Part of targeting adolescents for prevention and education involves an understanding of which groups of adolescents are most affected by drug and alcohol use. A study recently published in Archives of General Psychiatry highlights the increased use of substances by certain racial and ethnic groups of teenagers. The research was conducted by scientists at Duke University Medical Center in Durham, North Carolina.

The report found that substance abuse in the Unites States is a serious problem among Hispanics, Native Americans, whites and those who report being of multiple ethnicities/races. The researchers say that these groups of teens seem to be disproportionately affected by substance abuse problems.

The researchers explain that while a goal of the National Institutes of Health is to eliminate the differences between racial groups when it comes to substance abuse, the first step must be to identify the groups most at risk. Little information exists for teens groups that are non-white.

Leading the group of researchers was Li-Tzy Wu, Sc.D., and colleagues, whose objective was to determine variations of substance use and abuse across racial and ethnic variations. Non-white teens comprise the fastest growing group in the United States.

The researchers utilized data from the National Survey on Drug Use and Health, accessing the reports from 2005 to 2008, and examined surveys administered to 72,561 teens between the ages of 12 and 17. The presence of substance abuse was determined using criteria from the DSM-IV.

The findings of the study revealed that 27,705 of adolescents surveyed reported that they had used alcohol or drugs within the last year, and 7.9 percent met criteria for a substance use disorder, according to DSM-IV. The highest level of substance use was among Native Americans, of whom 47.5 percent reported alcohol use and 15 percent could be diagnosed with a substance use disorder.

The report found that 20.5 percent of Native Americans, 18.1 percent of those with multiple races/ethnicities, and 16.2 percent of whites indicated that they had used both alcohol and drugs.

The researchers believe that the results indicate a need for identification and expansion of prevention efforts targeting specific cultural groups.

Investigators claim that Medicare officials have been extremely slow in recognizing and acting on this evidence. Gregory D. Kutz, the director of forensic audits and special investigations, says their analysis determined that around 170,000 Medicare recipients had visited five or more practitioners in the medical field to receive prescriptions such as OxyContin and Percocet.

In one case, a recipient in Georgia obtained a 150-day Oxycodone supply in just 27 days by visiting four different doctors resulting in seven prescriptions. Throughout the course of one year, the women received a total of 3,655 oxycodone pills from 58 different prescribers and had filled them at over 40 pharmacies.

Senator Thomas R. Carper of Delaware stated that federal dollars, which are intended to help the elderly and poor, are being abused and used instead to feed addictions or to fill the wallets of drug dealers. Prescription drug abuse is now causing increased expense to taxpayers and also threatening the health of Medicare beneficiaries.

Medicare’s drug benefits are managed by privately owned insurance companies that are under contract with our government. Their drug plans gave out almost 57 million prescriptions for opiates last year. This number increased by 11 million from just 2007 – a 24 percent increase.

Investigators argue that we could reduce fraud and prescription drug abuse by simply using electronic health records and electronic broadcast of prescriptions among pharmacies to keep better track of patients’ medical history. Medicare officials argue that high use of pain medications isn’t necessarily an indicator of abuse but rather a poor coordination by medical care in treating pain symptoms.

Many drug addicts are, in fact, individuals in their 50s and 60s, living in comfortable middle-class homes and well-established in their careers. Originally prescribed a pain reliever for a valid chronic pain problem, they became addicted to a medication and have struggled to overcome their prescription drug addiction.

A new study developed by Dr. Richard Cooper, lecturer in public health at the School of Health and Related Research at the University of Sheffield, examines the problems associated with over-the-counter (OTC) medicine abuse. The report was published by the Pharmacy Practice Research Trust and was funded through its Research Awards program.

The study sought to understand current issues relating to OTC medicine addiction by examining the factors affecting individuals. The study included information gathered from pharmacists, medicines counter assistants (MCAs) and key stakeholders.

The report indicates that there is a range of problems associated with codeine-based medications purchased from pharmacies. Individuals participating in the qualitative study indicated that their use of codeine-containing medication began with a genuine medical reason.

Three types of abuse were designated based on the amount of medication used, ranging from “never exceeding maximum recommended dosage” to “using significantly higher levels of medication than recommended.” The participants described withdrawal symptoms and admitted to using the medication for different reasons than originally intended. All had attempted to stop using the medication.

The individuals had used various means to stop using the medication, ranging from Internet support groups to medical treatment. However, none of the participants sought pharmacy advice, citing the need to hide their addiction as a reason to avoid seeking help at a pharmacy or substance abuse treatment facility.

