature through unique wilderness experiences like
sweat lodges and vision quests." After James' successful wilderness
treatment at Passages to Recovery, he continued his recovery process at
NorthStar Center, an Aspen Education Group young-adult aftercare program in
Bend, Oregon.
Aspen's success in helping young people overcome substance abuse has
been documented and featured in international media, including the United
States' nationally syndicated "Dr. Phil" and in the United Kingdom on ITV's
"Britain's Youngest Boozers" and "Tonight with Trevor McDonald." Aspen's
programs also have been featured on CNN, National Public Radio, "Dateline
NBC," NBC's "Today," ABC's "Good Morning America," and in the New York
Times, Los Angeles Times Magazine, U.S. News & World Report, and USA Today.
Aspen's programs offer a combination of education and therapy or
counseling for young people who have demonstrated behavioral, learning or
substance use issues that interfere with their performance in school and
their relations with peers, family and friends. Aspen's offerings range
from short-term interventions to long-term programs, and include a variety
of settings, including wilderness therapy, boarding schools, residential
treatment, and weight-loss programs.
For more information on Passages to Recovery, call 866-625-8809 or
visit passagestorecovery. For more information on Aspen's other
programs, visit aspeneducation or call 888-972-7736. For more
information on A&E INTERVENTION(TM), please visit
aetv/intervention.
Aspen Education Group
aetv/intervention
turned to methamphetamines to help him cope with his mother's near-fatal
illness and to be accepted by peers. Little did he know the drug would
later place him in his own life-or-death struggle to overcome addiction.
James' journey to overcome addiction at Passages to Recovery, a unique
wilderness-based substance recovery program, was featured on the July 30,
2006, episode of A&E Television Network's documentary series
"INTERVENTION(TM)."
"With the help of A&E Television, James' mother was introduced to
Passages to Recovery for the treatment of her son," said Trilby Hoover,
executive director of Passages to Recovery. "Passages to Recovery
incorporates individual, group and family therapy, proven treatment
methods, and a 12-step philosophy to create a successful 'wilderness rehab'
experience for young adults."
Based in southern Utah, Passages to Recovery is a program of Aspen
Education Group, the nation's private-sector leader in providing
therapeutic education to under-achieving or struggling young people.
"Passages to Recovery is an incredible program that brought hope, joy
and love back into our lives," said mom Marybeth. "The tools and knowledge
they taught at Passages to Recovery were unbelievable," James' father,
James, Sr., noted. "James' outlook on life has done a complete turnaround."
"During my therapy in the wilderness, I learned self-reliance and
self-confidence, and most importantly I learned how to face my fears
without drugs," said James. "I hope my experience can help others
understand that they can overcome addiction at programs like Passages to
Recovery."
According to Hoover, students like James benefit from the
individualized clinical care and therapy they receive from the program's
professional therapists and wilderness guides. "The Passages to Recovery
wilderness rehab program is designed specifically for young adults who are
18-30 years old; and it allows them to experience success and develop
self-esteem by overcoming the physical, mental and emotional challenges of
living in the wilderness," added Hoover. "Students experience firsthand the
transformational power of nature through unique wilderness experiences like
sweat lodges and vision quests." After James' successful wilderness
treatment at Passages to Recovery, he continued his recovery process at
NorthStar Center, an Aspen Education Group young-adult aftercare program in
Bend, Oregon.
Aspen's success in helping young people overcome substance abuse has
been documented and featured in international media, including the United
States' nationally syndicated "Dr. Phil" and in the United Kingdom on ITV's
"Britain's Youngest Boozers" and "Tonight with Trevor McDonald." Aspen's
programs also have been featured on CNN, National Public Radio, "Dateline
NBC," NBC's "Today," ABC's "Good Morning America," and in the New York
Times, Los Angeles Times Magazine, U.S. News & World Report, and USA Today.
Aspen's programs offer a combination of education and therapy or
counseling for young people who have demonstrated behavioral, learning or
substance use issues that interfere with their performance in school and
their relations with peers, family and friends. Aspen's offerings range
from short-term interventions to long-term programs, and include a variety
of settings, including wilderness therapy, boarding schools, residential
treatment, and weight-loss programs.
For more information on Passages to Recovery, call 866-625-8809 or
visit passagestorecovery. For more information on Aspen's other
programs, visit aspeneducation or call 888-972-7736. For more
information on A&E INTERVENTION(TM), please visit
aetv/intervention.
Aspen Education Group
aetv/intervention
понедельник, 23 мая 2011 г.
Drunk gene found
SAN FRANCISCO, California (USA) -- Researchers found a gene responsible for drunkenness in worms after plying thousands of the tiny creatures with booze, a discovery that could boost the fight against alcoholism.
The experiment was conducted by University of California, San Francisco researchers and was to be published Friday in the science journal Cell.
Because it is believed that alcohol affects all animals similarly, humans, like worms, may also possess a single gene responsible for drunkenness.
'Our end goal is to find a way to cure alcoholism and drug abuse,' Dr. Steven McIntire said. 'We hope to develop effective therapeutics to improve the ability of people to stop drinking.'
After six years of work on the project, McIntire can now spot a soused worm about as well as a highway patrol trooper can spot a drunken driver.
He and the other scientists dosed hundreds of thousands of worms with enough alcohol that they would be too drunk to drive legally -- if they were human with the same blood-to-alcohol levels.
The drunken worms moved slower and more awkwardly than sober ones, and laid fewer eggs. Teetotaler worms form a neat S shape to power propulsion while the bodies of drunken worms were straighter and less active.
Researchers found that the sober worms had the same mutated gene that appears to make them immune to alcohol's intoxicating effects.
The natural job of the gene they found is to help slow brain transmissions. Alcohol increases the gene's activity, which slows down brain activity even more. But if the gene is disabled, as it was in the mutant worms, the brain never gets the chance to slow down.
Still, McIntire and other addiction experts caution there's much research left to do before the leap to people can be made.
'Humans are a lot more complicated than the worm,' said neurobiology professor Steven Treistman of the University of Massachusetts Medical School. Treistman said many other genes are probably involved in helping people get drunk and that McIntire's work with worms couldn't measure other human intoxicating effects such as slurred speech and loss of inhibition.
Nonetheless, Treistman said the findings are important because they highlight an important new target in the fight against alcoholism.
According to the National Institute of Alcohol Abuse and Alcoholism, 14 million Americans abuse alcohol.
The experiment was conducted by University of California, San Francisco researchers and was to be published Friday in the science journal Cell.
Because it is believed that alcohol affects all animals similarly, humans, like worms, may also possess a single gene responsible for drunkenness.
'Our end goal is to find a way to cure alcoholism and drug abuse,' Dr. Steven McIntire said. 'We hope to develop effective therapeutics to improve the ability of people to stop drinking.'
After six years of work on the project, McIntire can now spot a soused worm about as well as a highway patrol trooper can spot a drunken driver.
He and the other scientists dosed hundreds of thousands of worms with enough alcohol that they would be too drunk to drive legally -- if they were human with the same blood-to-alcohol levels.
The drunken worms moved slower and more awkwardly than sober ones, and laid fewer eggs. Teetotaler worms form a neat S shape to power propulsion while the bodies of drunken worms were straighter and less active.
Researchers found that the sober worms had the same mutated gene that appears to make them immune to alcohol's intoxicating effects.
The natural job of the gene they found is to help slow brain transmissions. Alcohol increases the gene's activity, which slows down brain activity even more. But if the gene is disabled, as it was in the mutant worms, the brain never gets the chance to slow down.
Still, McIntire and other addiction experts caution there's much research left to do before the leap to people can be made.
'Humans are a lot more complicated than the worm,' said neurobiology professor Steven Treistman of the University of Massachusetts Medical School. Treistman said many other genes are probably involved in helping people get drunk and that McIntire's work with worms couldn't measure other human intoxicating effects such as slurred speech and loss of inhibition.
Nonetheless, Treistman said the findings are important because they highlight an important new target in the fight against alcoholism.
According to the National Institute of Alcohol Abuse and Alcoholism, 14 million Americans abuse alcohol.
HIV Positive Injection Drug Users On Worldwide Scale
There could be three million HIV positive injection drug users
(IDUs)? in the world, according to an article released on
September
24, 2008 in The Lancet.
To investigate the current state of HIV status in IDUs, Dr Bradley
Mathers, National Drug and Alcohol Research Centre,
University of? New South Wales, Sydney, Australia, and
colleagues
from
the 2007 Reference Group to the? UN on HIV and Injecting Drug
Use
performed a systematic review of data from 148 different countries.
In the analysis, the authors estimated that 15.9 million people
worldwide inject drugs. In 1998, one study reported injecting drug use
in 129 countries, and of these, 103 reported HIV status. Later research
indicates that at least 148 countries have IDUs, with 120 reporting HIV
positive IDUs. Over 40% of IDUs are HIV positive in at least nine
countries, including
Estonia, Ukraine, Burma, Indonesia,? Thailand, Nepal,
Argentina,
Brazil, and Kenya. In an examination of people between 15 and 64 years
old, the analysis showed significant differences between different
countries. Within this age group, the following notable proportions of
IDUs and HIV status have been estimated:
Italy and Switzerland showed the highest estimated
proportions of IDUs in Western Europe, with 0.83% and 0.65%
respectively.?
Spain and Portugal showed the highest proportion of IDUs
who are
HIV positive in Western Europe, with 39.7% and 15.6%
respectively.?
The United States has an estimated rate of 0.96% IDUs, with
15.6% of these HIV positive.
The authors generally call for more data regarding IDUs and HIV status,
especially in light of the importance of injecting drug use in HIV
transmission. "There is a pressing need to? understand
injecting
drug use in all countries," they said. There was a notable absence of
data from countries in Africa. Due to a number of influences, which the
authors refer to as "constellation of risk factors exists for the
development of injecting drug use," this is especially troubling. They
also note that "Areas of particular concern? are countries in
southeast Asia, eastern
Europe, and Latin America, where the prevalence of? HIV
infection
among
some subpopulations of people who inject drugs has been
reported?
to be
over 40%."
The authors conclude, emphasizing the need for research in this area:
"Injecting drug use occurs in most countries and HIV infection is
prevalent? among many populations of IDUs, representing a
major
challenge to global public health. People who inject drugs have the
right to enjoy the highest standard of health
attainable.? There is
a clear mandate to invest in HIV prevention activities such as needle
and syringe programmes and opioid substitution treatments and to
provide treatment and care for those? living with HIV/AIDS.
The
magnitude of this risk has not be met with an equally
concerted?
investment in research to accurately quantify the problem."
Dr. Kamyar Arasteh and Dr. Don C. Des Jarlais, Beth Israel?
Medical Center, Baron Edmond de Rothschild Chemical Dependency
Institute, New York, contributed an accompanying comment in which they
explore many risk factors taht could be contributing to injecting drug
use. They say: "The one optimistic aspect of this rather gloomy
situation is that, if HIV-prevention? efforts are implemented
on a
large scale when prevalence is low in injecting drug users, it
is?
possible to avert HIV epidemics in users. Thus it should be an
imperative - for both resource constrained countries and international
donors - to implement large-scale evidence-based programmes for
HIV-prevention whenever there is an indication of a developing
injecting drug-use problem."
Global epidemiology of injecting drug use and HIV
among? people who inject drugs: a systematic review Bradley M
Mathers,
Louisa Degenhardt, Benjamin Phillips, Lucas Wiessing, Matthew Hickman,
Steffanie A Strathdee, Alex Wodak,? Samiran Panda, Mark
Tyndall,
Abdalla Toufik, Richard P Mattick, for the 2007 Reference Group to the
UN on HIV and Injecting Drug Use
The Lancet September 24, 2008
DOI:10.1016/S01406736(08)61311-2
Click Here for Journal
Written by Anna Sophia McKenney
(IDUs)? in the world, according to an article released on
September
24, 2008 in The Lancet.
To investigate the current state of HIV status in IDUs, Dr Bradley
Mathers, National Drug and Alcohol Research Centre,
University of? New South Wales, Sydney, Australia, and
colleagues
from
the 2007 Reference Group to the? UN on HIV and Injecting Drug
Use
performed a systematic review of data from 148 different countries.
In the analysis, the authors estimated that 15.9 million people
worldwide inject drugs. In 1998, one study reported injecting drug use
in 129 countries, and of these, 103 reported HIV status. Later research
indicates that at least 148 countries have IDUs, with 120 reporting HIV
positive IDUs. Over 40% of IDUs are HIV positive in at least nine
countries, including
Estonia, Ukraine, Burma, Indonesia,? Thailand, Nepal,
Argentina,
Brazil, and Kenya. In an examination of people between 15 and 64 years
old, the analysis showed significant differences between different
countries. Within this age group, the following notable proportions of
IDUs and HIV status have been estimated:
Italy and Switzerland showed the highest estimated
proportions of IDUs in Western Europe, with 0.83% and 0.65%
respectively.?
Spain and Portugal showed the highest proportion of IDUs
who are
HIV positive in Western Europe, with 39.7% and 15.6%
respectively.?
The United States has an estimated rate of 0.96% IDUs, with
15.6% of these HIV positive.
The authors generally call for more data regarding IDUs and HIV status,
especially in light of the importance of injecting drug use in HIV
transmission. "There is a pressing need to? understand
injecting
drug use in all countries," they said. There was a notable absence of
data from countries in Africa. Due to a number of influences, which the
authors refer to as "constellation of risk factors exists for the
development of injecting drug use," this is especially troubling. They
also note that "Areas of particular concern? are countries in
southeast Asia, eastern
Europe, and Latin America, where the prevalence of? HIV
infection
among
some subpopulations of people who inject drugs has been
reported?
to be
over 40%."
