The Drug Abuse Warning Network is a public health surveillance system that monitors emergency department visits that involve drugs, including methamphetamine. In order for an emergency department visit to be a DAWN case, the emergency department visit must have involved a drug, either as the direct cause of the visit or as a contributing factor.

DAWN recently released a report that offers important information about the emergency department visits involving methamphetamine between 2004 and 2008.

In 2004, there were 132,576 visits (8.2 percent of all visits) to the emergency department that involved methamphetamine but by 2008 that number had been reduced to 66,308 visits (3.3 percent). The trend was consistent among both males and females, showing a significant decline between 2004 and 2008 (a decrease of 39 percent and 37 percent, respectively).

In 2008, the report showed that methamphetamine-related visits to the emergency department varied by age. 34.7 percent of the visits were made by individuals aged 25 to 34. 24.5 percent of the visits were made by individuals 35 to 44, and 23.7 percent were made by individuals 18 to 24.

Most of the visits to the emergency department that involved methamphetamine also involved other drugs or alcohol. More than a quarter involved methamphetamine and another drug, and 34.2 percent involved methamphetamine combined with two or more other drugs.

Almost a quarter of methamphetamine-related visits to the emergency department also involved alcohol or marijuana. Nearly one in five methamphetamine-related visits involved cocaine or opiates.

The majority of methamphetamine-related visits to the emergency department resulted in the patient being treated and released (60.0 percent). Almost a quarter of the emergency department visits ended in the patient being admitted to a hospital, and 15.8 percent ended in another type of discharge (e.g., patient transfers, death, or some other type of discharge).

Emergency room visits involving methamphetamine provide an opportunity for medical staff to intervene in a situation where someone is abusing methamphetamine, often along with other drugs. The patient can be warned and educated about the dangers of mixing multiple substances and assist them in obtaining treatment for drug withdrawal, if necessary.
 

Massachusetts has experienced a rising increase in overdose deaths caused by prescription drug abuse in recent years. Approximately 9,000 state residents are abusing prescription drugs by engaging in doctor shopping, according to the state Bureau of Health Care and Safety. Prescription drug addicts may feign injuries to get multiple prescriptions for strong painkillers from one or more doctors. Then, doctor-shopping addicts will fill the prescriptions at different pharmacies, and will either abuse them or sell them on the streets. Although legal drugs—including antidepressants, anti-anxiety medications, and pain relievers—all have the potential to help treat serious mental and physical illnesses, the surge in prescription drug abuse has now reached epidemic levels throughout the U.S., causing the need for a prescription drug crackdown.

In Massachusetts, prescription drug abuse has now become just as widespread as illicit drug abuse. Massachusetts has been operating its current prescription drug monitoring program (PMP) since 1992. However, this PMP’s database only registers information on one category of prescription drugs that includes OxyContin, Percocet, and morphine, and has limited access for health professionals. When a potential drug-abusing patient raises a red flag in the system, health professionals and law enforcement are alerted through official reports and necessary action is instated. So far, 45 patients in Massachusetts have received such reports within the PMP. With the integration of this latest detection system, physicians and pharmacists will be able to instantly track patients’ prescription drug use history in an online database that includes powerful prescription pain relievers like Darvon, Vicodin, and even steroids. It is estimated that over 9 million prescriptions per year will be entered into the new system.

As opposed to the existing PMP that is updated monthly, the new database will be updated weekly. Pharmacists will be required to inform state officials of an array of medications they fill for patients’ prescriptions, with the exception of medications for chronic health conditions. Also, individuals filling a prescription for the first time will be required to show identification, but the same will not be required for refills just yet. The state’s authorities will conduct random screenings throughout the system to ensure that no information is mishandled by its users and is registered accordingly. If users are considered to have performed misconduct with the database’s information, they could be charged with severe fines or penalties.

