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Kids And Prescriptions

The New Fix-Its

U.S. teens are abusing illegal drugs such as marijuana less, but abuse of legal prescription drugs is rising, according to a new study by the National Institute on Drug Abuse.  However, an increase in abuse of prescription and over-the-counter medications has left anti-drug campaigners confused as to how to combat the problem of legal drugs. Nearly one in 10 high school seniors reported using the prescription painkiller Vicodin without a prescription, while roughly one in 20 said they had used Oxycontin without a prescription.  Overdoses of prescription and over-the-counter drugs accounted for about one-quarter of the 1.3 million drug-related emergency room admissions in 2004.  Some kids are self-medicating undiagnosed depression or anxiety, while others are using stimulants to try to get an edge on tests and studying.  Sadly, prescription drugs are familiar mood-altering substances for a generation that grew up as prescriptions soared for Ritalin and other stimulants to treat maladies such as attention-deficit disorder.  A staggering five million kids take prescription drugs every day for behavior disorders.  Pharmaceutical companies’ production of two often-abused prescription drugs — hydrocodone and oxycodone, the active ingredients in drugs such as Vicodin and OxyContin — has risen dramatically as the drugs’ popularity for legitimate uses has increased.  To try to reduce the supply of prescription drugs on the black market, authorities have shut down several “pill mills” — where doctors prescribe inordinate amounts of narcotics — as well as Internet pharmacies that ship drugs with little medical consultation, says Catherine Harnett, chief of demand reduction for the Drug Enforcement Administration (DEA).  Essentially what is most important is not locking up the narcotics it is better parenting and more involvement.

Wide Awake….

Drug addiction exacts a variety of ill effects on a user’s health. Among other things, drug addicts often experience disrupted sleep. The mechanism behind how the substances may change a user’s circadian rhythms remains unknown but new research on mice is providing some insight.  Sleep is extremely important and our R.E.M. cycles are important, circadian rhythm genes help to regulate the brain’s reward system and could influence the addictive properties of drugs such as cocaine.  Circadian gene deficient animals exhibited increased activity in the dopamine neurotransmitter system in the brain, which is heavily stimulated by cocaine use.  The next step is to ascertain the affects of this gene in humans and perhaps find a link between those with low levels and the connection to habitual drug use.

Wide Awake

For example, in one study, human patients addicted to cocaine took much longer to fall asleep. Also, EEG measures of their brain activity showed that they experienced much less deep sleep than did people who did not use the drug. When the subjects were sleep deprived, their immune system had a reduced ability to fight infection.  In another study, heroin patients with less than one year of methadone treatment had poor sleep, the possible cause of which could be measured at the molecular level, Gordon says. Magnetic resonance spectroscopy imaging of these patients showed some energy-indicating molecules in their brain had failed to recover properly after sleep deprivation.  Scientists also have determined that cognitive deficits characteristic of people who regularly use the street drug ecstasy may be based on drug-induced changes in sleep neurobiology. Their altered sleep patterns, cognitive deficits, and impulsivity may be worsened by high levels of catecholamines, brain chemicals that the body produces in response to stress.

Although the neurobiology underlying the sleep disturbance can be directly related to the disease process itself, it is often impossible to determine cause and effect.  Therefore, it is important to study both sleep and the disease simultaneously to get a full understanding.  Researchers also are trying to identify the neurobiological factors that help explain a recovering addict’s vulnerability to relapse.

“Drug addiction is characterized by compulsive drug taking, which occurs even though addicts understand that the behavior is harmful to them. It is also a chronic disorder. Addicts find it extremely difficult to suppress drug taking and often relapse, even after years of abstinence,” says Laura Peoples, PhD, of the University of Pennsylvania Medical School.

The compulsive nature of the behavior and the ever present vulnerability to relapse suggests that drug addiction is accompanied by long-lasting changes in those parts of the brain that control motivation and behavioral choice.  Recent findings have led to a new hypothesis, that experience- and activity-dependent adaptations cause a progressive and persistent increase in the response of specific neurons to specific signals that promote drug-seeking relative to the signals that facilitate other motivated behaviors.

Health Care Costs and Addiction…A relationship.

Health Care

The interrelationship between addiction treatment and general health was noted in a report by the Institute of Medicine, a branch of the National Academy of Sciences. In 2006, an Institute study bureau found that improving the nation’s general health and resolving the major problems of the overall health care system will require attending equally to the major problems of mental and substance use health care.

“Some of the destructive medical consequences of drug abuse and addiction are temporary – the conditions improve after patients receive treatment and are able to stop their drug use. Other consequences may be more persistent, diminishing the quality of patients’ health long after drug use has stopped. Whether short-lived or chronic, the growing list of recognized health consequences of abuse and addiction underscores the fact that drug abuse is not just a brain disease that exists in medical isolation – it manifests itself throughout the body with a broad array of medical consequences.”