The authors conclude, emphasizing the need for research in this area:
"Injecting drug use occurs in most countries and HIV infection is
prevalent? among many populations of IDUs, representing a
major
challenge to global public health. People who inject drugs have the
right to enjoy the highest standard of health
attainable.? There is
a clear mandate to invest in HIV prevention activities such as needle
and syringe programmes and opioid substitution treatments and to
provide treatment and care for those? living with HIV/AIDS.
The
magnitude of this risk has not be met with an equally
concerted?
investment in research to accurately quantify the problem."
Dr. Kamyar Arasteh and Dr. Don C. Des Jarlais, Beth Israel?
Medical Center, Baron Edmond de Rothschild Chemical Dependency
Institute, New York, contributed an accompanying comment in which they
explore many risk factors taht could be contributing to injecting drug
use. They say: "The one optimistic aspect of this rather gloomy
situation is that, if HIV-prevention? efforts are implemented
on a
large scale when prevalence is low in injecting drug users, it
is?
possible to avert HIV epidemics in users. Thus it should be an
imperative - for both resource constrained countries and international
donors - to implement large-scale evidence-based programmes for
HIV-prevention whenever there is an indication of a developing
injecting drug-use problem."
Global epidemiology of injecting drug use and HIV
among? people who inject drugs: a systematic review Bradley M
Mathers,
Louisa Degenhardt, Benjamin Phillips, Lucas Wiessing, Matthew Hickman,
Steffanie A Strathdee, Alex Wodak,? Samiran Panda, Mark
Tyndall,
Abdalla Toufik, Richard P Mattick, for the 2007 Reference Group to the
UN on HIV and Injecting Drug Use
The Lancet September 24, 2008
DOI:10.1016/S01406736(08)61311-2
Click Here for Journal
Written by Anna Sophia McKenney
воскресенье, 22 мая 2011 г.
Greater Risk Of Preterm Birth A Consequence Of Binge Drinking
A new study from the Telethon Institute for Child Health Research has revealed the consequences of heavy and binge drinking on pregnancy even after these drinking patterns have stopped.
The study, to be published in BJOG: An International Journal of Obstetrics and Gynaecology, investigated the relationship between prenatal exposure to alcohol and the effects on fetal growth and preterm birth.
A random sample of 4,719 women who gave birth in Western Australia between 1995 and 1997 took part in a survey. Data such as how often participants drank alcohol, the amount of alcohol consumed in each occasion and the types of alcoholic beverage consumed were collated.
The researcher team from the Institute with the National Perinatal Epidemiology Unit at the University of Oxford found that, on average, levels of alcohol intake decreased from the pre-pregnancy period to the second and third trimester. There was no difference in outcomes for women who drank low levels of alcohol during their pregnancy and those that abstained.
The incidence of preterm birth was highest amongst women who binged (9.5%) or drank heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy. There was a 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped (CI 0.7, 7.7) after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol consumption before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth. There was no evidence of an increased likelihood of preterm birth at low levels of alcohol consumption.
Prenatal alcohol exposure did not increase the risk of babies being born small for gestational age once maternal smoking was accounted for.
Researchers noted a link between smoking and alcohol consumption - they found women who smoked during pregnancy were less likely to abstain from alcohol at any time during their pregnancy than non-smokers. Over one quarter (27.7%) of women who drank in late pregnancy also smoked, compared with 19% of women who had abstained from alcohol during pregnancy. Other factors associated with late term pregnancy drinking include: a maternal age of 30 years and above, higher income, use of illicit drugs.
Institute researcher Colleen O'Leary said "Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester.
"The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.
"Health professionals should routinely screen pregnant women and all women of child bearing age for alcohol use/misuse. It's important that women should be given information about the possible risks to the baby from alcohol exposure during pregnancy.
"Women should be advised that during pregnancy, drinking alcohol above low levels increases the risk to the baby and that the safest choice is not to drink alcohol during pregnancy. If pregnant women cannot stop or reduce their drinking, they should seek medical advice."
[A standard drink in this analysis is the Australian standard10gm of alcohol, eg 100ml of wine]
Professor Philip Steer, BJOG editor-in-chief said, "This study provides useful insight into the drinking habits of a representative group of women. It is very telling how the combination of smoking and heavy drinking can mean double trouble for pregnant mothers and their babies.
"It shows the effects of high alcohol use and demonstrates that heavy and binge levels of alcohol during pregnancy increases the risk to the baby, even if drinking is stopped in the first three months of pregnancy. These findings are sobering and should act as a deterrent to heavy or binge drinking during pregnancy. However, the results also show that low levels of alcohol consumption (less than 7 standard drinks per week and no more than two on any one occasion) appeared not to constitute a significant risk of preterm birth provided all other forms of unhealthy behaviour were avoided."
Notes:
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide.
The Telethon Institute for Child Health Research is based in Perth, Western Australia and adopts a multidisciplinary approach to investigating the major issues in child health and development. The Institute has more than 450 staff and post-graduate students, and is headed by Professor Fiona Stanley AC.
Reference O'Leary C, Nassar N, Kurinczuk J, Bower C. Impact of maternal alcohol consumption on fetal growth and preterm birth. BJOG 2009;116:390.
Source: Elizabeth Chester
Research Australia
The study, to be published in BJOG: An International Journal of Obstetrics and Gynaecology, investigated the relationship between prenatal exposure to alcohol and the effects on fetal growth and preterm birth.
A random sample of 4,719 women who gave birth in Western Australia between 1995 and 1997 took part in a survey. Data such as how often participants drank alcohol, the amount of alcohol consumed in each occasion and the types of alcoholic beverage consumed were collated.
The researcher team from the Institute with the National Perinatal Epidemiology Unit at the University of Oxford found that, on average, levels of alcohol intake decreased from the pre-pregnancy period to the second and third trimester. There was no difference in outcomes for women who drank low levels of alcohol during their pregnancy and those that abstained.
The incidence of preterm birth was highest amongst women who binged (9.5%) or drank heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy. There was a 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped (CI 0.7, 7.7) after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol consumption before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth. There was no evidence of an increased likelihood of preterm birth at low levels of alcohol consumption.
Prenatal alcohol exposure did not increase the risk of babies being born small for gestational age once maternal smoking was accounted for.
Researchers noted a link between smoking and alcohol consumption - they found women who smoked during pregnancy were less likely to abstain from alcohol at any time during their pregnancy than non-smokers. Over one quarter (27.7%) of women who drank in late pregnancy also smoked, compared with 19% of women who had abstained from alcohol during pregnancy. Other factors associated with late term pregnancy drinking include: a maternal age of 30 years and above, higher income, use of illicit drugs.
Institute researcher Colleen O'Leary said "Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester.
"The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.
"Health professionals should routinely screen pregnant women and all women of child bearing age for alcohol use/misuse. It's important that women should be given information about the possible risks to the baby from alcohol exposure during pregnancy.
"Women should be advised that during pregnancy, drinking alcohol above low levels increases the risk to the baby and that the safest choice is not to drink alcohol during pregnancy. If pregnant women cannot stop or reduce their drinking, they should seek medical advice."
[A standard drink in this analysis is the Australian standard10gm of alcohol, eg 100ml of wine]
Professor Philip Steer, BJOG editor-in-chief said, "This study provides useful insight into the drinking habits of a representative group of women. It is very telling how the combination of smoking and heavy drinking can mean double trouble for pregnant mothers and their babies.
"It shows the effects of high alcohol use and demonstrates that heavy and binge levels of alcohol during pregnancy increases the risk to the baby, even if drinking is stopped in the first three months of pregnancy. These findings are sobering and should act as a deterrent to heavy or binge drinking during pregnancy. However, the results also show that low levels of alcohol consumption (less than 7 standard drinks per week and no more than two on any one occasion) appeared not to constitute a significant risk of preterm birth provided all other forms of unhealthy behaviour were avoided."
Notes:
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide.
The Telethon Institute for Child Health Research is based in Perth, Western Australia and adopts a multidisciplinary approach to investigating the major issues in child health and development. The Institute has more than 450 staff and post-graduate students, and is headed by Professor Fiona Stanley AC.
Reference O'Leary C, Nassar N, Kurinczuk J, Bower C. Impact of maternal alcohol consumption on fetal growth and preterm birth. BJOG 2009;116:390.
Source: Elizabeth Chester
Research Australia
High Novelty-Seeking And Low Avoidance Of Harm Contribute To Alcohol Dependence
Personality factors can influence the development of alcohol dependence (AD). Researchers examined a group of AD individuals with the inactive form of aldehyde dehydrogenase-2 (ALDH2) - persons who would normally have a low incidence of alcoholism because the inactive form of ALDH2 causes flushing, nausea, and headaches. Results indicate that a strong need for novelty and little need for avoiding harm appear to increase the risk of AD.
Findings will be published in the May issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"Some case-control studies have shown that high novelty-seeking (NS) and low harm-avoidance (HA) are associated with alcoholism," said Mitsuru Kimura, chief of the department of psychiatry and section of behavioral science at the National Hospital Organization. "But a personality profile associated with alcoholism is not well-established. This is the first study that demonstrates there is a difference between personality profiles of alcoholics with inactive and active form of ALDH2 polymorphism." Kimura is also the corresponding author for the study.
"Alcoholism is usually subtyped by clinical features, such as Type I vs. Type II or Type A vs. Type B," explained Ihn-Geun Choi, professor and chair of the department of neuropsychiatry at Hallym University College of Medicine in South Korea. "Researchers categorized alcoholics according to alcohol-metabolizing enzyme activities and studied their relevance to personality traits. This [study] is a new perspective of categorizing clinically similar alcoholics who were believed to have the same subtypes and personality profiles."
Researchers interviewed and genotyped 460 male Japanese alcoholics who had been hospitalized at the Kurihama Alcoholism Center. All patients filled out the Tridimensional Personality Questionnaire (TPQ). Of the total, 66 patients had the inactive form of ALDH2 (ALDH2*1/2*2), and 394 had the active form (ALDH2*1/2*1).
"Individuals who became alcoholics in spite of having a strong negative risk factor, the inactive type of ALDH2, revealed a characteristic personality profile, that is, higher NS and lower HA compared with those who had the active type of ALDH2," said Kimura. "This tells us that high NS and low HA are predisposing factors for alcoholism." High NS and low HA scores tend to reflect impulsive, danger-seeking, and aggressive personalities, he added.
"Alcoholism is a complex disease with multiple causes," noted Choi. "Personality traits are both inborn and acquired, and genetic and environmental factors are also important for developing alcoholism. If your child is aggressive or impulsive, perhaps it would be wise to refrain from allowing him or her to drink."
"This study shows the alcoholics with inactive ALDH2 are a unique group with perhaps stronger risk factors for alcoholism," said Kimura. "Since the inactive ALDH2 group tended to have less familial alcoholic history, a study of alcoholics with inactive ALDH2 could be useful for detecting environmental or personality factors related to alcoholism."
Notes:
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Association between Personality Traits and ALDH2 polymorphism in Japanese Male Alcoholics," were: Toru Sawayama of the Department of Psychiatry at Kitasato University School of Medicine; Sachio Matsushita and Susumu Higuchi of the Kurihama Alcoholism Center at the National Hospital Organization; and Haruo Kashima of the Department of Neuropsychiatry in the School of Medicine at Keio University, all in Japan.
Source:
Mitsuru Kimura, M.D.
National Hospital Organization
Ihn-Geun Choi, M.D., Ph.D.
Hallym University College of Medicine
Alcoholism: Clinical & Experimental Research
Findings will be published in the May issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"Some case-control studies have shown that high novelty-seeking (NS) and low harm-avoidance (HA) are associated with alcoholism," said Mitsuru Kimura, chief of the department of psychiatry and section of behavioral science at the National Hospital Organization. "But a personality profile associated with alcoholism is not well-established. This is the first study that demonstrates there is a difference between personality profiles of alcoholics with inactive and active form of ALDH2 polymorphism." Kimura is also the corresponding author for the study.
"Alcoholism is usually subtyped by clinical features, such as Type I vs. Type II or Type A vs. Type B," explained Ihn-Geun Choi, professor and chair of the department of neuropsychiatry at Hallym University College of Medicine in South Korea. "Researchers categorized alcoholics according to alcohol-metabolizing enzyme activities and studied their relevance to personality traits. This [study] is a new perspective of categorizing clinically similar alcoholics who were believed to have the same subtypes and personality profiles."
Researchers interviewed and genotyped 460 male Japanese alcoholics who had been hospitalized at the Kurihama Alcoholism Center. All patients filled out the Tridimensional Personality Questionnaire (TPQ). Of the total, 66 patients had the inactive form of ALDH2 (ALDH2*1/2*2), and 394 had the active form (ALDH2*1/2*1).
"Individuals who became alcoholics in spite of having a strong negative risk factor, the inactive type of ALDH2, revealed a characteristic personality profile, that is, higher NS and lower HA compared with those who had the active type of ALDH2," said Kimura. "This tells us that high NS and low HA are predisposing factors for alcoholism." High NS and low HA scores tend to reflect impulsive, danger-seeking, and aggressive personalities, he added.