The study found that the individuals were more likely to blame themselves for the addiction rather than finding fault with a lack of pharmacy regulation or manufacturers or doctors failing to warn them about the potential dangers of the medication. The individuals in the study were called “respectable addicts” because there was a desire consistent among participants to be distinct from the associations typically made when considering drug addiction.

Dr. Cooper and colleagues indicated that a major tension emerging from the study is the need for availability of medications for the public while protecting individuals from the potential harms of OTC drug addiction. There is also a perception that OTC medications are less harmful than prescription medications, but individuals must be informed that many OTC drugs are still highly addictive.

One potential tool on the horizon is the drug Vigabatrin. Vigabatrin is more fondly referred to as GVG and is chiefly administered to epileptic patients as an anti-convulsant medication. The drug is powerful and for that reason is usually only prescribed after other epilepsy medications have failed to work. Likewise, it is usually only prescribed for patients above the age of 16 years. Used in combination with other drugs, GVG has proven to be effective in controlling partial seizures.

In recent years, however, GVG has been tested in the treatment of cocaine addiction. Here’s how it works. Vigabatrin increases the amount of GABA in the brain. That is key because GABA inhibits the production of dopamine and dopamine is the chemical which cocaine use causes to wash over the brain creating the intense pleasure that users are seeking. A drug which can temper the effects of dopamine essentially reduces the addictive effects of cocaine. After all, what is cocaine minus the high?

There have been several phases of clinical studies on the efficacy of Vigabatrin already.There have been trials of the drug in other countries, but in the US preliminary testing has been performed by the National Institutes of Health, by the NYU school of Medicine and the Brookhaven National Laboratory. Results from these trials have shown GVG’s potential in the treatment of cocaine addiction. Actually, in the preliminary US trial a significant 40% of addicts who, concurrently to taking the drug, were involved in counseling, kicked the habit for the 60 day duration of the study. It is hard to overstate the significance of a drug that can reduce cravings with that degree of success.

Critics of the drug’s potential say that it doesn’t address the key problem which is getting an addict to want to break his addiction. There are 1.5 million cocaine addicts in the United States and they are largely recreational users. They enjoy their habit and are not likely to be interested in a drug which essentially steals their high. Therefore, some critics say that GVG will have little effect in reducing numbers of cocaine addicts overall.

On the other hand, few, if any, physicians or treatment experts would be likely to rely on pharmacology alone even should GVG prove successful. Experts who have gone on record with their comments have said that robust treatment which combines psychosocial and behavioral cognitive therapies would be augmented by the use of GVG. Multi-faceted treatment would likely remain the standard of care – but with a kick that could finally budge what formerly seemed an immovable rock.

For the present, GVG will remain in the lab here in the US. Prolonged use of the drug could cause tunnel vision. Until such concerns are satisfied, FDA approval will remain withheld.

Doctors who give prescription medications to people who already have drug addictions could face more scrutiny and restrictions as groups like the American Society of Addiction Medicine strive toward tighter regulations.

The problem is made more complex by the reality that some physicians, like several in Florida, actually work in both realms – they work with people suffering from drug addictions and also help patients manage chronic pain by giving them prescriptions for painkillers like Oxycontin and Vicodin. It’s a delicate matter, say addiction professionals, because the practice can encourage people struggling with drug addictions to move from pain clinic to pain clinic in search of prescriptions while veering away from treatments that could bring them to recovery.

According to University of Miami Miller School of Medicine’s Dr. Ihsan Salloum, a specialist in addiction psychiatry, pain clinics may create a situation where a person with an addiction can have increased access to the drugs.

Other pain clinics are actually undercover drug stops, fueled by black market drug trafficking. Concerns are also increasing toward some pain clinics who may strive to keep patients dependent on anti-addiction drugs in order to increase business.

Efforts to close illegitimate pain clinics can be slow. Federal law offers protection to physicians who are approved to provide prescriptions for narcotic drugs, and law enforcement agents must acquire an order from a judge before beginning an investigation of a pain clinic or physician.

In Florida, a series of pain clinics have opened up along a large stretch near Miami, numbering well over 100 in just one county. Data from the U.S. Drug Enforcement Administration says South Florida has the physicians who prescribe the nation’s highest levels of oxycodone. Outspoken marketing campaigns for the clinics, including coupons, newspaper ads and special information for clients from other states have added to the complexity of the situation. Some ads list prescription withdrawal medications by brand name, especially those available on an outpatient basis.