Funding for the new system will cost approximately $1 million to start; Massachusetts will contribute $400,000 per year to keep the system operating. Funding for the widely successful prescription screening system is rather affordable in comparison to the damage that prescription drug abuse costs the economy. The state’s low-income health insurance program could be afforded up to $2 million each year with the new system in place, according to health officials.

According to a recent report from the Substance Abuse and Mental Health Services Administration (SAMHSA), treatment admissions for prescription drug abuse have increased fourfold nationwide within the past decade. SAMHSA also reports that emergency department visits related to the non-medical use of prescription pain relievers increased by 111% between 2004 and 2008. Some Massachusetts hospitals have reported receiving just as many emergency department visits related to prescription drug misuse as emergencies caused by disasters. Not only to PMPs help doctors ensure that legal medications are being used effectively and safely, but it keeps these potent drugs from falling into the wrong hands and causing more unwanted injuries.

Source: The Boston Globe, Stephen Smith, State OK’s tool to detect prescription drug abuse, August 12, 2010

While, in almost all cases, the user of illicit drugs enters into the world of drug addiction knowing, at least on some level, that what they’re doing is dangerous, those who are addicted to pain medication and other prescription drugs are not always afforded the opportunity to turn back before sliding down that slippery slope. You see, for many prescription drug addicts, the first dealer is actually a trusted friend and adviser – a doctor. We’ve all experienced a situation where a doctor has written us a prescription for a potentially addictive pain killer… for a bad back, a toothache, or a broken leg. In most cases, we take the drugs as prescribed (or even stop early) and forget about them once the pain is gone. For someone prone to addiction, however, this first taste of Vicodin or Percocet is like a junky’s first taste of heroin.

The problem is, however, prescription drugs eventually become harder for people to get than the illegal ones. Most doctors are stingy with their prescription pad, and rightly so. They have become increasingly aware of the role that they could be playing in today’s addiction problem. When doctors stop writing prescriptions, however, the craving for the drug does not stop along with it. Prescription drug addicts are forced to look elsewhere for the drugs. The most common method is doctor shopping (bouncing from doctor to doctor or emergency room to emergency room, hoping to find someone who doesn’t notice the signs of a pill seeker). Once this method fails, however, the addict becomes truly desperate and does things that are truly bizarre.

Michael Loverde, an Illinois man in his 40’s, developed a prescription drug addiction in the late 1990’s. Back then, this type of addiction got very little press and, because it often came about as the result of authorized medical treatment, was little understood. Loverde’s addiction didn’t start out as the result of pain management gone bad. Instead, he got a Vicodin from a friend. What’s unique about Loverde’s story, however, is the method he used to get the drugs. When legitimate medical and black-market sources dried up, he turned to unsuspecting homeowners. Loverde developed a system by which he would pretend to be interested in buying a house that was on the real estate market. During the showing, he would excuse himself to use the bathroom. Once there, he would raid the medicine cabinet and, more often than not, walk away with a handful of narcotics.

By now we’ve all heard about the drug-store robbery epidemic that has gripped the nation. Strung out and desperate addicts, with nothing left to lose, will commit daring robberies of pharmacies to obtain the wonder drug OxyContin. While most of these are smash and grabs that happen when the store is closed, a bolder generation of Oxy thieves is emerging, those who will walk into a pharmacy in broad daylight and demand drugs at gunpoint.

Out of Southern California comes a new method by which prescription drug addicts are obtaining narcotics. Law enforcement officials in the Santa Clarita Valley report that prescription drug addicts have begun targeting the trash of nursing homes in search of discarded pill bottles. This bizarre practice was first reported by an elderly patient, who discovered two men ransacking the trash outside an upscale assisted living facility. The next day, the patient found a pile of empty pill bottles on the ground beside the recycling bin – her own empty Vicodin bottle among them.

An undercover investigation revealed that area pharmacies were honoring refills of pain medication, such as Vicodin, that were requested by people pretending to be relatives of the named patients. Leaders in that community have spearheaded a movement to terminate the practice of automatic refills on narcotic prescriptions and to require identification when refilling prescriptions.
 