"Alcoholism is a complex disease with multiple causes," noted Choi. "Personality traits are both inborn and acquired, and genetic and environmental factors are also important for developing alcoholism. If your child is aggressive or impulsive, perhaps it would be wise to refrain from allowing him or her to drink."
"This study shows the alcoholics with inactive ALDH2 are a unique group with perhaps stronger risk factors for alcoholism," said Kimura. "Since the inactive ALDH2 group tended to have less familial alcoholic history, a study of alcoholics with inactive ALDH2 could be useful for detecting environmental or personality factors related to alcoholism."
Notes:
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Association between Personality Traits and ALDH2 polymorphism in Japanese Male Alcoholics," were: Toru Sawayama of the Department of Psychiatry at Kitasato University School of Medicine; Sachio Matsushita and Susumu Higuchi of the Kurihama Alcoholism Center at the National Hospital Organization; and Haruo Kashima of the Department of Neuropsychiatry in the School of Medicine at Keio University, all in Japan.
Source:
Mitsuru Kimura, M.D.
National Hospital Organization
Ihn-Geun Choi, M.D., Ph.D.
Hallym University College of Medicine
Alcoholism: Clinical & Experimental Research
суббота, 21 мая 2011 г.
Successful Treatment Of Alcoholism Found In The Doctor's Office
Alcoholism can be successfully treated in primary care settings, when brief sessions with health professionals are coupled with either the drug naltrexone or specialized counseling, according to new clinical trial results published in JAMA.
The randomized, controlled trial, called "Combining Medications and Behavioral Interventions for Alcoholism," or COMBINE, is the largest ever conducted of drug and behavioral treatments for alcohol dependence. COMBINE included 1,383 subjects at 11 clinical sites across the country. Brown Medical School oversaw the largest site, enrolling 133 patients through Roger Williams Medical Center.
Robert Swift, M.D., served as principal investigator of the Roger Williams site and is an author of the JAMA report. Swift, a professor of psychiatry and human behavior and associate director of the Center for Alcohol and Addiction Studies at Brown Medical School and associate chief of staff for research at the Providence V.A. Medical Center, has studied alcoholism and drug addiction for more than 20 years. He said the COMBINE results send a clear message to problem drinkers - and the doctors who care for them.
"Medical care works - and alcoholics don't need to check into a specialty treatment program to get it," Swift said. "We found that just nine 20-minute sessions with a medical professional, in conjunction with naltrexone or intensive counseling, yields good clinical results. This is a critical finding. While an estimated 8 million Americans are alcoholics, fewer than 1 million get treatment. Yet alcoholism has serious medical consequences and devastating societal effects. COMBINE shows that medical management, along with naltrexone or therapy, can significantly help people with this disease."
Richard Longabaugh, a clinical psychologist and professor of research in the Department of Psychiatry and Human Behavior, served as co-investigator at the Brown site. Longabaugh, who has researched treatments for alcoholism for 25 years, is also an author of the JAMA report.
"The finding that alcoholism can be treated in a primary care setting is good news," Longabaugh said. "This makes confronting this disease a lot simpler. And this should make effective treatment available to a much larger number of people who need it."
COMBINE set out to test the best treatments for alcohol dependence, in a variety of combinations, to see whether medication and therapy pairings would have an additive benefit.
Two drugs were tested. One is naltrexone, which blocks some of the brain's pleasure receptors and reduces alcohol cravings. The other is acamprosate, a medication that modifies different brain receptors and is more recently approved by the U.S. Food and Drug Administration to treat alcoholism. Researchers also tested a new form of therapy called combined behavioral intervention, or CBI, which uses treatment techniques that boost motivation, promote self-help programs, help cope with drinking triggers, and improve refusal skills for achieving and maintaining abstinence. Trained therapists led these 50-minute, one-on-one sessions.
Finally, COMBINE researchers created a new intervention to test. Called medical management, or MM, the treatment is based on care given to patients with other chronic illnesses, such as diabetes. Trained medical professionals - doctors, nurses, physician assistants or pharmacists - first reviewed the diagnosis, recommended abstinence and dispensed pills. In 20-minute follow-up visits, providers asked about a patient's drinking, general health, and medication adherence and dispensed additional medications.
All trial participants were alcohol dependent patients who recently abstained from drinking. They were randomly assigned to one of nine treatment groups:
* 1. MM, naltrexone and placebo acamprosate
* 2. MM, acamprosate and placebo naltrexone
* 3. MM and both acamprosate and naltrexone
* 4. MM and double placebo
* 5. MM, naltrexone and placebo acamprosate plus CBI
* 6. MM, acamprosate and placebo naltrexone plus CBI
* 7. MM and both acamprosate and naltrexone plus CBI
* 8. MM and double placebo plus CBI
* 9. CBI only, plus four doctor's visits
After 16 weeks, researchers found that patients who received MM and naltrexone and those who received MM and CBI were the least likely to relapse into heavy drinking, defined as five or more drinks a day for men and four or more drinks for women. One year after treatment, patients who received naltrexone continued to have fewer relapses and reported fewer alcohol cravings.
Some of the results were surprising. Researchers found no additive benefit from combining the two drugs and no effect on drinking for acamprosate, which had shown promise in treating alcoholism in Europe before being approved by the FDA in 2004.
Swift said another finding is intriguing: Every group substantially improved. Overall, the percentage of days abstinent tripled, from 25 to 73 percent during treatment. Alcohol consumption per week also dropped dramatically, from an average of 66 drinks to 13.
"What was really compelling is that people did well, regardless of the specific treatment," Swift said. "There may be a few explanations for this. One is the placebo effect from taking a pill. The other answer may lie in the fact that all but one of the trial groups received medical management. Having someone check on a patient's progress, assess their health and provide encouragement - routine practice in treating high blood pressure or diabetes - speaks to the power of sustained, professional medical care."
To encourage the use of medical management, the National Institute on Alcohol Abuse and Alcoholism will include an abbreviated version of the protocol in its Clinician's Guide, which the institute expects to release in early summer. The COMBINE team, meanwhile, is conducting a cost-benefit analysis on medical management with either naltrexone or CBI and will also study DNA samples from trial participants to try and better understand the role genes may play in predicting responses to drugs or therapy.
The National Institute on Alcohol Abuse and Alcoholism funded the research.
Contact: Wendy Lawton
Brown University
View drug information on Naltrexone Hydrochloride Tablets.
The randomized, controlled trial, called "Combining Medications and Behavioral Interventions for Alcoholism," or COMBINE, is the largest ever conducted of drug and behavioral treatments for alcohol dependence. COMBINE included 1,383 subjects at 11 clinical sites across the country. Brown Medical School oversaw the largest site, enrolling 133 patients through Roger Williams Medical Center.
Robert Swift, M.D., served as principal investigator of the Roger Williams site and is an author of the JAMA report. Swift, a professor of psychiatry and human behavior and associate director of the Center for Alcohol and Addiction Studies at Brown Medical School and associate chief of staff for research at the Providence V.A. Medical Center, has studied alcoholism and drug addiction for more than 20 years. He said the COMBINE results send a clear message to problem drinkers - and the doctors who care for them.
"Medical care works - and alcoholics don't need to check into a specialty treatment program to get it," Swift said. "We found that just nine 20-minute sessions with a medical professional, in conjunction with naltrexone or intensive counseling, yields good clinical results. This is a critical finding. While an estimated 8 million Americans are alcoholics, fewer than 1 million get treatment. Yet alcoholism has serious medical consequences and devastating societal effects. COMBINE shows that medical management, along with naltrexone or therapy, can significantly help people with this disease."
Richard Longabaugh, a clinical psychologist and professor of research in the Department of Psychiatry and Human Behavior, served as co-investigator at the Brown site. Longabaugh, who has researched treatments for alcoholism for 25 years, is also an author of the JAMA report.
"The finding that alcoholism can be treated in a primary care setting is good news," Longabaugh said. "This makes confronting this disease a lot simpler. And this should make effective treatment available to a much larger number of people who need it."
COMBINE set out to test the best treatments for alcohol dependence, in a variety of combinations, to see whether medication and therapy pairings would have an additive benefit.
Two drugs were tested. One is naltrexone, which blocks some of the brain's pleasure receptors and reduces alcohol cravings. The other is acamprosate, a medication that modifies different brain receptors and is more recently approved by the U.S. Food and Drug Administration to treat alcoholism. Researchers also tested a new form of therapy called combined behavioral intervention, or CBI, which uses treatment techniques that boost motivation, promote self-help programs, help cope with drinking triggers, and improve refusal skills for achieving and maintaining abstinence. Trained therapists led these 50-minute, one-on-one sessions.
Finally, COMBINE researchers created a new intervention to test. Called medical management, or MM, the treatment is based on care given to patients with other chronic illnesses, such as diabetes. Trained medical professionals - doctors, nurses, physician assistants or pharmacists - first reviewed the diagnosis, recommended abstinence and dispensed pills. In 20-minute follow-up visits, providers asked about a patient's drinking, general health, and medication adherence and dispensed additional medications.
All trial participants were alcohol dependent patients who recently abstained from drinking. They were randomly assigned to one of nine treatment groups:
* 1. MM, naltrexone and placebo acamprosate
* 2. MM, acamprosate and placebo naltrexone
* 3. MM and both acamprosate and naltrexone
* 4. MM and double placebo
* 5. MM, naltrexone and placebo acamprosate plus CBI
* 6. MM, acamprosate and placebo naltrexone plus CBI
* 7. MM and both acamprosate and naltrexone plus CBI
* 8. MM and double placebo plus CBI
* 9. CBI only, plus four doctor's visits
After 16 weeks, researchers found that patients who received MM and naltrexone and those who received MM and CBI were the least likely to relapse into heavy drinking, defined as five or more drinks a day for men and four or more drinks for women. One year after treatment, patients who received naltrexone continued to have fewer relapses and reported fewer alcohol cravings.
Some of the results were surprising. Researchers found no additive benefit from combining the two drugs and no effect on drinking for acamprosate, which had shown promise in treating alcoholism in Europe before being approved by the FDA in 2004.
Swift said another finding is intriguing: Every group substantially improved. Overall, the percentage of days abstinent tripled, from 25 to 73 percent during treatment. Alcohol consumption per week also dropped dramatically, from an average of 66 drinks to 13.
"What was really compelling is that people did well, regardless of the specific treatment," Swift said. "There may be a few explanations for this. One is the placebo effect from taking a pill. The other answer may lie in the fact that all but one of the trial groups received medical management. Having someone check on a patient's progress, assess their health and provide encouragement - routine practice in treating high blood pressure or diabetes - speaks to the power of sustained, professional medical care."
To encourage the use of medical management, the National Institute on Alcohol Abuse and Alcoholism will include an abbreviated version of the protocol in its Clinician's Guide, which the institute expects to release in early summer. The COMBINE team, meanwhile, is conducting a cost-benefit analysis on medical management with either naltrexone or CBI and will also study DNA samples from trial participants to try and better understand the role genes may play in predicting responses to drugs or therapy.
The National Institute on Alcohol Abuse and Alcoholism funded the research.
Contact: Wendy Lawton
Brown University
View drug information on Naltrexone Hydrochloride Tablets.
All 50 States And DC Continue To Achieve Goals In Restricting Tobacco Sales To Minors Under Synar Program - A State/Federal Partnership
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that all the states and the District of Columbia have continued to meet their goals of curtailing sales of tobacco to underage youth (those under 18). However, in federal fiscal year 2009, for the first time ever, the data show a slight increase in the average national rate of tobacco sales to underage youth of about one percent. States goals, set under the Synar Amendment program - a federal and state partnership, are aimed at ending illegal tobacco sales to minors.
The Synar Amendment (introduced by the late Representative Mike Synar of Oklahoma and enacted as Section 1926 of the federal Public Health Service Act) requires states to have laws and enforcement programs for prohibiting the sale and distribution of tobacco to persons under 18. The program is part of SAMHSA's Strategic Initiative on promoting emotional health and preventing substance abuse and mental illness.
Under the regulations implementing the Synar Amendment, states and other jurisdictions must report annually to SAMHSA on their retailer violation rates, which represent the percentage of inspected retail outlets that sold tobacco product to a customer under the age of 18.
Over the last 13 years, data reported by states has indicated a clear downward trend towards reducing tobacco sales to minors. However, in federal fiscal year 2009, the average national retailer violation rate of tobacco sales to minors has increased from a historic low of 9.9 percent in 2008 to a rate of 10.9 percent in 2009.
In addition
- In 2009, 43 of the 51 states and Washington, D.C. achieved rates below 15.0 percent, down from 46 states in 2008, and
- Twenty-two (22) of the 51 achieved rates below 10.0 percent, down from 26 states in 2008.
These rates continue to stand in sharp contrast with the situation 13 years ago at the Synar program's inception when the highest reported retailer violation rate was 72.7 percent.
According to the report, reasons for the slight increase in violation rates may include the cutbacks in state enforcement programs due to the economy and budget reductions.
"Today's report shows that we need to continue to be vigilant in our efforts, including providing adequate attention and resources, to continue the hard-earned progress we have made over the past 13 years in reducing youth access to tobacco products, "said SAMHSA Administrator Pamela S. Hyde, J.D. "Tobacco use often goes hand in hand with behavioral health problems. At SAMHSA we are putting into place programs that address the common set of risk and protective factors contributing to a range of mental, physical, and behavioral problems including alcohol, tobacco and illicit drug use."
