In my post on the interactive map of US prescription opiate use trends provided by the Las Vegas Sun I initially missed the association with a three-part series on “The New Addiction”. This explains why the Sun came up with the map in the first place which I should have thought about a bit more. Bad DM!
At any rate there’s all kinds of interesting stuff in here such as a reader poll with only 53% of respondents (as of 7/22/08) saying it is “difficult” to persuade a doctor to provide a prescription for narcotics:

Jennifer Hilton says that after she had a tooth filled, her dentist handed her a prescription for Vicodin even though she was not complaining about pain. She bristled at the unsolicited prescription because she’s a program coordinator for an inpatient drug addiction program for adolescent girls that’s run by Westcare, a Las Vegas nonprofit that specializes in substance abuse treatment.

and a suggestion that the rising trend is all the fault of the American Pain Society in cahoots with BigPharma.

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A story I recently heard from an correspondent who works as a medical professional in a general surgery practice reminds me of the distance we have yet to travel in understanding even the seemingly obvious implications of drug abuse. My correspondent’s practice sees a breadth of cases, including a diversity of acute trauma cases which are severe enough to require a surgery consult. Some cases will require immediate surgery and a lengthy hospitalization for recovery; several weeks may be required when someone has suffered severe trauma. Other cases might involve a little wait-and-see to determine if surgical intervention is going to be required; a several day observation window would not be uncommon. One of these latter cases resulted in an interesting story.
Agent: “We had a guy check himself out against medical advice while we were waiting to see if he was going to get better or require surgery. The patient was apparently really ticked off that they wouldn’t let him out to smoke. He was found a couple of hours later lying in the street.”
YHN: “So what happened, you mean he bled out or something?”
Agent: “Oh, no. In the Emergency Department they hit him with [the opiate antagonist] Narcan and he woke right up”

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Recreational use and abuse of prescription narcotics has received much attention in recent years, from the 2003 revelation that Rush Limbaugh was abusing OxyContin to the multi-drug overdose of Heath Ledger. If you do a little searching you will no doubt run across some descriptions of prescription narcotic abuse as growing and alarming trends. Kevin Z of Deep Sea News and The Other 95% pointed me to a handy little tool to take a look at a couple of aspects of these trends.

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Perennial Playboy Magazine Top-Ten Party School San Diego State University is in the news following the arrest of some of its students on allegations of illicit drug dealing and drug possession. The San Diego Union Tribune is reporting:

Federal agents and SDSU police culminated a yearlong investigation into drug dealing around campus yesterday, …Ninety-six suspects, including 75 SDSU students, have been arrested on drug-related charges…The SDSU Police Department approached the DEA and county narcotics task-force officials for assistance in December, when it became clear that the trafficking was more widespread than it could handle.
Investigation seizures by the numbers (sidebar; SOURCE: SD County District Attorney’s Office)

  • 50: Pounds of marijuana
  • 4: Pounds of cocaine
  • 3: Semiautomatic handguns
  • 1: Shotgun
  • 48: Marijuana plants
  • 350: Ecstasy pills
  • 30: Vials of hash oil
  • $60,000: Cash

Sadly, the investigation was sparked by a drug-overdose fatality, albeit of an anonymous undergraduate rather than someone as famous as Heath Ledger or Len Bias. There is also another drug-overdose fatality caught up in this story.
I want to talk about Jennifer Poliakoff and Kurt Baker today.

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Salvia divinorum smoking is apparently popular with the kids these days.
Drug Law Blog had a recent note on progress of a California Assembly bill AB 259 which:

Provides that any person who sells, dispenses, distributes, furnishes, administers, gives, or offers to sell, dispense, distribute, furnish, administer or give Salvia divinorum, or Salvinorin A, or any substance or material containing Salvia divinorum or Salvianorin [sic] A, to any person under 18 years of age shall be guilty of a misdemeanor.