Researchers from the Scripps Research Institute wanted to see whether dysregulation of the function of mGluRs plays a role in increasing cocaine administration in rats. They tested rats with daily one-hour or six-hour access to cocaine for differences in cocaine use after being treated with LY379268, an mGluR2/3 agonist, and MTEP, an mGluR5 antagonist.

During the development of the rats’ addiction, LY379268 and MTEP changed in capacity to reduce cocaine use. LY379268 became more effective and MTEP became less effective in rats that had six-hour access to cocaine.

Corresponding author Dr. Yue Hao explains that their study shows that during the transition from “casual” cocaine use to addiction, dysregulation occurs in mGluR function, suggesting that functional changes in mGlu receptions may play a role in cocaine addiction.

Dr. John Krystal, editor of Biological Psychiatry, the journal in which the study was published, said the study underscores the complexity of treating cocaine addiction because different extents of cocaine use may affect brain systems differently. These findings could lead to effective treatments for different kinds of cocaine use.

Source: Science Daily, Drugs to Treat Cocaine Abuse? Effectiveness May Depend on How One Uses Cocaine, August 10, 2010

A new study says that the young people turning 21 might need more guidance, before they become a legal drinker, in how to moderate the amount of alcohol they consume. Released in May, the study explains that many of those celebrating their 21st birthday consume more alcohol than planned.

The researchers recruited 150 individuals attending a southwestern university. The students reported that they planned to drink for their 21st birthday, but they consumed more than they had anticipated.

More than two-thirds, or 68 percent, of the individuals turning 21 consumed more alcohol than they had planned. Those who underestimated their drinking had anticipated drinking an average of 7 drinks at their birthday celebration. They consumed, on average, 12 drinks at their party.

The researchers discovered that students who consumed more alcohol than they planned were more likely to drink faster and to drink more shots than those who were accurate in their estimates for alcohol consumption. 55 percent of the students studied reported that they had consumed free shots in bars.

Students who drank more than they had planned were also more likely to have participated in 21st birthday party games. The students often were celebrating in bars where popular 21st birthday traditions included games like drinking 21 shots or drinking at midnight. These parties were also more likely to include influential peers who encouraged the individual turning 21 to drink.
This type of party atmosphere is popular among college students turning 21. Overall, 60 percent of the birthday parties involved one or more 21st birthday drinking traditions, and 61 percent of the parties had one or more influential peers present.
With so many college students choosing to participate in these types of birthday celebrations, it may be helpful to target students with education about how to prevent underestimating the amount of alcohol they will consume on their birthdays.

Strategies can be taught for students to know how to avoid being pressured to drink too much alcohol on their 21st birthdays. They may be caught in an embarrassing situation if they resist the efforts of their friends to have a memorable 21st birthday.
 

The Florida Department of Law Enforcement released a report showing data that the 1,185 deaths in the state in 2009 were caused by oxycodone. These figures represent a 26 percent increase from the prior year and a 249 percent increase from 2005.

The deaths are divided according to counties within the state. Data shows that the hardest hit counties last year were Pinellas and Pasco, with the total number of deaths hitting 197. This district also claims the lead for the number of methadone deaths at 117 and deaths as a result of hydrocodone at 45.

Oxycodone is not the only prescription drug abused in the state and drug deaths overall as a result of such activities hit 2,488 last year. While this figure was climbing, the number of deaths as a result of illegal drugs was declining. Heroin deaths, for instance, have decreased by 20 percent and cocaine deaths by a little more than 18 percent.

This growing trend of prescription drug deaths appears to have no end in sight, forcing lawmakers to take a hard look at what needs to change in the system. The state recently passed a law to establish a prescription drug monitoring program which would collect information on drugs dispensed in the state. Will it be enough to turn the tide for so many Floridians at risk?
 