In order to sustain the declines in tobacco sales to minors, SAMHSA is working closely with states to determine ways to fund enforcement, including the use of local tobacco licensing to help fund enforcement. Additionally, Congress included a provision in the Family Smoking Prevention and Tobacco Control Act, which was signed into law by President Obama on June 22, 2009, that has the Food and Drug Administration (FDA) to the extent feasible, contract with states to carry out inspections of retailers in connection with the enforcement of the Act, including enforcement of the new Federal youth access regulations. The FDA is expected to begin contracting with states to enforce these laws this summer (2010). See here.
The Synar Amendment supports the national Healthy People 2010 objective to reduce the illegal sales rate to minors through enforcement of laws prohibiting the sale of tobacco products to minors.
The FFY2009 Annual Synar Reports: State Compliance, which includes compliance rates for each of the states and the District of Columbia, as well as a section on compliance rates for the U.S. Jurisdictions, is available here. For related publications and information, visit samhsa/.
Source
SAMHSA
The Synar Amendment (introduced by the late Representative Mike Synar of Oklahoma and enacted as Section 1926 of the federal Public Health Service Act) requires states to have laws and enforcement programs for prohibiting the sale and distribution of tobacco to persons under 18. The program is part of SAMHSA's Strategic Initiative on promoting emotional health and preventing substance abuse and mental illness.
Under the regulations implementing the Synar Amendment, states and other jurisdictions must report annually to SAMHSA on their retailer violation rates, which represent the percentage of inspected retail outlets that sold tobacco product to a customer under the age of 18.
Over the last 13 years, data reported by states has indicated a clear downward trend towards reducing tobacco sales to minors. However, in federal fiscal year 2009, the average national retailer violation rate of tobacco sales to minors has increased from a historic low of 9.9 percent in 2008 to a rate of 10.9 percent in 2009.
In addition
- In 2009, 43 of the 51 states and Washington, D.C. achieved rates below 15.0 percent, down from 46 states in 2008, and
- Twenty-two (22) of the 51 achieved rates below 10.0 percent, down from 26 states in 2008.
These rates continue to stand in sharp contrast with the situation 13 years ago at the Synar program's inception when the highest reported retailer violation rate was 72.7 percent.
According to the report, reasons for the slight increase in violation rates may include the cutbacks in state enforcement programs due to the economy and budget reductions.
"Today's report shows that we need to continue to be vigilant in our efforts, including providing adequate attention and resources, to continue the hard-earned progress we have made over the past 13 years in reducing youth access to tobacco products, "said SAMHSA Administrator Pamela S. Hyde, J.D. "Tobacco use often goes hand in hand with behavioral health problems. At SAMHSA we are putting into place programs that address the common set of risk and protective factors contributing to a range of mental, physical, and behavioral problems including alcohol, tobacco and illicit drug use."
In order to sustain the declines in tobacco sales to minors, SAMHSA is working closely with states to determine ways to fund enforcement, including the use of local tobacco licensing to help fund enforcement. Additionally, Congress included a provision in the Family Smoking Prevention and Tobacco Control Act, which was signed into law by President Obama on June 22, 2009, that has the Food and Drug Administration (FDA) to the extent feasible, contract with states to carry out inspections of retailers in connection with the enforcement of the Act, including enforcement of the new Federal youth access regulations. The FDA is expected to begin contracting with states to enforce these laws this summer (2010). See here.
The Synar Amendment supports the national Healthy People 2010 objective to reduce the illegal sales rate to minors through enforcement of laws prohibiting the sale of tobacco products to minors.
The FFY2009 Annual Synar Reports: State Compliance, which includes compliance rates for each of the states and the District of Columbia, as well as a section on compliance rates for the U.S. Jurisdictions, is available here. For related publications and information, visit samhsa/.
Source
SAMHSA
пятница, 20 мая 2011 г.
Functional Roles And Therapeutic Opportunities For Endocannabinoids
Cannabis (marijuana) is the most widely produced plant-based illicit drug worldwide and the illegal drug most frequently used in Europe. Its use increased in almost all EU countries during the 1990s, in particular among young people, including school students. Cannabis use is highest among 15- to 24-year-olds, with lifetime prevalence ranging for most countries from 20-40% (EMCDDA 2006).
Recently there has been a new surge in the level of concern about potential social and health outcomes of cannabis use, although the available evidence still does not provide a clear-cut understanding of the issues. Intensive cannabis use is correlated with non-drug-specific mental problems, but the question of co-morbidity is intertwined with the questions of cause and effect (EMCDDA 2006). Prevention is of importance in adolescents, which is underlined by evidence that early-onset cannabis-users (pre- to mid-adolescence) have a significantly higher risk of developing drug problems, including dependence (Von Sydow et al., 2002; Chen et al., 2005).
The illegal status and wide-spread use of cannabis made basic and clinical cannabis research difficult in the past decades; on the other hand, it has stimulated efforts to identify the psychoactive constituents of cannabis. As a consequence, the endocannabinoid system was discovered, which was shown to be involved in most physiological systems -- the nervous, the cardiovascular, the reproductive, the immune system, to mention a few.
One of the main roles of endocannabinoids is neuroprotection, but over the last decade they have been found to affect a long list of processes, from anxiety, depression, cancer development, vasodilatation to bone formation and even pregnancy (Panikashvili et al., 2001; Pachter et al., 2006).
Cannabinoids and endocannabinoids are supposed to represent a medicinal treasure trove which waits to be discovered.
What is the endocannabinoid system?
In the 1960s the constituent of the cannabis plant was discovered -- named tetrahydrocannabinol, or THC -- which causes the 'high' produced by it (Gaoni & Mechoulam, 1964). Thousands of publications have since appeared on THC. Today it is even used as a therapeutic drug against nausea and for enhancing appetite, and, surprisingly, has not become an illicit drug -- apparently cannabis users prefer the plant-based marijuana and hashish.
Two decades later it was found that THC binds to specific receptors in the brain and the periphery and this interaction initiates a cascade of biological processes leading to the well known marijuana effects. It was assumed that a cannabinoid receptor is not formed for the sake of a plant constituent (that by a strange quirk of nature binds to it), but for endogenous brain constituents and that these putative 'signaling' constituents together with the cannabinoid receptors are part of a new biochemical system in the human body, which may affect various physiological actions. In trying to identify these unknown putative signaling molecules, our research group in the 1990s was successful in isolating 2 such endogenous 'cannabinoid' components -- one from the brain, named anandamide (from the word ??ananda, meaning ??supreme joy?? in Sanscrit), and another one from the intestines named 2-arachidonoyl glycerol (2-AG) (Devane et al., 1992; Mechoulam et al., 1995).
Neuroprotection
The major endocannabinoid (2-AG) has been identified both in the central nervous system and in the periphery. Stressful stimuli -- traumatic brain injury (TBI) for example -- enhance brain 2-AG levels in mice. 2-AG, both of endogenous and exogenous origin, has been shown to be neuroprotective in closed head injury, ischemia and excitotoxicity in mice. These effects may derive from the ability of cannabinoids to act through a variety of biochemical mechanisms. 2-AG also helps repair the blood brain barrier after TBI. The endocannabinoids act via specific cannabinoid receptors, of which the CB1 receptors are most abundant in the central nervous system. Mice whose CB1 receptors are knocked out display slower functional recovery after TBI and do not respond to treatment with 2-AG. Over the last few years several groups have noted that CB2 receptors are also formed in the brain, particularly as a reaction to numerous neurological diseases, and are apparently activated by the endocannabinoids as a protective mechanism.
Through evolution the mammalian body has developed various systems to guard against damage that may be caused by external attacks. Thus, it has an immune system, whose main role is to protect against protein attacks (microbes, parasites for example) and to reduce the damage caused by them. Analogous biological protective systems have also been developed against non-protein attacks, although they are much less well known than the immune system. Over the last few years the research group of Esther Shohami in collaboration with our group showed that the endocannabinoid system, through various biological routes, lowers the damage caused by brain trauma. Thus, it helps to attenuate the brain edema and the neurological injuries caused by it (Panikashvili et al., 2001; Panikashvili et al., 2006).
Clinical importance
Furthermore it is assumed that the endocannabinoid system may be involved in the pathogenesis of hepatic encephalopathy, a neuropsychiatric syndrome induced by fulminant hepatic failure. Indeed in an animal model the brain levels of 2-AG were found to be elevated. Administration of 2-AG improved a neurological score, activity and cognitive function (Avraham et al., 2006). Activation of the CB2 receptor by a selective agonist also improved the neurological score. The authors concluded that the endocannabinoid system may play an important role in the pathogenesis of hepatic encephalopathy. Modulation of this system either by exogenous agonists specific for the CB2 receptors or possibly also by antagonists to the CB1 receptors may have therapeutic potential. The endocannabinoid system generally is involved in the protective reaction of the mammalian body to a long list of neurological diseases such as multiple sclerosis, Alzheimer's and Parkinson's disease. Thus, there is hope for novel therapeutic opportunities.
Numerous additional endocannabinoids -- especially various fatty acid ethanolamides and glycerol esters -- are known today and regarded as members of a large ??endocannabinoid family??. Endogenous cannabinoids, the cannabinoid receptors and various enzymes that are involved in their syntheses and degradations comprise the endocannabinoid system.
The endocannabinoid system acts as a guardian against various attacks on the mammalian body.
Conclusion
The above described research concerning the endocannabinoid-system is of importance in both basic science and in therapeutics:
* The discovery of the cannabis plant active constituent has helped advance our understanding of cannabis use and its effects.
* The discovery of the endocannabinoids has been of central importance in establishing the existence of a new biochemical system and its physiological roles -- in particular in neuroprotection.
* These discoveries have opened the door for the development of novel types of drugs, such as THC for the treatment of nausea and for enhancing appetite in cachectic patients.
* The endocannabinoid system is involved in the protective reaction of the mammalian body to a long list of neurological diseases such as multiple sclerosis, Alzheimer's and Parkinson's disease which raises hope for novel therapeutic opportunities for these diseases.
References
Avraham Y, Israeli E, Gabbay E, et al. Endocannabinoids affect neurological and cognitive function in thioacetamide-induced hepatic encephalopathy in mice. Neurobiology of Disease 2006;21:237-245
Chen CY, O??Brien MS, Anthony JC. Who becomes cannabis dependent soon after onset of use" Epidemiological evidence from the United States: 2000-2001. Drug and alcohol dependence 2005;79:11-22
Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992;258:1946-1949
[EMCDDA 2006] European Monitoring Centre for Drugs and Drug Addiction. The state of the drugs problem in Europe. Annual Report 2006 (emcdda.europa.eu)
Gaoni Y, Mechoulam R. Isolation, structure and partial synthesis of an active constituent of hashish. J Amer Chem Soc 1964;86:1646-1647
Journal Interview 85: Conversation with Raphael Mechoulam. Addiction 2007;102:887-893
Mechoulam R, Ben-Shabat S, Hanus L, et al. Identification of an endogenous 2-monoglyceride, present in canine gut, that binds to cannabinoid receptors. Biochem Pharmacol 1995;50:83-90
Mechoulam R, Panikashvili D, Shohami E. Cannabinoids and brain injury. Trends Mol Med 2002;8:58-61
Pachter P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006;58:389-462
Panikashvili D, Simeonidou C, Ben-Shabat S, et al. An endogenous cannabinoid (2-AG) is neuroprotective after brain injury. Nature 2001;413:527-531
Panikashvili D, Shein NA, Mechoulam R, et al. The endocannabinoid 2-AG protects the blood brain barrier after closed head injury and inhibits mRNA expression of proinflammatory cytokines. Neurobiol Disease 2006;22:257-264
Von Sydow K, Lieb R, Pfister H, et al. What predicts incident use of cannabis and progression to abuse and dependence" A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and alcohol dependence 2002;68:49-64
Source: Professor Raphael Mechoulam
European College of Neuropsychopharmacology
Recently there has been a new surge in the level of concern about potential social and health outcomes of cannabis use, although the available evidence still does not provide a clear-cut understanding of the issues. Intensive cannabis use is correlated with non-drug-specific mental problems, but the question of co-morbidity is intertwined with the questions of cause and effect (EMCDDA 2006). Prevention is of importance in adolescents, which is underlined by evidence that early-onset cannabis-users (pre- to mid-adolescence) have a significantly higher risk of developing drug problems, including dependence (Von Sydow et al., 2002; Chen et al., 2005).
The illegal status and wide-spread use of cannabis made basic and clinical cannabis research difficult in the past decades; on the other hand, it has stimulated efforts to identify the psychoactive constituents of cannabis. As a consequence, the endocannabinoid system was discovered, which was shown to be involved in most physiological systems -- the nervous, the cardiovascular, the reproductive, the immune system, to mention a few.
One of the main roles of endocannabinoids is neuroprotection, but over the last decade they have been found to affect a long list of processes, from anxiety, depression, cancer development, vasodilatation to bone formation and even pregnancy (Panikashvili et al., 2001; Pachter et al., 2006).
Cannabinoids and endocannabinoids are supposed to represent a medicinal treasure trove which waits to be discovered.
What is the endocannabinoid system?
In the 1960s the constituent of the cannabis plant was discovered -- named tetrahydrocannabinol, or THC -- which causes the 'high' produced by it (Gaoni & Mechoulam, 1964). Thousands of publications have since appeared on THC. Today it is even used as a therapeutic drug against nausea and for enhancing appetite, and, surprisingly, has not become an illicit drug -- apparently cannabis users prefer the plant-based marijuana and hashish.