–Feb 2004  Dr. Nora Volkow. Director, National Institute on Drug Abuse

Treating people for addiction disorders reduces expensive health care use. Without a doubt, there is a health care justification for treating addiction, but there also is a proven economic justification. Addiction treatment programs result in significant cost-savings for health care systems compared with the cost of not treating addictions. In addition, treating addiction will save money from the reduced costs of treating other general medical and chronic illness conditions such as diabetes and hypertension.

When addiction is treated, the overall health of patient improves. The mountain of evidence shows that these patients fare better with their other health issues and use fewer costly medical services. Several studies have found that substance abuse treatment reduces the medical costs of patients with alcohol and drug use disorders, who utilize health care services at a much higher rate than other patients.

Addiction is pervasive in the United States. An estimated 23 million Americans suffer from alcohol and drug addiction, according to the most recent government survey. Yet only one in 10 of these persons – 2.4 million – get treatment.  With advances in our health care system we, as a nation may be able to arrest, no pun intended, our mental health problems and save our money.  Every little thing we do has an effect on the rest.

Want vs. Consequences

Relapse

Relapse prevention is crucial to an addict’s recovery.  Relapse, although it doesn’t have to be, is a prominent feature of addiction, and one of the most painful.  Most people who struggle with addiction will have one or more relapses – the return to drug use after a drug-free period – during their ongoing attempts to recover. This can be extremely frustrating for patients and for families, as they have already experienced great pain.  Even more interesting, researchers could prevent these relapses by treating rats with a molecule that blocks glutamate signals, suggesting that this chemical might be investigated as a new treatment to prevent relapse in former cocaine-addicts. “Since wanting a drug is more directly connected to relapse [than liking it], glutamate could prove a promising target for new drug developments designed to treat cocaine addiction,” Vorel says. “Considering all the social and economic aspects of drug abuse, pharmacological intervention alone may not solve the burden. But it could help cocaine abusers which number 1.8 million in the U.S. alone.”

Relapse happens with all addictive drugs not just cocaine there are multiple – and often interactive – factors can increase the likelihood of relapse. These are some of the commonly cited precursors:

• drug-related “reminder” cues (sights, sounds, smells, drug thoughts or drug dreams) tightly linked to use of the preferred drug(s) can trigger craving and drug seeking
• negative mood states or stress
• positive mood states or celebrations
• sampling the drug itself, even in very small amounts

The motivation to seek a drug, once triggered, can feel overwhelming and sometimes leads to very poor decision making: the user will pursue the drug, despite potentially disastrous future negative consequences (and many past negative consequences).  The most confusing part about relapse for someone who is not an addict, is that decision to relapse is made from a sober state of mind.  The importance of a strong program and a defined support group is the foundation upon which a better decision process can be made.

Brain-imaging is aiding the medical field to understand the paradox of the decision to pursue a drug reward despite knowing the consequences. For example, very recent imaging research shows that visual drug cues as short as 33 milliseconds can activate the ancient reward (“go”) circuitry, and that this process does not require conscious processing – it can begin outside awareness.  By the time the motivation does reach awareness the reward circuit has a strong head start. This head start means the area of the brain is responsible for weighing the consequences of a decision and for helping to “stop” the drug thoughts is already behind in the process and without a sufficient block or contrary action the addict is well on their way to relapse.

At War With Alcoholism

In America, where there is an “epidemic” of mental health problems and alcohol abuse that have been reported in the troops returning home from war zones in recent years.  Overall, more than one in ten (13 percent) of the respondents said that they were drinking alcohol in quantities defined by researchers as hazardous, according to the World Health Organization’s Alcohol Use Disorders Identification Test .

Soldiers and Alcoholism

It is a concern for officials in Britain and America to focus on prevention of PTSD, whereas a culture of binge drinking and alcohol misuse could be more of a problem, both before and after each soldier’s tour of duty.  American’s serve at least a 15 month deployment compared to the 5-6 months in other countries.  This has added to the mental unstability of the troops returning from duty. In Britain The charity Combat Stress said, however, that it had seen a 66 per cent rise in demand for its services in the past five years, with veterans taking an average of 14 years to seek help after being discharged. Support services were now seeing about 4,000 new veterans each year, but this could rise to 9,000 a year within a decade, the charity added.

A recent Army mental health report concluded that most service members need closer to two years between tours before their battle-related symptoms resolve themselves. Studies show that alcohol consumption is up 13% amongst armed forces.  There are several factors which lead to the higher rate of PTSD, alcoholism, and mental instability within returning troops.  Although our troops are fighting our country’s battles, sadly they return to only 5 years of coverage after their duty is completed.  Compare that with Britain’s lifetime care and it is absolutely unacceptable considering soldiers do not report their symptoms on the whole for quite some time after their return.