addiction

RECENT POSTS

Study: Young Adults’ Casual Marijuana Use Causes Brain Changes

(prensa420/Flickr)

(prensa420/Flickr)

A new study by Boston researchers is believed to be the first that shows that young adults who even occasionally smoke marijuana could be damaging their brains.

The study, just published in The Journal of Neuroscience, found abnormalities in areas of the brain related to emotion, motivation and decision-making.

The researchers say the degree of brain changes appeared to be directly related to how frequently the study’s participants smoked pot.

The authors write in their paper:

The results of this study indicate that in young, recreational marijuana users, structural abnormalities in gray matter density, volume, and shape of the nucleus accumbens and amygdala can be observed. Pending confirmation in other cohorts of marijuana users, the present findings suggest that further study of marijuana effects are needed to help inform discussion about the legalization of marijuana.

The study comes with a plurality of Massachusetts residents supporting the legalization of marijuana for recreational use, and as the state is in the process of opening medical marijuana dispensaries.

Here & Now has more on the study this afternoon.

And hat-tip to The Boston Globe, which has more on the findings.

Second Opinion: Doc Says Blue Cross Opioid Policy Is Flawed

Amidst concerns over a massive national increase in the use and abuse of prescription painkillers, health insurer Blue Cross Blue Shield of Massachusetts instituted a new policy to reduce pain medication addiction and misuse.

This week The Boston Globe reports that as a result of the new policy, Blue Cross has cut prescriptions of narcotic painkillers by an estimated 6.6 million pills in 18 months.

But Daniel P. Alford, MD, an associate professor of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program at Boston University School of Medicine and Boston Medical Center, calls the policy “flawed and irresponsible.” Here’s Alford’s response:

By Dr. Daniel P. Alford
Guest Contributor

The Blue Cross Blue Shield of Massachusetts opioid management program was implemented to provide members with “appropriate pain care” and reduce the risk of opioid addiction and diversion.

In a recent Boston Globe report they claim “very significant success” with this program after 18 months because they have cut opioid prescriptions by 6.6 million pills.

Dr. Dan Alford

Dr. Dan Alford

Is this really a measure of success and if so, for whom? It likely saves Blue Cross money but has it successfully achieved their program’s stated goals? Does decreased opioid prescribing mean more appropriate pain care? Does decreased opioid prescribing reduce the risk of addiction or diversion, or does it decrease access to a specific pain medication (opioids) for treating legitimate chronic pain? Is the observed decrease in opioid prescribing evidence that opioids have been overprescribed, as Blue Cross claims, or is it proof that instituting a barrier to opioid prescribing (prior authorization) will decrease prescribing even for legitimate need? Are patients with chronic pain really benefiting from this program? I doubt it.

Adding yet more paperwork for physicians will not improve pain care, decrease addiction or the numbers of accidental overdoses from prescription opioids. Those physicians who are unwilling (or ambivalent) to prescribe opioids even when indicated will use the prior authorization requirement as an excuse to continue not prescribing. Those who are overly liberal in prescribing will figure out the most efficient way to satisfy the insurance requirements for approvals. Physicians who responsibly prescribe opioids – that is, prescribing them only when the benefits outweigh any risks — will be saddled with more administrative burdens to justify their well thought-out treatment decisions.

Some physicians may ultimately decide that prescribing opioids isn’t worth the trouble despite known benefits for some patients. Continue reading

In Defense Of 12 Steps: What Science Really Tells Us About Addiction

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

The chips AA members receive to mark sobriety. (Randy Heinitz/Flickr)

Last week, Radio Boston featured an interview with Dr. Lance Dodes, author of “The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry.” Here, two Harvard Medical School professors of psychiatry respond, arguing that Dr. Dodes misrepresents the evidence and that 12-step programs have among the strongest scientific underpinnings of any addiction treatment.

By John F. Kelly and Gene Beresin
Guest Contributors

In a recent WBUR interview, Dr. Lance Dodes discussed his new book, which attempts to “debunk” the science related to the effectiveness of 12-step mutual-help programs, such as Alcoholics Anonymous, as well as 12-step professional treatment. He claims that these approaches are almost completely ineffective and even harmful in treating substance use disorders.

What he claims has very serious implications because hundreds of Americans are dying every day as a result of addiction. If the science really does demonstrate that the millions of people who attend AA and similar 12-step organizations each week are really deluding themselves as to any benefit they may be getting, then this surely should be stated loud and clear.

In fact, however, rather than support Dr. Dodes’ position, the science actually supports the exact opposite: AA and 12-step treatments are some of the most effective and cost-effective treatment approaches for addiction.