The feelings mentioned above drive many individuals to abuse MDMA, which is generally found among the nightclub scene. Users tend to be Caucasian adolescents and young adults, although that profile seems to be changing. While it is still common to find MDMA readily available and used at weekend-long dance parties – known as raves – the substance is finding acceptance among other ethnic groups.

MDMA also appears to be the preferred social drug among the urban, gay male population. Reports from certain sectors of this group cite MDMA is often used as part of a multi-drug experience. MDMA is combined with marijuana, cocaine, methamphetamine, ketamine and other substance – both legal and illegal – to achieve the desired effect.

Much of the popularity of MDMA is based in its affect on the brain. MDMA will focus primarily on neurons that use the chemical serotonin to drive communication with other neurons. The serotonin system is used to regulate mood, aggression, sexual activity, sleep and even sensitivity to pain. The MDMA will chemically bind to the serotonin transporter, which in effect terminates the signal between the neurons, significantly impacting the individual.

The result for the MDMA user is often confusion, sleep problems, cravings for the drug – or even other drugs, severe anxiety and depression. While such symptoms can appear immediately after consuming MDMA, they can also takes weeks to surface. When given cognitive or memory tests, frequent MDMA users tend to perform more poorly than those who do not take or abuse the substance.

Research into the effect of MDMA on the brain in animals demonstrates clear damage that can be caused with its use. Exposure to MDMA for four days in nonhuman primates damaged serotonin nerve terminals. When the animals were tested six to seven years later, the damage was still evident. Similar damage has not been measured definitely in humans, yet the overwhelming evidence in animal studies suggests MDMA should not be considered safe for consumption in humans.

Even with such knowledge, many humans will still indulge in MDMA, especially if it achieves the effects they desire. As a result, they are prone to develop an addiction to MDMA as it is an addictive substance. In fact, a study of young adult and adolescent users revealed 43 percent of reported MDMA users met the accepted diagnostic criteria for dependence. Without an interruption in use, these individuals are putting their lives at risk.
 

The arrest, which coincides with the arrest of another NFL player for codeine possession—Green Bay Packer defensive end Johnny Jolly—brings much attention on the substance at matter. A narcotic, codeine is a type of opiate that is used for analgesic and antitussive purposes in medicine. Aside from being a cough suppressant, codeine cough syrup is a central nervous system depressant that can cause sedation and altered states of consciousness at high dosages, and is available by prescription only because it has the potential for dependency and abuse. The syrup is also the main ingredient in a concocted beverage known as "purple drank," in which codeine is mixed with soda, candy, and alcohol. Although purple drank existed for decades among the underground hiphop scene as well as in the South, it has otherwise remained unknown to outside regions. Recent events such as Russell and Jolly’s arrests, however, have now brought national media attention upon the dangerous drink.

When mixed with alcohol, codeine has the potential to cause serious adverse effects such as mood swings, delayed reactions, impaired cognition, seizures, respiratory depression, and respiratory or cardiac arrest. Use of codeine over a three- or four-week period can cause dependence and incite withdrawal symptoms. Other noticeable side effects caused by purple drank include weight gain, tooth decay, and other health problems due to the excessive amount of sugar contained in the drink’s ingredients. The intoxicating beverage derives its nickname from the purple hue the codeine syrup creates when combined with soda and candies like Jolly Ranchers. Different forms of codeine syrup may come in various colors like yellow or pink, and other slang terms for the beverage may be based off these as well. Purple drank is believed to have caused the premature deaths of such prominent hiphop idols as DJ Screw from Houston, who is alleged to have popularized purple drank during the 1990s.

NFL officials have stated that they believe codeine abuse is not a growing problem among players, even though Russell, Jolly, and other players such as Terrence Kiel have had Drug Enforcement Administration investigations on their possession and distribution of the substance. A former Denver Bronco player, Shannon Sharpe, recalls the growing popularity of purple drank among players during his time in the NFL. As of July 16, Jolly has indefinitely been suspended from the NFL during his trial for codeine possession, and may face up to 20 years in prison. Kiel pleaded guilty to two felony charges of codeine possession and intent to distribute a controlled substance back in 2006 after being caught trying to ship codeine cough syrup to a friend via Fed-Ex.