Many addiction experts have expressed serious concerns over pain clinics’ use of pill-based forms of treatment for addictions, rather than a whole-picture approach that includes counseling and lifestyle changes. In some states, such as New Jersey, only physicians who are board-certified in the field of managing pain can administer addiction treatment medications like Suboxone. Expert-level status in addictions is not required for physicians to give prescriptions for anti-addiction medications like Suboxone, in which a physician can be ready to prescribe after completing a course offered online.

Several fatalities from drug overdose are also believed linked to pain clinics over-administering medications, prompting law enforcement officials and drug research organizations to push for stricter regulations for pain clinics nationwide.

More specifically, the Treatment Episode Data Set (TEDS) recorded the first, second and third substance of abuse among those admitted to substance abuse treatment in that ten year period. It found a fourfold increase (from 2.2 to 9.8 percent) in the nonmedical use of prescription pain relievers among those admitted for treatment during that time. This included the use of pain relievers such as hydrocodone, oxycodone, morphine and other morphine-like medications.

TEDS indicates significant availability of pain relievers and pervasive misuse of them across the United States and in all walks of life. The increases in pain reliever use were found to have occurred across all demographic categories including age, gender, race, ethnicity, education, employment and geographic region. How individuals gained access to the pain relievers varied, but the majority of those in this set of data were apt to obtain these substances without prescription and from a friend or relative for free.

The information given in this TEDS study included drug use in individuals over the age of 12 who are admitted to substance abuse treatment facilities. The pain reliever use cited by those in this study included primary, secondary or tertiary use (first, second or third preference among substances used). It is significant, however, that the misuse of pain relievers was second only to the use of cannabis among all who were studied.

While use of pain relievers increased across the board, there were dramatic increases in pain reliever use among certain groups. Specifically, in the age group 18 to 34 there was an increase in those who reported use from 1.5 percent in 1998 to 13.7 percent in 2008. Other notable increases occurred among those identifying themselves as Non-Hispanic White (from 3.2 percent in 1998 to 14.4 percent in 2008) and American Indian. This last group was 6 times more likely to use pain relievers in 2008 than in 1998. Geographically, the percentages of admissions for pain reliever abuse increased almost fourfold in all U.S. areas except the West which showed a slower but significant increase as well (1.9-6.1%).

Among other populations that showed a significant increase in the nonmedical use of pain relievers were individuals with a co-occurring psychiatric disorder. These numbers rose from 3.4 percent reporting pain reliever abuse in 1998 to 14.4 percent in 2008. Also, previous treatment did not seem to have an impact upon the rising numbers of those who report use of pain relievers during later episodes of treatment. The proportion of those who had been in substance disorder treatment previously and returned to a program also showed an increase in pain reliever use over the years. Similarly, the proportion of those who use pain relievers and who are new to substance abuse treatment have steadily increased as well during the 10 year period from 1998-2008.

If you believe someone you care about is using increasingly risky amounts of pain relievers, a drug intervention may be something to consider.

This career criminal went on a raiding spree merely days after his release from jail. His recent activities include breaking into the home of an 88-year-old victim and slashing the tires of a witness’s car in revenge for her calling the police.

When arrested, Craig did own up to a long list of crimes he had committed to fund his expensive drug habit. His criminal record, not surprisingly, goes back to when he was a boy. He received a sentence of three years in jail for the burglary of the 88-year-old woman’s home and the tire damage.

The judge in Craig’s case told him he had an appalling criminal record. "You know that these offenses are so serious only a custodial sentence can be imposed for them," he was quoted in the Burnely Express.

Craig had also been responsible for break-ins at Blessed Trinity College, helping himself to at least three overhead projectors. Craig owned up to three of the break-ins. He was found in a raid of a house and when interviewed, made a full confession to his crimes.

On November 10th, Craig had been released from custody for other drug-related crimes and within days was breaking the law again to support his habit. At his point of arrest, he had 98 previous convictions, had breached court orders and had qualified for a minimum of three years behind bards as a “three-strike” burglar.

Philip Holden, defense attorney said: "His problem, of course, is drugs, and his good intentions seem to lapse very quickly after release. There is a glimmer of hope for the future if he can rid himself of his drug addiction."
 

Opioids are easily abused as they produce a sense of well-being or a high that makes the user feel as if they have achieved a high. The problem is that users continue to seek this high and addiction can develop while an individual also puts themselves at risk of accidental overdose.

To help try and curb this use and abuse, the United States Food and Drug Administration last year ordered several pharmaceutical companies to develop plans to help reduce inappropriate use.