In his book, Dr. Dodes commits the same misguided offenses he condemns. His critique of the science behind treatment of addiction is deeply flawed, and ironically, his own psychoanalytic model of an approach to solve the “problem of addiction” has no independent scientific proof of effectiveness, particularly in comparison to other methods of treatment.

Below, we address some of the specific pronouncements he made on Radio Boston and in his book in order to convey what well-conducted science actually tells us about how to treat addiction.

What he says: 12-Step programs do not work, are not backed by science, and are probably harmful.

The evidence is overwhelming that AA, and treatments that facilitate patients’ engagement with groups like AA, are among the most effective and best studied treatments for helping change addictive behavior. Continue reading

Citing Addiction Fears, Group Asks FDA To Revoke Painkiller Approval

Instant Vantage/flickr

Instant Vantage/flickr

By Judy Foreman
Guest Contributor

In an unusual move, a coalition of activists and physicians, concerned about the problem of prescription pain-reliever abuse, yesterday asked the U.S. Food and Drug Administration to revoke its approval of a new type of opioid called Zohydro. The medication is expected to be on the market soon.

“Too many people have already become addicted to similar opioid medications and too many lives have been lost,” said the Feb. 26 letter to the FDA, signed by a coalition of consumer health advocates, addiction treatment and health care providers.

But that request is provoking outrage and anxiety among chronic pain patients who applauded the FDA’s approval of the new medication last fall and would like to see Zohydro added to the list of prescription pain-relievers now on the market.

Zohydro is a type of opioid called hydrocodone and, in its chemical structure, is similar to morphine, said June Dahl, a professor of neuroscience at the University of Wisconsin School of Medicine and Public Health, in a telephone interview and email conversation.

“It’s an advantage to have another pure opioid agonist on the market and to have that agonist in a controlled release formulation,” said Dahl. She questioned, however, whether it is wise to allow the current formulation of Zohydro on the market right away, instead of waiting a few years for an abuse-deterrent, a formulation specifically designed to thwart abusers.

Until recently, the only hydrocodone-containing products on the market were combination medications such as Vicodin which contains both hydrocodone and acetaminophen. The major concern about Vicodin is actually not the opioid it contains but the acetaminophen (which is also the active ingredient in Tylenol), noted Dahl. (Last fall, the FDA took the first steps toward moving medications like Vicodin to a more restrictive category, which would limit the how easily patients could get refills.)

Zohydro is different from Vicodin in that it contains only hydrocodone, with no other ingredients. The company that makes Zohydro argues that this formulation makes the drug safer than the combination products.

Dr. James Cleary, a palliative care specialist at the University of Wisconsin, said in a telephone interview that “it is reasonable to have this product [Zohydro] out there.” Opioids are defined as “essential medications” by the World Health Organization and several other major groups, he added.

“Therefore we need to make sure they are available to appropriate patients and we need to establish a balanced system that also reduces abuse and diversion. We need to understand the opioid crisis much better.” Continue reading

Addiction, Once Again In The News, Affects Us All

By Dr. Kevin P. Hill
Guest contributor

Today, as we have done on too many other days, we are talking about a great talent lost too soon to the disease of addiction. But while today we mourn the tragic death of the gifted actor Philip Seymour Hoffman — someone who lived in the public eye — every day someone, somewhere mourns a loved one lost to addiction. It affects us all. It should only take a moment to think of someone in your life with addiction. There are many stressors that can contribute to an addiction problem, and while they may be different for an actor as opposed to a blue-collar worker, they are shared by all of us. Addiction is not homogenous. It doesn’t care what you look like, what age you are, or what socioeconomic background you have.

Every day in the United States, 105 people die as a result of drug overdose, and another 6,748 are treated in emergency rooms across the country for the misuse or abuse of drugs. Addiction to opioids like oxycodone and heroin can happen quickly and end catastrophically. Often people are introduced to prescription opioids like oxycodone after a surgery or by friends, and the powerful high can become something that consumes their lives. Time and money are spent chasing this high, and relationships and careers suffer. It is expensive to finance a prescription opioid habit, so many end up turning to the cheaper, yet still incredibly powerful, heroin. When using heroin, it is difficult to know exactly what you are injecting and how much, sometimes tragically resulting in accidental overdoses.