Russell, now 24 years old, was once considered a first-hand draft pick before playing three disappointing seasons on the Oakland Raiders. Russell was released from the Raiders in May this year due to his poor performance, weight gain, and bad behavior.

Source: USA Today, John Saraceno, JaMarcus Russel case shows danger behind ‘purple drank,’ July 7, 2010

The projected four-year study will focus on the higher rates of oral diseases among methamphetamine users and how the presence of serious dental diseases in patients can help identify methamphetamine users in the early stages of abuse since other medical symptoms are usually not manifest in the outset of abuse.

The study will be led by Dr. Vivek Shetty, professor of oral and maxillofacial surgery at UCLA’s School of Dentistry. Dr. Shetty co-authored a new report in the Journal of the American Dental Association on recognizing how severe oral disease plays a prevalent role in diagnosing methamphetamine abuse along with the other comorbid physical and physiological adverse reactions that are caused by this addiction. Dr. Shetty emphasized the unique ability of dental professionals to participate in the intervention process of drug abuse management upon discovering signs of methamphetamine use in their patients to help offer these individuals the medical assistance and support they badly require.

The NIDA-funded study is also aimed at defining the burden to oral health and hygiene that methamphetamine use causes, and to characterize how this problem has grown into a public health epidemic. NIDA estimated that there were 850,000 Americans ages 12 and older in 2008 who had abused methamphetamine that year, and that 10 million Americans have abused methamphetamine during their lifetime. The RAND Corporation estimates that methamphetamine abuse had cost the nation $23.4 billion in 2005, including costs for criminal justice, law enforcement, medical and emergency resources, premature deaths, loss of productivity, foster care, illicit production resulting in domestic disaster (i.e., home-made meth lab explosions), and treatment resources.

Aside from the severe dental problems caused by methamphetamine use (known as "meth mouth”), methamphetamine abusers can experience a range of physical symptoms including increased alertness, wakefulness, sleep deprivation, increased blood pressure, increased respiration, rapid heart rate, hyperthermia, and decreased appetite. More serious long-term effects include anxiety, uncharacteristic moods, anger, aggressiveness, confusion, memory loss, extreme weight loss, paranoia, hallucinations, delusions, and irreversible brain damage. Methamphetamine abusers also have a higher risk of obtaining HIV/AIDS and other infectious diseases.

Methamphetamine addiction causes hundreds of premature deaths in the U.S. each year. With the integration of this new research funded by NIDA, even medical practitioners in the dental profession can join the forefront on drug abuse prevention and intervention.

A recent Business Week report captured the events of a recent rave in Los Angeles, the events of which were reported on by the U.S. Centers for Disease Control and Prevention. Nearly 45,000 people attended this particular event, the outcome of which included the death of one and hospitalization of 18 others.

The CDC report showed that of the 18 people treated, all were between 16 and 34 years of age and nine were women. While ecstasy was definitely involved in the activities of all 19 individuals, another 10 had also used alcohol and five consumed other drugs.

One of the patients ended up in intensive care, suffering seizures, a breakdown of muscle tissue, kidney and liver failure. The fatality was a young man who reportedly used multiple drugs at the rave. Friends reported he had used ecstasy and cocaine at the rave and injected heroin when he returned back home.

Throughout the nation, ecstasy continues to be a growing problem. Hospital related visits as a result of its use have risen nearly 75 percent from 2004 to 2008. The rise in L.A. county surpasses all others, showing a 650 percent increase in ecstasy preference between 2005 and 2009.

According to Dr. Adam Bisaga, with Columbia University and New York State Psychiatric Institute, ecstasy generally does not cause fatal intoxication. The problem arises when the drug is mixed with alcohol and other drugs. He advises that medical care be immediately available at rave events to prevent serious injury or death as a result of poor combinations or choices.