Two decades later it was found that THC binds to specific receptors in the brain and the periphery and this interaction initiates a cascade of biological processes leading to the well known marijuana effects. It was assumed that a cannabinoid receptor is not formed for the sake of a plant constituent (that by a strange quirk of nature binds to it), but for endogenous brain constituents and that these putative 'signaling' constituents together with the cannabinoid receptors are part of a new biochemical system in the human body, which may affect various physiological actions. In trying to identify these unknown putative signaling molecules, our research group in the 1990s was successful in isolating 2 such endogenous 'cannabinoid' components -- one from the brain, named anandamide (from the word ??ananda, meaning ??supreme joy?? in Sanscrit), and another one from the intestines named 2-arachidonoyl glycerol (2-AG) (Devane et al., 1992; Mechoulam et al., 1995).
Neuroprotection
The major endocannabinoid (2-AG) has been identified both in the central nervous system and in the periphery. Stressful stimuli -- traumatic brain injury (TBI) for example -- enhance brain 2-AG levels in mice. 2-AG, both of endogenous and exogenous origin, has been shown to be neuroprotective in closed head injury, ischemia and excitotoxicity in mice. These effects may derive from the ability of cannabinoids to act through a variety of biochemical mechanisms. 2-AG also helps repair the blood brain barrier after TBI. The endocannabinoids act via specific cannabinoid receptors, of which the CB1 receptors are most abundant in the central nervous system. Mice whose CB1 receptors are knocked out display slower functional recovery after TBI and do not respond to treatment with 2-AG. Over the last few years several groups have noted that CB2 receptors are also formed in the brain, particularly as a reaction to numerous neurological diseases, and are apparently activated by the endocannabinoids as a protective mechanism.
Through evolution the mammalian body has developed various systems to guard against damage that may be caused by external attacks. Thus, it has an immune system, whose main role is to protect against protein attacks (microbes, parasites for example) and to reduce the damage caused by them. Analogous biological protective systems have also been developed against non-protein attacks, although they are much less well known than the immune system. Over the last few years the research group of Esther Shohami in collaboration with our group showed that the endocannabinoid system, through various biological routes, lowers the damage caused by brain trauma. Thus, it helps to attenuate the brain edema and the neurological injuries caused by it (Panikashvili et al., 2001; Panikashvili et al., 2006).
Clinical importance
Furthermore it is assumed that the endocannabinoid system may be involved in the pathogenesis of hepatic encephalopathy, a neuropsychiatric syndrome induced by fulminant hepatic failure. Indeed in an animal model the brain levels of 2-AG were found to be elevated. Administration of 2-AG improved a neurological score, activity and cognitive function (Avraham et al., 2006). Activation of the CB2 receptor by a selective agonist also improved the neurological score. The authors concluded that the endocannabinoid system may play an important role in the pathogenesis of hepatic encephalopathy. Modulation of this system either by exogenous agonists specific for the CB2 receptors or possibly also by antagonists to the CB1 receptors may have therapeutic potential. The endocannabinoid system generally is involved in the protective reaction of the mammalian body to a long list of neurological diseases such as multiple sclerosis, Alzheimer's and Parkinson's disease. Thus, there is hope for novel therapeutic opportunities.
Numerous additional endocannabinoids -- especially various fatty acid ethanolamides and glycerol esters -- are known today and regarded as members of a large ??endocannabinoid family??. Endogenous cannabinoids, the cannabinoid receptors and various enzymes that are involved in their syntheses and degradations comprise the endocannabinoid system.
The endocannabinoid system acts as a guardian against various attacks on the mammalian body.
Conclusion
The above described research concerning the endocannabinoid-system is of importance in both basic science and in therapeutics:
* The discovery of the cannabis plant active constituent has helped advance our understanding of cannabis use and its effects.
* The discovery of the endocannabinoids has been of central importance in establishing the existence of a new biochemical system and its physiological roles -- in particular in neuroprotection.
* These discoveries have opened the door for the development of novel types of drugs, such as THC for the treatment of nausea and for enhancing appetite in cachectic patients.
* The endocannabinoid system is involved in the protective reaction of the mammalian body to a long list of neurological diseases such as multiple sclerosis, Alzheimer's and Parkinson's disease which raises hope for novel therapeutic opportunities for these diseases.
References
Avraham Y, Israeli E, Gabbay E, et al. Endocannabinoids affect neurological and cognitive function in thioacetamide-induced hepatic encephalopathy in mice. Neurobiology of Disease 2006;21:237-245
Chen CY, O??Brien MS, Anthony JC. Who becomes cannabis dependent soon after onset of use" Epidemiological evidence from the United States: 2000-2001. Drug and alcohol dependence 2005;79:11-22
Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992;258:1946-1949
[EMCDDA 2006] European Monitoring Centre for Drugs and Drug Addiction. The state of the drugs problem in Europe. Annual Report 2006 (emcdda.europa.eu)
Gaoni Y, Mechoulam R. Isolation, structure and partial synthesis of an active constituent of hashish. J Amer Chem Soc 1964;86:1646-1647
Journal Interview 85: Conversation with Raphael Mechoulam. Addiction 2007;102:887-893
Mechoulam R, Ben-Shabat S, Hanus L, et al. Identification of an endogenous 2-monoglyceride, present in canine gut, that binds to cannabinoid receptors. Biochem Pharmacol 1995;50:83-90
Mechoulam R, Panikashvili D, Shohami E. Cannabinoids and brain injury. Trends Mol Med 2002;8:58-61
Pachter P, Batkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev 2006;58:389-462
Panikashvili D, Simeonidou C, Ben-Shabat S, et al. An endogenous cannabinoid (2-AG) is neuroprotective after brain injury. Nature 2001;413:527-531
Panikashvili D, Shein NA, Mechoulam R, et al. The endocannabinoid 2-AG protects the blood brain barrier after closed head injury and inhibits mRNA expression of proinflammatory cytokines. Neurobiol Disease 2006;22:257-264
Von Sydow K, Lieb R, Pfister H, et al. What predicts incident use of cannabis and progression to abuse and dependence" A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug and alcohol dependence 2002;68:49-64
Source: Professor Raphael Mechoulam
European College of Neuropsychopharmacology
Increased Risk For Alcohol Problems In Adulthood When Alcohol Consumed Before 15 Years Of Age
It may seem like a minor point, but it matters when someone takes their first drink of alcohol relative to later development of alcohol problems. A new study of the relationship between age at first drink (AFD) and the risk of developing alcohol-use disorders (AUDs) during adulthood has found that the risk is greatest when AFD occurs before the age of 15.
Results will be published in the December issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"Some early drinkers become alcohol dependent while still in their teens, a time when those who have not yet started drinking are not even at risk of becoming dependent." explained Deborah A. Dawson, staff scientist at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and corresponding author for the study. "By looking at adult-onset dependence, we can see for the first time that the association between early AFD and increased AUD risk ??¦ is not time limited, but rather persists into adulthood."
"In addition," said Howard B. Moss, associate director for Clinical and Translational Research at NIAAA, "this study controls for a variety of individual risk factors that could contribute to both early drinking behavior and later alcohol problems."
Researchers analyzed data from a three-year longitudinal study of U.S. drinkers 18 years of age and older at baseline (n=22,316). They examined associations between three groups of AFD - younger than 15, between 15 and 17, and 18 years of age or older - and first incidence of alcohol dependence, abuse, and specific AUD criteria as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. They also controlled for duration of exposure, family history and a wide range of baseline and childhood risk factors.
"The key finding of this study was that people who started drinking before age 15, and to a lesser extent those who started drinking at ages 15 to 17, were more likely to become alcohol dependent as adults than people who waited until 18 or older to start drinking," said Dawson. "Past studies have often suggested that this association might result from common risk factors predisposing people to both early drinking and AUDs. Although the current study does not provide conclusive evidence that early drinking directly increases AUD risk, it suggests that it is premature to rule out the possibility of such a direct effect."
"By controlling for a variety of confounding risk factors in their analysis, Dawson and colleagues were able to demonstrate that ... early alcohol consumption itself, as a misguided choice or decision, is driving the relationship between early drinking and risk for development of later alcohol problems," observed Moss.
"We believe that impaired executive cognitive function (EGF) may lead to choices that favor the immediate pleasures of heavy drinking over avoiding the long-term risks of developing an AUD," said Dawson. "Impaired EGF would likely result from frequent and/or extremely heavy drinking at early ages, not from the simple fact of having initiated drinking at early ages. The big question is whether the impaired EGF preceded and led to the early drinking (and the increased risk of AUD), or whether the early drinking caused the impaired EGF."
These findings, she added, help build a body of research that will eventually help scientists deduce whether early drinking is a marker of high risk for AUD or a direct risk factor for AUD. "If the latter is true, it adds to the importance of preventing early drinking," she said. "Especially in light of the finding that the likelihood of developing these AUDs in adulthood is about 50 percent higher for persons who start drinking before 15 as for those who did not drink until 18 or older."
Moss agrees. "The data support the notion of delaying the onset of drinking behavior as late as possible as an important principle for the prevention of AUDs later in life," he said. "More specifically, these findings provide the scientific basis of those prevention programs that focus on decreasing underage drinking, as well as supporting those public-health policies that are geared towards the prevention of underage drinking."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Age at First Drink and the First Incidence of Adult-Onset DSM-IV Alcohol Use Disorders," were: Ris?« B. Goldstein, S. Patricia Chou, W. June Ruan, and Bridget F. Grant of the Laboratory of Epidemiology and Biometry in the Division of Intramural Clinical and Biological Research at the National Institute on Alcohol Abuse and Alcoholism. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.
Source: NIAAA Press Office
National Institute on Alcohol Abuse and Alcoholism
Alcoholism: Clinical & Experimental Research
Results will be published in the December issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.
"Some early drinkers become alcohol dependent while still in their teens, a time when those who have not yet started drinking are not even at risk of becoming dependent." explained Deborah A. Dawson, staff scientist at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and corresponding author for the study. "By looking at adult-onset dependence, we can see for the first time that the association between early AFD and increased AUD risk ??¦ is not time limited, but rather persists into adulthood."
"In addition," said Howard B. Moss, associate director for Clinical and Translational Research at NIAAA, "this study controls for a variety of individual risk factors that could contribute to both early drinking behavior and later alcohol problems."
Researchers analyzed data from a three-year longitudinal study of U.S. drinkers 18 years of age and older at baseline (n=22,316). They examined associations between three groups of AFD - younger than 15, between 15 and 17, and 18 years of age or older - and first incidence of alcohol dependence, abuse, and specific AUD criteria as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. They also controlled for duration of exposure, family history and a wide range of baseline and childhood risk factors.
"The key finding of this study was that people who started drinking before age 15, and to a lesser extent those who started drinking at ages 15 to 17, were more likely to become alcohol dependent as adults than people who waited until 18 or older to start drinking," said Dawson. "Past studies have often suggested that this association might result from common risk factors predisposing people to both early drinking and AUDs. Although the current study does not provide conclusive evidence that early drinking directly increases AUD risk, it suggests that it is premature to rule out the possibility of such a direct effect."
"By controlling for a variety of confounding risk factors in their analysis, Dawson and colleagues were able to demonstrate that ... early alcohol consumption itself, as a misguided choice or decision, is driving the relationship between early drinking and risk for development of later alcohol problems," observed Moss.
"We believe that impaired executive cognitive function (EGF) may lead to choices that favor the immediate pleasures of heavy drinking over avoiding the long-term risks of developing an AUD," said Dawson. "Impaired EGF would likely result from frequent and/or extremely heavy drinking at early ages, not from the simple fact of having initiated drinking at early ages. The big question is whether the impaired EGF preceded and led to the early drinking (and the increased risk of AUD), or whether the early drinking caused the impaired EGF."
These findings, she added, help build a body of research that will eventually help scientists deduce whether early drinking is a marker of high risk for AUD or a direct risk factor for AUD. "If the latter is true, it adds to the importance of preventing early drinking," she said. "Especially in light of the finding that the likelihood of developing these AUDs in adulthood is about 50 percent higher for persons who start drinking before 15 as for those who did not drink until 18 or older."
Moss agrees. "The data support the notion of delaying the onset of drinking behavior as late as possible as an important principle for the prevention of AUDs later in life," he said. "More specifically, these findings provide the scientific basis of those prevention programs that focus on decreasing underage drinking, as well as supporting those public-health policies that are geared towards the prevention of underage drinking."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Age at First Drink and the First Incidence of Adult-Onset DSM-IV Alcohol Use Disorders," were: Ris?« B. Goldstein, S. Patricia Chou, W. June Ruan, and Bridget F. Grant of the Laboratory of Epidemiology and Biometry in the Division of Intramural Clinical and Biological Research at the National Institute on Alcohol Abuse and Alcoholism. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.
Source: NIAAA Press Office
National Institute on Alcohol Abuse and Alcoholism
Alcoholism: Clinical & Experimental Research
четверг, 19 мая 2011 г.
Call For Move Toward Street-Based Services Working With Young People On Their Own 'Territory' To Help Those At Risk Of Drugs Misuse
Current government programmes aimed at reducing drug and alcohol use among young people may be ineffective and may even be doing more harm than good, according to a paper published in Public Policy Research, the quarterly journal published by the Institute for Public Policy Research.
Street-based programmes, by contrast, which aim to engage with young people on their own 'territory', have the potential to be more effective in reaching the most at-risk young people and are also likely to be cheaper to operate.