Currently legal psychoactive? Efforts afoot to regulate and/or limit use? Game on, DearReader…

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This week’s fax from the Center for Substance Abuse Research at the University of Maryland touches on an issue of continual interest, namely the determination of “how addictive” different drugs of abuse may be. As I have mentioned a time or two (or three) before, I believe this is an area where the scientific research tends to skirt a key issue. From my perspective, this is one of the hardest questions to answer on the basis of the available human data and the animal models tend to drive right over the essential concepts.
This week’s CESAR fax (sign up here) reports rates of discontinuation, continued use without dependence and dependence for most major drugs of abuse. These data can help us to answer the question of “how addictive” are various recreational drugs.

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In his classic song the great philosopher and student of addictive disorders, Hank Williams, Jr., blames a traditional source for increasing the probability of developing substance abuse:

….Hank why do you drink?
(Hank) why do you roll smoke?
Why must you live out the songs you wrote?
Stop and think it over
Try and put yourself in my unique position
If I get stoned and sing all night long
It’s a family tradition!

A piece in the New York Times covers a county in New Mexico which experiences some of the highest drug-overdose rates in the nation

recorded deaths have been steady, around 20 a year in a county of 41,000. Meanwhile, the health department trades about 12,000 clean syringes for used ones in the county each week.

The article attributes much of the blame to a familiar “Grim Tradition”.

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In his classic song the great philosopher and student of addictive disorders, Hank Williams, Jr., blames a traditional source for increasing the probability of developing substance abuse:

….Hank why do you drink?
(Hank) why do you roll smoke?
Why must you live out the songs you wrote?
Stop and think it over
Try and put yourself in my unique position
If I get stoned and sing all night long
It’s a family tradition!

A piece in the New York Times covers a county in New Mexico which experiences some of the highest drug-overdose rates in the nation

recorded deaths have been steady, around 20 a year in a county of 41,000. Meanwhile, the health department trades about 12,000 clean syringes for used ones in the county each week.

The article attributes much of the blame to a familiar “Grim Tradition”.

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I have a tendency to refer to data from the Monitoring the Future study with some frequency. Unfortunately I’ve been too lazy to post the critical data figures for your entertainment. Until today DearReader.
One example of which I am particularly fond, is what I call the “Len Bias effect” on the public perception of “risk” associated with casual use of cocaine. I refer to this so often because of the casual sneering response I (and others of my approximate generation) retain for the “Just Say No” program championed by Nancy Reagan in the mid-80s. The MtF data suggest to me at any rate that our “gut feeling” that these types of programs are stupid should be more nuanced.

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As a follow to my prior comments pointing out that the press reports on Heath Ledger’s death were unnecessarily devoid of neuropharmacological perspective, I’ll note that the report on the drugs found in Heath Ledger’s body after his death is now out. Abel Pharmboy has the call:

this report is just in from AP on Heath Ledger’s toxicology report:

The cause of death was “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine,” spokeswoman Ellen Borakove said in a statement.

The opiates oxycodone (OxyContinTM) and hydrocodone (VicodinTM and a host of other products) did not appear, to my knowledge, in the news that leaked out in the days following Ledger’s death. This is an interesting twist.

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As a follow to my prior comments pointing out that the press reports on Heath Ledger’s death were unnecessarily devoid of neuropharmacological perspective, I’ll note that the report on the drugs found in Heath Ledger’s body after his death is now out. Abel Pharmboy has the call:

this report is just in from AP on Heath Ledger’s toxicology report:

The cause of death was “acute intoxication by the combined effects of oxycodone, hydrocodone, diazepam, temazepam, alprazolam and doxylamine,” spokeswoman Ellen Borakove said in a statement.

The opiates oxycodone (OxyContinTM) and hydrocodone (VicodinTM and a host of other products) did not appear, to my knowledge, in the news that leaked out in the days following Ledger’s death. This is an interesting twist.

Read the rest of this entry »