Philip Seymour Hoffman poses at the premiere of the film "A Most Wanted Man" during the 2014 Sundance Film Festival, Jan. 19 in Park City, Utah. (Danny Moloshok/Invision/AP)

Philip Seymour Hoffman poses at the premiere of the film “A Most Wanted Man” during the 2014 Sundance Film Festival, Jan. 19 in Park City, Utah. (Danny Moloshok/Invision/AP)

We can do many things to prevent bad outcomes from addiction. The first step is recognizing that, despite the stigma associated with it, addiction is a chronic medical illness like asthma, diabetes, or high blood pressure.

It is too often assumed that addiction is a sign of moral weakness or lack of willpower, but there is a strong genetic component to it that makes some people more likely to become addicted to drugs. Addiction never completely goes away, but, with treatment, people with addiction can do well in relationships, work, and school. Treatment programs, behavioral therapy, support groups and even medication can be parts of successful treatment regimens. The use of medications can be controversial, although we would not think twice about taking a medication for diabetes or high blood pressure if we knew it would help us manage these problems. Continue reading

Cigarette Study: Increased Nicotine ‘Yield’ May Make Quitting Even Harder

kenji.aryan/flickr

kenji.aryan/flickr

Fifty years after the U.S. Surgeon General issued the first report on the health hazards of smoking, cigarettes are potentially more addictive than ever, according to a new study that examines so-called “nicotine yields” — essentially the amount of nicotine delivered via smoke.

The study, led by the Massachusetts Department of Public Health and researchers at UMass Medical School, found that nicotine yield “increased sharply from 1998 to 2012 even as the total amount of nicotine in cigarettes has leveled off.”

Public health officials suggest that cigarette makers have cleverly changed the design of their product to increase the amount of nicotine smokers are taking in. (I asked whether the researchers had confronted the tobacco companies directly on these findings. Their response: No, tobacco companies were not directly questioned: “We use the data that they are required to provide to DPH annually,” a UMass Medical School spokesperson emailed.

Here’s more from the news release:

“This study indicates that cigarette manufacturers have recently altered the design of cigarettes. This can significantly increase the amount of nicotine a person receives while smoking,” said Thomas Land, PhD, director of the Office of Health Information Policy and Informatics for the Massachusetts Department of Public Health (MDPH) and principal investigator for the study.

“Cigarettes have a more efficient nicotine delivery system than ever before,” Dr. Land said. “Because smokers have no way of knowing that the level of nicotine they are receiving has increased, they can become more addicted more easily without knowing why.” Continue reading

At The White House, Learning How Not To Talk About Addiction

Gil Kerlikowske, director of the U.S office of National Drug Control Policy. (THE CANADIAN PRESS/Pawel Dwulit Via AP)

Gil Kerlikowske, director of the U.S office of National Drug Control Policy. (The Canadian Press/Pawel Dwulit Via AP)

We don’t refer to someone who has anorexia or bulimia as having a “food abuse” problem. We say they have an eating disorder. So why do we refer to someone who is addicted to alcohol or pain pills as having a “substance abuse” problem?

Harvard’s John Kelly, director of the new Recovery Research Institute at Massachusetts General Hospital, made that point this week at what was billed as the first-ever White House summit on drug policy reform. The Obama administration has moved far from the old “war on drugs” model. The current federal drug czar, Gil Kerlikowske, wrote in his email invitation to the summit: “Drug policy reform should be rooted in neuroscience, not political science.” And “it should be a public health issue, not just a criminal justice issue. That’s what a 21st-century approach to drug policy looks like.”

Dr. Kelly, an associate professor of psychiatry, spoke to the summit-goers about the stigma around addiction — so pervasive it can even be seen in language. I asked him to elaborate; our conversation, edited:

It seems clear that addiction is not a good thing. It can cause people many problems, even kill them. But you’re saying that the trouble with addiction stigma is that it goes beyond seeing addiction as bad, to actually blaming the addict?

Yes. The degree of stigma is influenced by two main factors: cause — ‘Did they cause it?’ — and controllability — ‘Can they control it?’ We now know that about half the risk of addiction is conferred by genetics – what you’re born with. On controllability, neuroscience has also taught us that alcohol and other drugs cause profound changes in the structure and function of the brain that radically impair individuals’ ability to stop, despite often severe consequences.

Okay, but what about the other half? There is some element of choice in addiction, at least initially, isn’t there?

Addiction is like many other medical illnesses, in that there’s an interaction between the genetics and the environment. This makes some people more susceptible. For example, a lot of people are exposed to alcohol in our culture, but not everybody becomes addicted to alcohol. The genes may mediate the liking and wanting of that particular substance. For some people, alcohol is aversive for others, it’s kind of okay; for other people, it becomes everything.