The Connexions service, which launched in 2001, aims to provide advice, guidance, support and personal development opportunities for 13-19 year olds, focusing on the one-in ten young people 'not in education, employment or training' who are known to be most at risk of misusing drugs and alcohol.
Connexions advisers work with young people individually, in isolation from their friends and social networks. They are assessed on the numbers of young people with whom they have contact, and whether they progress to education, employment or training.
But Adam Fletcher and Chris Bonell, of the London School of Hygiene & Tropical Medicine's Centre for Research on Drugs and Health Behaviour, argue that Connexions is too target-driven and individually-focused, and that it may not be working. Current targets neglect outcomes such as young people's self-esteem, happiness and wellbeing, all of which are likely to be critical if lasting and meaningful change is to be achieved. And, crucially, the service fails to address the importance of peer pressure in influencing a young person's decision to misuse drugs and alcohol.
Perhaps most worrying, the authors cite research which indicates that centre-based youth work approaches may actually do more harm than good, by inadvertently introducing young people to peers engaged in frequent and heavy drug and alcohol use.
They call for more attention to be given to 'detached', street-based youth work, whereby youth workers meet and support young people away from youth centres or other buildings linked to the youth service, such as sports centres, and instead work with them on their own territory, on the streets, in parks, bus shelters and other places where they choose to meet and socialise.
The authors comment: 'Centre-based youth work programmes targeting individual young people are likely to have only limited success because they still largely ignore their social relationships and, in particular, the norms of their peer group. Once a young person is in contact with drug-using peers, such youth work responses are insufficient.
'Detached youth work, by contrast, has been shown to be more effective in reaching those young people most at risk. By working with young people in their existing friendship groups rather than by engineering new ones, detached youth workers can avoid the potentially harmful social network effects associated with centre-based youth work and avoid introducing young people to whole new networks of drug-using peers'.
Detached youth work could also be cheaper to deliver. Providing detached youth work for the 5% most deprived young people in the UK would cost around ??24 million a year, with coverage for the bottom 50% only ??142 million a year. This is far less than has been spent on the Connexions service (??450 million between 2001 and 2004 alone).
The authors conclude by cautioning that existing detached youth work projects are rigorously evaluated to assess their impact on young people's drug and alcohol misuse before any roll-out.
Source: Gemma Howe
London School of Hygiene & Tropical Medicine
Street-based programmes, by contrast, which aim to engage with young people on their own 'territory', have the potential to be more effective in reaching the most at-risk young people and are also likely to be cheaper to operate.
The Connexions service, which launched in 2001, aims to provide advice, guidance, support and personal development opportunities for 13-19 year olds, focusing on the one-in ten young people 'not in education, employment or training' who are known to be most at risk of misusing drugs and alcohol.
Connexions advisers work with young people individually, in isolation from their friends and social networks. They are assessed on the numbers of young people with whom they have contact, and whether they progress to education, employment or training.
But Adam Fletcher and Chris Bonell, of the London School of Hygiene & Tropical Medicine's Centre for Research on Drugs and Health Behaviour, argue that Connexions is too target-driven and individually-focused, and that it may not be working. Current targets neglect outcomes such as young people's self-esteem, happiness and wellbeing, all of which are likely to be critical if lasting and meaningful change is to be achieved. And, crucially, the service fails to address the importance of peer pressure in influencing a young person's decision to misuse drugs and alcohol.
Perhaps most worrying, the authors cite research which indicates that centre-based youth work approaches may actually do more harm than good, by inadvertently introducing young people to peers engaged in frequent and heavy drug and alcohol use.
They call for more attention to be given to 'detached', street-based youth work, whereby youth workers meet and support young people away from youth centres or other buildings linked to the youth service, such as sports centres, and instead work with them on their own territory, on the streets, in parks, bus shelters and other places where they choose to meet and socialise.
The authors comment: 'Centre-based youth work programmes targeting individual young people are likely to have only limited success because they still largely ignore their social relationships and, in particular, the norms of their peer group. Once a young person is in contact with drug-using peers, such youth work responses are insufficient.
'Detached youth work, by contrast, has been shown to be more effective in reaching those young people most at risk. By working with young people in their existing friendship groups rather than by engineering new ones, detached youth workers can avoid the potentially harmful social network effects associated with centre-based youth work and avoid introducing young people to whole new networks of drug-using peers'.
Detached youth work could also be cheaper to deliver. Providing detached youth work for the 5% most deprived young people in the UK would cost around ??24 million a year, with coverage for the bottom 50% only ??142 million a year. This is far less than has been spent on the Connexions service (??450 million between 2001 and 2004 alone).
The authors conclude by cautioning that existing detached youth work projects are rigorously evaluated to assess their impact on young people's drug and alcohol misuse before any roll-out.
Source: Gemma Howe
London School of Hygiene & Tropical Medicine
Ban Advertising Of Cannabis Products, Says Charity On Tobacco Anniversary
Ban the advertising of all tobacco related products - including those used for smoking cannabis - mental health charity Rethink says on the fifth anniversary of the end of tobacco advertising.
The ban on tobacco advertising is thought to have played a major part in the reduction of smoking rates in Great Britain. In 2002, the year before the ban came into force, 26% of adults were cigarette smokers compared to 22% in 2006.
Rethink believes that a ban on all tobacco related products, including king-size rolling papers, could have a similar impact on cannabis rates - and reduce the number of people experiencing mental health problems as a result.
Jane Harris, Rethink's head of campaigns, said that it was not acceptable for tobacco products such as rolling papers to continue to be exempt from the advertising ban.
"Research has shown that more people think king-size rolling papers are used for cannabis than for tobacco. Given the mental health risks of using cannabis, along with the physical health risks of smoking, any tactics used to promote products such as these should be outlawed.
"More restrictive advertising guidelines would help to protect young people who are most at risk of developing mental illness as a result of cannabis use. It is time the government recognised the influence of advertising and made a decision on health grounds to widen the current tobacco advertising restrictions as part of a package of measures to tackle cannabis use."
1. On 14 February 2003, the Tobacco Advertising and Promotion Act 2002 came into force. It does not cover advertisements of rolling papers or filters.
2. Rethink carried out a survey. In response to the question: "In your experience which, if any, of the following do people use king size rolling papers for ?", 50% said cannabis and 49% said tobacco.
In the 25-34 age range this rose to 65% saying cannabis and 46% saying tobacco. To see the full findings go to rethink/educatingreefer
rethink
The ban on tobacco advertising is thought to have played a major part in the reduction of smoking rates in Great Britain. In 2002, the year before the ban came into force, 26% of adults were cigarette smokers compared to 22% in 2006.
Rethink believes that a ban on all tobacco related products, including king-size rolling papers, could have a similar impact on cannabis rates - and reduce the number of people experiencing mental health problems as a result.
Jane Harris, Rethink's head of campaigns, said that it was not acceptable for tobacco products such as rolling papers to continue to be exempt from the advertising ban.
"Research has shown that more people think king-size rolling papers are used for cannabis than for tobacco. Given the mental health risks of using cannabis, along with the physical health risks of smoking, any tactics used to promote products such as these should be outlawed.
"More restrictive advertising guidelines would help to protect young people who are most at risk of developing mental illness as a result of cannabis use. It is time the government recognised the influence of advertising and made a decision on health grounds to widen the current tobacco advertising restrictions as part of a package of measures to tackle cannabis use."
1. On 14 February 2003, the Tobacco Advertising and Promotion Act 2002 came into force. It does not cover advertisements of rolling papers or filters.
2. Rethink carried out a survey. In response to the question: "In your experience which, if any, of the following do people use king size rolling papers for ?", 50% said cannabis and 49% said tobacco.
In the 25-34 age range this rose to 65% saying cannabis and 46% saying tobacco. To see the full findings go to rethink/educatingreefer
rethink
среда, 18 мая 2011 г.
New Form Of Ketamine Treats Depression "Like Magic"
Most Popular Articles For Depression
These are the most read articles from this news category for the last 6 months:
Giving Up Smoking Linked To Greater Happiness And Elevated Mood
05 Dec 2010
It appears to be a myth that giving up smoking most likely makes you miserable. Brown University researchers found that those who were in the process of quitting smoking were never happier...
Being Born In Winter Affects Biological Clock, Influencing Neurological Disorder Risk
07 Dec 2010
Loneliness In Our Modern Age
04 Mar 2011
Gene Therapy For Major Depression Treatment Has Huge Potential
21 Oct 2010
Diabetes May Cause Depression, Depression Can Cause Diabetes
23 Nov 2010
_uacct = "UA-849615-1";
urchinTracker();
These are the most read articles from this news category for the last 6 months:
Giving Up Smoking Linked To Greater Happiness And Elevated Mood
05 Dec 2010
It appears to be a myth that giving up smoking most likely makes you miserable. Brown University researchers found that those who were in the process of quitting smoking were never happier...
Being Born In Winter Affects Biological Clock, Influencing Neurological Disorder Risk
07 Dec 2010
Loneliness In Our Modern Age
04 Mar 2011
Gene Therapy For Major Depression Treatment Has Huge Potential
21 Oct 2010
Diabetes May Cause Depression, Depression Can Cause Diabetes
23 Nov 2010
_uacct = "UA-849615-1";
urchinTracker();
Marijuana Incorporated (OTC: PCIO) Announces The Pending Patent Application For A True Cannabis Derived Remedy
Marijuana, Inc. (PINKSHEETS: PCIO) announces the pending application for a true cannabis derived remedy. Marijuana, Inc. intends to file a patent application as the owner of a cannabis-based capsule to be taken orally.
This formulation for pain management, one of the integral properties of cannabis, may help those suffering pain from a myriad of diseases. Formulator and inventor Reverend Dr. Douglas Van Dyke stated, "This Shamanistic blend of herbs has shown great promise for pain management treatment among a closed group of patients.
The probability of efficacy among a large control group is quite feasible and we welcome the opportunity to prove the formulation." Marijuana Incorporated has several other planned patent applications waiting to be filed including a topical lotion.
Source:
Marijuana Incorporated
This formulation for pain management, one of the integral properties of cannabis, may help those suffering pain from a myriad of diseases. Formulator and inventor Reverend Dr. Douglas Van Dyke stated, "This Shamanistic blend of herbs has shown great promise for pain management treatment among a closed group of patients.
The probability of efficacy among a large control group is quite feasible and we welcome the opportunity to prove the formulation." Marijuana Incorporated has several other planned patent applications waiting to be filed including a topical lotion.
Source:
Marijuana Incorporated
вторник, 17 мая 2011 г.
Direct Link Found Between Alcohol Sponsorship And Hazardous Drinking Among Sportspeople
Commenting on a new report by the University of Manchester that finds a direct link between alcohol sponsorship in the sports industry and hazardous drinking among sportspeople, Professor Ian Gilmore, President of the Royal College of Physicians and chair of the UK Alcohol Health Alliance said:
"This study, undertaken in a country with a similar sports and drinking culture to our own, gives the stark messages that hazardous drinking, common in sport, is seen more when the individual or club is sponsored by the drinks industry. Providing discounted or free alcoholic drinks was the worst offender. Alcohol producers and retailers have worked long and hard to align themselves to the positive and healthy image of sport, and we now have evidence that this is not only proving effective but also potentially damaging to those that participate. Some countries like France have already banned alcohol-related sports sponsorship and it is time we had that debate in the UK"
Royal College of Physicians
"This study, undertaken in a country with a similar sports and drinking culture to our own, gives the stark messages that hazardous drinking, common in sport, is seen more when the individual or club is sponsored by the drinks industry. Providing discounted or free alcoholic drinks was the worst offender. Alcohol producers and retailers have worked long and hard to align themselves to the positive and healthy image of sport, and we now have evidence that this is not only proving effective but also potentially damaging to those that participate. Some countries like France have already banned alcohol-related sports sponsorship and it is time we had that debate in the UK"
Royal College of Physicians
DrugScope Responds To Advisory Council's Review Of Ecstasy, UK
DrugScope, the leading independent centre of expertise on drugs and drug policy, has today welcomed publication of the findings from the Advisory Council on the Misuse of Drugs (ACMD) review of ecstasy [1] [2].
Based on a review of the social and health harms of ecstasy, the ACMD recommends that the government reclassify the drug from Class A to Class B. The Council also advised that the government revise and widen access to public health messages and guidance on the drug's harms, particularly for young people.
Other key recommendations include:
- Parents, carers, teachers and those working in the criminal justice system should be informed about the risks of ecstasy and how these compare with those of other drugs.
- More research is required into the effects of ecstasy upon the brain.
- More research should be conducted regarding the nature and extent of ecstasy use among young people.
Responding to today's report, DrugScope Chief Executive Martin Barnes said:
"DrugScope welcomes the ACMD's report on ecstasy and we support all its recommendations. It is appropriate that drugs controlled under the Misuse of Drugs Act are subject to regular review, in order to ensure that decisions on drugs policy are informed by the latest and best evidence.
"DrugScope supports the ACMD's recommendation that ecstasy be reclassified to Class B. The advice is based on a thorough, objective and independent review of the latest evidence. Previous reviews of drug policy, not least a Home Affairs Select Committee report in 2002, have questioned the classification of ecstasy as a Class A drug. [3]
"The challenge is to ensure that any debate over ecstasy's classification is not perceived - or indeed misrepresented - as indicating that the drug is in any way 'safe'. It is precisely because ecstasy is a harmful drug that it is controlled under the Misuse of Drugs Act but evidence shows that its social and health harms are more consistent with drugs controlled under Class B, such as amphetamines.
"Today's report highlights the considerable health risks posed by ecstasy, particularly when used in combination with other drugs. We support the ACMD's call for credible and accurate public health information about ecstasy and its harms. Access to 'Safer Clubbing' guidance is essential - as ecstasy-related deaths are commonly linked to dehydration, overheating and excessive water consumption in clubbing environments, as well as to the direct toxic effects of the drug itself.
"It would be regrettable if we reached a situation where, for political reasons, drugs can only be placed within, or moved up, the classification system, but cannot be moved down regardless of the evidence. It is crucial that decisions on the penalties for the use and supply of controlled drugs should be based on the best available information, otherwise the drug laws themselves lose credibility, especially among young people."
About DrugScope
DrugScope is the national membership organisation for the drugs field and the leading independent centre of expertise on drugs and drug policy. Our aim is to inform policy and reduce drug-related harms - to individuals, families and communities.
For more information visit drugscope
[1] About the ACMD
The Advisory Council on the Misuse of Drugs is an independent expert body that advises government on drug related issues in the UK. It was established under the Misuse of Drugs Act 1971, its current chair is Professor David Nutt. The council's membership includes a range of experts in the social and health harms of drugs.
Although the ACMD was set up to advise the government on classification, ministers are not obliged to follow its recommendations and any decision on ecstasy's legal status will ultimately be made by Home Secretary Jacqui Smith.
More information on the ACMD can be found here.
[2] Information on ecstasy
Ecstasy is an illegally manufactured drug that usually comes in tablet or capsule form and is normally taken orally. The chemical name of pure ecstasy is 3,4 methylenedioxymethamphetamine or MDMA for short.
More information on ecstasy and its effects can be found here.
[3] Home Affairs Select Committee report on drug policy
In 2002, a Home Affairs Select Committee published a report entitled 'The Government's Drugs Policy: Is it working ?'. One of the report's key recommendations was that ecstasy should be downgraded from Class A to Class B.
The press notice for the report can be viewed here.
The full report can be viewed here.
DrugScope
Based on a review of the social and health harms of ecstasy, the ACMD recommends that the government reclassify the drug from Class A to Class B. The Council also advised that the government revise and widen access to public health messages and guidance on the drug's harms, particularly for young people.
Other key recommendations include:
- Parents, carers, teachers and those working in the criminal justice system should be informed about the risks of ecstasy and how these compare with those of other drugs.
- More research is required into the effects of ecstasy upon the brain.
- More research should be conducted regarding the nature and extent of ecstasy use among young people.
Responding to today's report, DrugScope Chief Executive Martin Barnes said:
"DrugScope welcomes the ACMD's report on ecstasy and we support all its recommendations. It is appropriate that drugs controlled under the Misuse of Drugs Act are subject to regular review, in order to ensure that decisions on drugs policy are informed by the latest and best evidence.
"DrugScope supports the ACMD's recommendation that ecstasy be reclassified to Class B. The advice is based on a thorough, objective and independent review of the latest evidence. Previous reviews of drug policy, not least a Home Affairs Select Committee report in 2002, have questioned the classification of ecstasy as a Class A drug. [3]
"The challenge is to ensure that any debate over ecstasy's classification is not perceived - or indeed misrepresented - as indicating that the drug is in any way 'safe'. It is precisely because ecstasy is a harmful drug that it is controlled under the Misuse of Drugs Act but evidence shows that its social and health harms are more consistent with drugs controlled under Class B, such as amphetamines.
"Today's report highlights the considerable health risks posed by ecstasy, particularly when used in combination with other drugs. We support the ACMD's call for credible and accurate public health information about ecstasy and its harms. Access to 'Safer Clubbing' guidance is essential - as ecstasy-related deaths are commonly linked to dehydration, overheating and excessive water consumption in clubbing environments, as well as to the direct toxic effects of the drug itself.
"It would be regrettable if we reached a situation where, for political reasons, drugs can only be placed within, or moved up, the classification system, but cannot be moved down regardless of the evidence. It is crucial that decisions on the penalties for the use and supply of controlled drugs should be based on the best available information, otherwise the drug laws themselves lose credibility, especially among young people."
About DrugScope
DrugScope is the national membership organisation for the drugs field and the leading independent centre of expertise on drugs and drug policy. Our aim is to inform policy and reduce drug-related harms - to individuals, families and communities.
For more information visit drugscope
[1] About the ACMD
The Advisory Council on the Misuse of Drugs is an independent expert body that advises government on drug related issues in the UK. It was established under the Misuse of Drugs Act 1971, its current chair is Professor David Nutt. The council's membership includes a range of experts in the social and health harms of drugs.
Although the ACMD was set up to advise the government on classification, ministers are not obliged to follow its recommendations and any decision on ecstasy's legal status will ultimately be made by Home Secretary Jacqui Smith.
More information on the ACMD can be found here.
[2] Information on ecstasy
Ecstasy is an illegally manufactured drug that usually comes in tablet or capsule form and is normally taken orally. The chemical name of pure ecstasy is 3,4 methylenedioxymethamphetamine or MDMA for short.
More information on ecstasy and its effects can be found here.
[3] Home Affairs Select Committee report on drug policy
In 2002, a Home Affairs Select Committee published a report entitled 'The Government's Drugs Policy: Is it working ?'. One of the report's key recommendations was that ecstasy should be downgraded from Class A to Class B.
The press notice for the report can be viewed here.
The full report can be viewed here.
DrugScope
понедельник, 16 мая 2011 г.
Cannabis Ingredient Can Help Cancer Patients Regain Their Appetites And Sense Of Taste
The active ingredient in cannabis can improve the appetites and sense of taste in cancer patients, according to a new study published online in the cancer journal, Annals of Oncology [1] today.
Loss of appetite is common among cancer patients [2], either because the cancer itself or its treatment affects the sense of taste and smell, leading to decreased enjoyment of food. This, in turn, can lead to weight loss, anorexia, a worse quality of life and decreased survival; therefore, finding effective ways of helping patients to maintain a good diet and consume enough calories is an important aspect of their treatment.
Researchers in Canada ran a small pilot study from May 2006 to December 2008 in 21 adult patients with any advanced cancer (except brain cancer) who had been eating less as a result of their illness for two weeks or more. All were either being treated with chemotherapy or had been in the past. The patients were randomly assigned to receive medication from a pharmacist in a double-blind manner, which meant that neither the patients nor the doctors knew which treatment they were receiving. Eleven patients received oral capsules containing delta-9-tetrahydrocannabinol (THC) - the main psychoactive ingredient in cannabis - and eight patients were assigned to the control group to receive placebo capsules. The active capsules contained 2.5mg of THC and the patients took them once a day for the first three days, twice a day thereafter, and they had the option to increase their dose up to a maximum of 20mg a day if they wished; however, most followed the dosing protocol, with three patients in both groups increasing their dose to three times a day. The treatment ran for 18 days.
From patient answers to questionnaires conducted before, during and at the end of the trial, the researchers found that the majority (73%) of THC-treated patients reported an increased overall appreciation of food compared with patients receiving placebo (30%) and more often stated that study medication "made food taste better" (55%) compared with placebo (10%).
The majority of THC-treated patients (64%) had increased appetite, three patients (27%) showed no change, and one patient's data was incomplete. No THC-treated patients showed a decrease in appetite. By contrast, the majority of patients receiving placebo had either decreased appetite (50%) or showed no change (20%).
Although there was no difference in the total number of calories consumed by both groups, the THC-treated patients tended to increase the proportion of protein that they ate, and 55% reported that savoury foods tasted better, whereas no patients in the placebo group reported an increased liking for these foods. (Cancer patients often find that meat smells and tastes unpleasant and, therefore, they eat less of it).
In addition, THC-treated patients reported better quality of sleep and relaxation than in the placebo group.
Dr Wendy Wismer (PhD), associate professor at the University of Alberta (Edmonton, Canada), who led the study, said: "This is the first randomised controlled trial to show that THC makes food taste better and improves appetites for patients with advanced cancer, as well as helping them to sleep and to relax better. Our findings are important, as there is no accepted treatment for chemosensory alterations experienced by cancer patients. We are excited about the possibilities that THC could be used to improve patients' enjoyment of food.
"Decreased appetite and chemosensory alterations can be caused by both cancer and its treatment; untreated tumours cause loss of appetite, and by itself, chemotherapy also causes loss of appetite. In any individual patient, some part of both of these effects is usually present.
"It's very important to address these problems as both appetite loss and alterations to taste and smell lead to involuntary weight loss and reduce an individual's ability to tolerate treatment and to stay healthy in general. Additionally, the social enjoyment of eating is greatly reduced and quality of life is affected. For a long time everyone has thought that nothing could be done about this. Indeed, cancer patients are often told to 'cope' with chemosensory problems by eating bland, cold and odourless food. This may well have the result of reducing food intake and food enjoyment."
The researchers say that larger, phase II trials should test their findings further, but, in the meantime Dr Wismer thinks that doctors could consider THC treatment for cancer patients. "It could be investigated for any stage of cancer where taste and smell dysfunction and appetite loss has been indicated by the patient," she said. In addition, treatment would not necessarily have to be limited to the 18 days of the study. "Long term therapy with cannabinoids is possible, however, in each case this would be up to the patient's physician to determine."
Although the study was unable to show that THC treatment could increase total calorie intake, Dr Wismer said this was unsurprising. "In the healthy adult population, we know from personal experience that we usually eat more of something if it tastes better. However, in this advanced cancer population, there is a real struggle with appetite; normal appetitive pathways do not seem to be functioning. We know from our earlier work that individuals with advanced cancer have diminished appetite and have to make a big conscious effort to eat; they are motivated to eat simply to survive. So, although THC did not significantly increase total calorie intake, the fact that it improved appetite and protein intake is important."
Notes:
[1] "Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial". Annals of Oncology. doi:10.1093/annonc/mdq727
[2] The prevalence of alterations in taste and smell is difficult to determine, but Dr Wismer and her colleagues found that in one study 86% of patients reported chemosensory alterations.
[3] This work was supported by the Canadian Institutes of Health Research, the Alberta Cancer Board, Alberta Heritage Foundation for Medical Research, and the Natural Sciences and Engineering Research Council of Canada.
Source: ESMO
Loss of appetite is common among cancer patients [2], either because the cancer itself or its treatment affects the sense of taste and smell, leading to decreased enjoyment of food. This, in turn, can lead to weight loss, anorexia, a worse quality of life and decreased survival; therefore, finding effective ways of helping patients to maintain a good diet and consume enough calories is an important aspect of their treatment.
Researchers in Canada ran a small pilot study from May 2006 to December 2008 in 21 adult patients with any advanced cancer (except brain cancer) who had been eating less as a result of their illness for two weeks or more. All were either being treated with chemotherapy or had been in the past. The patients were randomly assigned to receive medication from a pharmacist in a double-blind manner, which meant that neither the patients nor the doctors knew which treatment they were receiving. Eleven patients received oral capsules containing delta-9-tetrahydrocannabinol (THC) - the main psychoactive ingredient in cannabis - and eight patients were assigned to the control group to receive placebo capsules. The active capsules contained 2.5mg of THC and the patients took them once a day for the first three days, twice a day thereafter, and they had the option to increase their dose up to a maximum of 20mg a day if they wished; however, most followed the dosing protocol, with three patients in both groups increasing their dose to three times a day. The treatment ran for 18 days.
From patient answers to questionnaires conducted before, during and at the end of the trial, the researchers found that the majority (73%) of THC-treated patients reported an increased overall appreciation of food compared with patients receiving placebo (30%) and more often stated that study medication "made food taste better" (55%) compared with placebo (10%).
The majority of THC-treated patients (64%) had increased appetite, three patients (27%) showed no change, and one patient's data was incomplete. No THC-treated patients showed a decrease in appetite. By contrast, the majority of patients receiving placebo had either decreased appetite (50%) or showed no change (20%).
Although there was no difference in the total number of calories consumed by both groups, the THC-treated patients tended to increase the proportion of protein that they ate, and 55% reported that savoury foods tasted better, whereas no patients in the placebo group reported an increased liking for these foods. (Cancer patients often find that meat smells and tastes unpleasant and, therefore, they eat less of it).
In addition, THC-treated patients reported better quality of sleep and relaxation than in the placebo group.
Dr Wendy Wismer (PhD), associate professor at the University of Alberta (Edmonton, Canada), who led the study, said: "This is the first randomised controlled trial to show that THC makes food taste better and improves appetites for patients with advanced cancer, as well as helping them to sleep and to relax better. Our findings are important, as there is no accepted treatment for chemosensory alterations experienced by cancer patients. We are excited about the possibilities that THC could be used to improve patients' enjoyment of food.
"Decreased appetite and chemosensory alterations can be caused by both cancer and its treatment; untreated tumours cause loss of appetite, and by itself, chemotherapy also causes loss of appetite. In any individual patient, some part of both of these effects is usually present.
"It's very important to address these problems as both appetite loss and alterations to taste and smell lead to involuntary weight loss and reduce an individual's ability to tolerate treatment and to stay healthy in general. Additionally, the social enjoyment of eating is greatly reduced and quality of life is affected. For a long time everyone has thought that nothing could be done about this. Indeed, cancer patients are often told to 'cope' with chemosensory problems by eating bland, cold and odourless food. This may well have the result of reducing food intake and food enjoyment."