So genetics is related to the cause. Brain damage — the toxicity and profound alteration in neurochemical function and structure produced by these abnormally potent reinforcers — alcohol, heroin, cocaine — which causes brain damage — that’s the controllability part. And the language we use directly maps on to that issue of cause and controllability. The rhetoric and language of ‘the war on drugs’ talks about ‘abuse’ and ‘abusers’ and the new movement, toward smarter criminal justice and a more public health approach, needs to look at it as a medical condition and talk about it as ‘substance use disorder,’ which is more accurate medical terminology.

Why does it matter what we call it? Continue reading

Caffeine Withdrawal As A Mental Illness? Really?

I’ve had the headaches and grumpiness and desperate yearnings that accompany giving up my beloved daily Americano. But come on, caffeine withdrawal as a mental illness? Isn’t that just a wee bit farfetched?

Brietta Mengel/Health Care Savvy

(Source: Topcounselingschools.org — click to view full version)

Apparently not. Caffeine use disorder is right there in Section III of the DSM-5, the latest edition of the bible of psychiatric disorders formally known as the Diagnostic and Statistical Manual of Mental Disorders.

“Caffeine is a drug, a mild stimulant, used by almost everybody on a daily basis,” explains Charles O’Brien, MD, PhD, chair of the substance-related disorders work group of the American Psychiatric Association, which publishes the DSM. “But it does have a letdown afterwards.”

Indeed, and for some more than others. (For the full rationale behind caffeine withdrawal’s elevated status as a disorder worthy of further discussion, watch the video here.) Continue reading

Backlash Against Walgreen’s New Painkiller Crackdown

By Judy Foreman
Guest Contributor

You may be in for a shock if you try to get a prescription for any controlled substance – from Ambien to opioid pain relievers – filled at Walgreens anywhere around the country.

Walgreens recently announced what it calls a new “Good Faith Dispensing” policy under which the pharmacy giant – the largest in the nation – is suddenly requiring its pharmacists to take “additional steps” to verify prescriptions for controlled substances.

cheukiecfu/flickr

(cheukiecfu/Flickr)

This process, the company says, “may, at times, require” the pharmacist to contact the prescribing doctor to make sure the diagnosis, the exact billing code, the expected length of therapy and “the previous medications/therapies tried and failed” are correct.

In plain English, this means that Walgreens pharmacists are going to call your doctor, or at least your doctor’s office, to see if your doctor did the right thing in giving you a prescription for pain relievers and other drugs. The policy is provoking distress and outrage among pain patients, physicians and others.

In a telephone conversation, a Walgreens spokesman denied that the aggressive new policy was specifically triggered by the Drug Enforcement Administration’s crackdown on the company in the wake of problems with infamous “pill mills” in Florida. Until recently, unscrupulous “patients” and unscrupulous doctors in Florida have colluded in diverting massive quantities of prescription pain relievers such as oxycodone (an ingredient in OxyContin) through fake clinics dubbed “pill mills.”

In June, Walgreens and the DEA announced an $80 million settlement to resolve the government’s charges that Walgreens failed to control the sales of opioid pain relievers in some of its stores.

The government said that distributors of pain relievers failed to monitor suspiciously large orders for opioids Necessary as that crackdown was, a presumably unintended result is that legitimate pain patients are finding it harder to get the medications they need. Continue reading

Menthol Perils: ‘Health Enemy #1 For African-Americans’

By Karen Weintraub
Guest Contributor

The FDA this week issued a “preliminary” report after more than two years of study, concluding that menthol isn’t inherently dangerous in cigarettes, but that by masking the harsh flavor, it induces more people to start smoking and makes it harder for them to stop. The report was seen as a step toward an eventual ban on menthol in cigarettes – the one flavoring not already prohibited by federal law.

Now, public health experts say, it’s time to take menthol out of cigarettes.

cigarettes

“It makes smoking a blowtorch taste like rice pudding,” says Harvard School of Public Health Professor Gregory Connolly, director of the school’s Center for Global Tobacco Control. “And unfortunately, what’s in that rice pudding is very heavy toxins that go right to the lungs and you wind up with lung cancer, heart disease, stroke, emphysema, and so forth.”

Connolly, and several other local public health experts, says there’s no scientific doubt that menthol in cigarettes is a problem. And it’s one that disproportionately harms African-Americans and young people – who have a marked preference for menthol.

“If you ask me what is Public Health Enemy #1 for the African-American community in terms cancer: it’s Newport cigarettes – the menthol in cigarettes,” Connolly says. Continue reading