The researchers say that larger, phase II trials should test their findings further, but, in the meantime Dr Wismer thinks that doctors could consider THC treatment for cancer patients. "It could be investigated for any stage of cancer where taste and smell dysfunction and appetite loss has been indicated by the patient," she said. In addition, treatment would not necessarily have to be limited to the 18 days of the study. "Long term therapy with cannabinoids is possible, however, in each case this would be up to the patient's physician to determine."
Although the study was unable to show that THC treatment could increase total calorie intake, Dr Wismer said this was unsurprising. "In the healthy adult population, we know from personal experience that we usually eat more of something if it tastes better. However, in this advanced cancer population, there is a real struggle with appetite; normal appetitive pathways do not seem to be functioning. We know from our earlier work that individuals with advanced cancer have diminished appetite and have to make a big conscious effort to eat; they are motivated to eat simply to survive. So, although THC did not significantly increase total calorie intake, the fact that it improved appetite and protein intake is important."
Notes:
[1] "Delta-9-tetrahydrocannabinol may palliate altered chemosensory perception in cancer patients: results of a randomized, double-blind, placebo-controlled pilot trial". Annals of Oncology. doi:10.1093/annonc/mdq727
[2] The prevalence of alterations in taste and smell is difficult to determine, but Dr Wismer and her colleagues found that in one study 86% of patients reported chemosensory alterations.
[3] This work was supported by the Canadian Institutes of Health Research, the Alberta Cancer Board, Alberta Heritage Foundation for Medical Research, and the Natural Sciences and Engineering Research Council of Canada.
Source: ESMO
Minorities More Likely To Receive Alcohol Counseling
A study has found that African-American and Hispanic adults have twice the odds of reporting receiving counseling about alcohol use from a physician, compared with white adults. What causes this disparity in counseling is not known, but this may be a rare instance of minority populations receiving better and more appropriate health care than the majority.
However, the finding may also mean that physicians are more likely to assume that African-Americans and Hispanics have alcohol issues. "Yet blacks are less likely to be binge drinkers than whites," said study author Kenneth Mukamal, M.D., an associate professor at Harvard Medical School and an internist at Beth Israel Deaconess Medical Center in Boston.
The study evaluated data from an extensive national telephone survey performed in 1999. More than 15,000 people took part in the survey. Participants were asked about their alcohol use, among other topics, and about what preventive counseling services they received.
Compared with non-Hispanic whites, the odds of being counseled about alcohol use were 1.83 for non-Hispanic blacks and 2.17 for Hispanics roughly twofold higher.
The study appears in the March issue of the journal Alcoholism: Clinical and Experimental Research.
When Mukamal analyzed survey results for diet counseling, he found no substantial difference in the odds of receiving such counseling based on race or ethnicity, suggesting that the disparity in counseling about alcohol use did not extend to other preventive health counseling issues.
According to Mukamal, a difference in who gets alcohol counseling can lead to false excess reporting of alcohol abuse among blacks and Hispanics and may mean that problems with alcohol use are being missed among whites. "This will lead to perpetuation of stereotypes," he said.
"Everyone visiting the doctor should have this conversation, especially those with chronic conditions, regardless of their race or ethnicity," said Luisa N. Borrell, Ph.D., assistant professor of epidemiology with Columbia University's Mailman School of Public Health. "In contrast, it is interesting that the study also reports that there was no racial or ethnic difference in receiving diet counseling when the prevalence of overweight or obesity is higher among minorities."
It would be naive to disregard the possibility of racial bias or stereotype toward blacks and Hispanics in medical settings and assume that the difference in who gets counseling about alcohol use is coincidental, Borrell said.
Doctors should be asking about alcohol use, but should be asking about it across the board, Mukamal said.
Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
hbns
However, the finding may also mean that physicians are more likely to assume that African-Americans and Hispanics have alcohol issues. "Yet blacks are less likely to be binge drinkers than whites," said study author Kenneth Mukamal, M.D., an associate professor at Harvard Medical School and an internist at Beth Israel Deaconess Medical Center in Boston.
The study evaluated data from an extensive national telephone survey performed in 1999. More than 15,000 people took part in the survey. Participants were asked about their alcohol use, among other topics, and about what preventive counseling services they received.
Compared with non-Hispanic whites, the odds of being counseled about alcohol use were 1.83 for non-Hispanic blacks and 2.17 for Hispanics roughly twofold higher.
The study appears in the March issue of the journal Alcoholism: Clinical and Experimental Research.
When Mukamal analyzed survey results for diet counseling, he found no substantial difference in the odds of receiving such counseling based on race or ethnicity, suggesting that the disparity in counseling about alcohol use did not extend to other preventive health counseling issues.
According to Mukamal, a difference in who gets alcohol counseling can lead to false excess reporting of alcohol abuse among blacks and Hispanics and may mean that problems with alcohol use are being missed among whites. "This will lead to perpetuation of stereotypes," he said.
"Everyone visiting the doctor should have this conversation, especially those with chronic conditions, regardless of their race or ethnicity," said Luisa N. Borrell, Ph.D., assistant professor of epidemiology with Columbia University's Mailman School of Public Health. "In contrast, it is interesting that the study also reports that there was no racial or ethnic difference in receiving diet counseling when the prevalence of overweight or obesity is higher among minorities."
It would be naive to disregard the possibility of racial bias or stereotype toward blacks and Hispanics in medical settings and assume that the difference in who gets counseling about alcohol use is coincidental, Borrell said.
Doctors should be asking about alcohol use, but should be asking about it across the board, Mukamal said.
Health Behavior News Service
Center for the Advancement of Health 2000 Florida Ave. NW, Ste 210
Washington, DC 20009
United States
hbns
воскресенье, 15 мая 2011 г.
Alcohol Killing Our Kids - Australian Medical Association
As Schoolies Week and alcohol combine to produce tragic headlines about death and injury to young people and reports of antisocial behaviour by drunken teenagers, the AMA is calling for stronger policies to curb dangerous excess alcohol consumption.
AMA President, Dr Rosanna Capolingua, said today that irresponsible alcohol consumption causes harm across all age groups in the community, but the senseless loss of young lives through alcohol abuse must be stopped as a priority.
"Alcohol abuse by young people, highlighted by the culture of binge drinking, is harming the health of thousands of Australians every year," Dr Capolingua said.
Alcohol is second only to tobacco as a preventable cause of drug-related death and hospitalisations in Australia.
The National Health and Medical Research Council (NHMRC) reports that alcohol abuse costs Australia $15.3 billion a year through alcohol-related crime and violence, treatment costs, loss of productivity, and premature death.
According to the NHMRC, alcohol accounts for 13 per cent of all deaths among 14-17 year old Australians. The NHMRC estimates that one Australian teenager dies and more than 60 are hospitalised each week from alcohol-related causes.
"The binge drinking culture is alive and well in Australia and urgent action is needed to re-educate Australians about safe levels of alcohol consumption," Dr Capolingua said.
"The most frightening thing is that binge drinking has hit epidemic proportions among our young people.
"There is a disturbing acceptance, or even celebration, of excess drinking in Australia. Many people view it as a national pastime to be proud of.
"Young people are placing increasing social importance on how drunk they are when they go out, and young women in particular make a point of 'keeping up' with their male friends.
"We have to seriously question a society where young adults start their evening by getting drunk at home so they can enjoy their night out more.
"The drunken public behaviour of role models and celebrities, such as sporting heroes, is just helping to glamorise binge drinking in the eyes of Australians.
"People simply aren't aware of the tragic consequences of binge drinking.
"Many people just think about their hangover the next morning, and don't consider the long-term effects like brain damage or heart disease, let alone the immediate danger they may put themselves in while they are intoxicated."
A study by Alcohol Related Brain Injury Australian Services indicates that two million Australians, or one in eight adults, are at risk of permanent brain damage from alcohol.
At the same time, patterns of alcohol consumption have changed to reflect new products, with a doubling since 2001 in the proportion of teenagers consuming pre-mixed spirits.
Dr Capolingua said while initiatives such as the new NHMRC alcohol guidelines were helping to raise awareness of safe drinking, many public education campaigns were not effective in encouraging people to moderate their drinking.
"Alcohol education campaigns often focus on the number of standard drinks and this doesn't always make sense to people," Dr Capolingua said.
"People often think of the amount of alcohol they've consumed in terms of how many glasses they've had, how long they have been drinking, or how drunk they feel. It can be difficult in a social situation to judge what a standard drink is.
"This inconsistency in the way we refer to safe drinking levels makes it difficult to raise public awareness about alcohol-related harm.
"The harmful effects of alcohol abuse, including binge drinking, impact not just on the drinker, but on friends and family, the workplace, the wider community, and the health system.
"We need national public awareness campaigns that clearly and simply show the dangers of alcohol abuse, and which use language that people can easily understand."
The AMA is committed to achieving a reduction in the incidence of hazardous and harmful levels of alcohol consumption and is calling for:
- a partnership between the Government, industry, and community representatives to mobilise public opinion to recognise that hazardous alcohol consumption is socially unacceptable,
- increased taxes that directly reflect the total volume of alcohol in products to encourage a shift to consumption of products containing less alcohol,
standard alcohol drink labelling that includes information on the health and social risk associated with excess consumption and which is displayed in a prominent position on - all alcohol containers and is easily understood by the consumer,
- all advertisements for alcoholic beverages to encourage no more than the NHMRC-recommended levels of alcohol consumption, and to raise awareness about hazardous levels of consumption,
- stricter controls to curb the marketing of products like 'alcopops' (sweetened ready-to-drink alcoholic beverages) to teenagers, and
- effective, wide-reaching public education campaigns highlighting the risks associated with binge drinking and based on appropriate consultation and engagement with the key target audience groups.
Australian Medical Association
AMA President, Dr Rosanna Capolingua, said today that irresponsible alcohol consumption causes harm across all age groups in the community, but the senseless loss of young lives through alcohol abuse must be stopped as a priority.
"Alcohol abuse by young people, highlighted by the culture of binge drinking, is harming the health of thousands of Australians every year," Dr Capolingua said.
Alcohol is second only to tobacco as a preventable cause of drug-related death and hospitalisations in Australia.
The National Health and Medical Research Council (NHMRC) reports that alcohol abuse costs Australia $15.3 billion a year through alcohol-related crime and violence, treatment costs, loss of productivity, and premature death.
According to the NHMRC, alcohol accounts for 13 per cent of all deaths among 14-17 year old Australians. The NHMRC estimates that one Australian teenager dies and more than 60 are hospitalised each week from alcohol-related causes.
"The binge drinking culture is alive and well in Australia and urgent action is needed to re-educate Australians about safe levels of alcohol consumption," Dr Capolingua said.
"The most frightening thing is that binge drinking has hit epidemic proportions among our young people.
"There is a disturbing acceptance, or even celebration, of excess drinking in Australia. Many people view it as a national pastime to be proud of.
"Young people are placing increasing social importance on how drunk they are when they go out, and young women in particular make a point of 'keeping up' with their male friends.
"We have to seriously question a society where young adults start their evening by getting drunk at home so they can enjoy their night out more.
"The drunken public behaviour of role models and celebrities, such as sporting heroes, is just helping to glamorise binge drinking in the eyes of Australians.
"People simply aren't aware of the tragic consequences of binge drinking.
"Many people just think about their hangover the next morning, and don't consider the long-term effects like brain damage or heart disease, let alone the immediate danger they may put themselves in while they are intoxicated."
A study by Alcohol Related Brain Injury Australian Services indicates that two million Australians, or one in eight adults, are at risk of permanent brain damage from alcohol.
At the same time, patterns of alcohol consumption have changed to reflect new products, with a doubling since 2001 in the proportion of teenagers consuming pre-mixed spirits.
Dr Capolingua said while initiatives such as the new NHMRC alcohol guidelines were helping to raise awareness of safe drinking, many public education campaigns were not effective in encouraging people to moderate their drinking.
"Alcohol education campaigns often focus on the number of standard drinks and this doesn't always make sense to people," Dr Capolingua said.
"People often think of the amount of alcohol they've consumed in terms of how many glasses they've had, how long they have been drinking, or how drunk they feel. It can be difficult in a social situation to judge what a standard drink is.
"This inconsistency in the way we refer to safe drinking levels makes it difficult to raise public awareness about alcohol-related harm.
"The harmful effects of alcohol abuse, including binge drinking, impact not just on the drinker, but on friends and family, the workplace, the wider community, and the health system.
"We need national public awareness campaigns that clearly and simply show the dangers of alcohol abuse, and which use language that people can easily understand."
The AMA is committed to achieving a reduction in the incidence of hazardous and harmful levels of alcohol consumption and is calling for:
- a partnership between the Government, industry, and community representatives to mobilise public opinion to recognise that hazardous alcohol consumption is socially unacceptable,
- increased taxes that directly reflect the total volume of alcohol in products to encourage a shift to consumption of products containing less alcohol,
standard alcohol drink labelling that includes information on the health and social risk associated with excess consumption and which is displayed in a prominent position on - all alcohol containers and is easily understood by the consumer,
- all advertisements for alcoholic beverages to encourage no more than the NHMRC-recommended levels of alcohol consumption, and to raise awareness about hazardous levels of consumption,
- stricter controls to curb the marketing of products like 'alcopops' (sweetened ready-to-drink alcoholic beverages) to teenagers, and
- effective, wide-reaching public education campaigns highlighting the risks associated with binge drinking and based on appropriate consultation and engagement with the key target audience groups.
Australian Medical Association
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