While such efforts may help this growing epidemic, the very thing that makes the drugs work on reducing pain is also what leads to the addiction. Opioids work by attaching to specific receptors in the brain and blocking the perception of pain. Over time and long-term use, the drugs can cause physical and chemical changes in the brain’s pathways.

"Somewhere between 5 and 10% of people who take opioids regularly become addicted," said Dr. Nora Volkow in the LA Times. Dr. Volkow is director of the National Institute on Drug Abuse at the National Institutes of Health.

Aside from the problems of addiction, the risk of accidental overdose is very high with opioids. When too much of the drug is taken, breathing can slow and even stop completely. According to the Centers for Disease Control and Prevention, fatal poisonings that involve these medications more than tripled from 1999 through 2006 from 4,000 to more than 13,500.

Data from the 2007 National Survey on Drug Use and Health shows that more than 5 million Americans are currently using pain-relieving medications such as Vicodin, OxyContin and Percocet for non medical reasons.
 

When asked about losing his driver’s license in 2007 after he was found slumped at the steering wheel, he said: "For all the doctored pictures, every single breathalyzer test I’ve taken in my life has read 0.0, and I’ve never failed a sobriety test. I always preface this with, ‘I deserved to lose my license, I needed to lose my license.’" He admits that he had taken drugs that night, but insists he was capable of driving.

“I had a problem with sleeping pills for about a year and a half, and I (messed) up really badly. I got in the car twice when I’d forgotten I’d already downed something to try to get me to sleep. It doesn’t matter that it wasn’t deliberate—ultimately, I did it a second time, and I could have killed somebody. But the fact remains I was never accused of driving under the influence. I got done for exhaustion and sleeping pills,” he said.

Michael used to tell people that the worst thing about the stories in the papers was that 90 percent of them were true. Now, he says, hardly any are, and that the media takes advantage of him because they know he can’t afford to sue.

The most worrying report was that when he was arrested for engaging in anonymous sex with a man in a public restroom (referred to as “cottaging”), he was charged with possession of crack cocaine. When asked if he ever smoked crack, he defiantly said no and then admitted that he was smoking the drug on that occasion when pressed by Hattenstone.

"I mean, I’ve done different things at different times that I shouldn’t have done, once or twice, you know,” he admitted, adding, “I’m feeling more parental by the second.”

A few months ago Michael was involved in a serious accident with a truck. "He came into my lane, and I had nowhere to go and ended up being battered between him and the central reservation, and I have to say it’s amazing that I’m alive."

The accident made him reassess things. "If that juggernaut had killed me, I think I’d be perfectly happy with the amount of quality music I have left in the world. My ego is sated."

Hattenstone told Michael that the common perception is that Michael sleeps late, gets high, and goes cruising. "The handful of times a year it’s bloody warm enough, I’ll do it,” the singer admits. “I’ll do it on a nice summer evening. Quite often there are campfires up there. It’s a much nicer place to get some quick and honest sex than standing in a bar, (high on Ecstasy), shouting at somebody and hoping they want the same thing as you do in bed.”

Returning to his typical day, he said, "I normally get up about 10 am, my PA will bring me a Starbucks, I’ll have a look at my emails. At the moment I’ve got nothing that pressurized other than keeping an eye on the video they’re making for the Christmas single. Then, if I’m in the mood, I’ll come up to the office in Highgate, do some work, writing, backing tracks or whatever. Come home. Kenny (his boyfriend) will be here, the dogs are here. Maybe eat locally, hang out, and then probably go off and have a shag or have someone come here and have a shag." Laughing, he added, “It’s not typical—that’s probably a couple times a week."

Over the past few years, a number of stars have said they fear for Michael—notably Elton John, who is one of Michael’s heroes. "Elton lives on that. He will not be happy until I bang on his door in the middle of the night saying, ‘Please, please, help me, Elton. Take me to rehab.’ It’s not going to happen,” Michael responded, adding, “Look, if people choose to believe that I’m sitting here in my ivory tower, Howard Hughes-ing myself with long fingernails and loads of drugs, then I can’t do anything about that, can I?"

Michael recently received an advance from HarperCollins for his autobiography, but he is going to give it back, as he said the timing isn’t right and that he needs to make more progress before he can write well about himself. "There are things I need to resolve. And I think I’ll be a much better writer when I’ve got through those things. But it’s great to know that at 46 I’m still very much a changing person."

When asked if he likes the way he’s changed, he responded, “Well, yeah, thank Christ. Most visible traces of self-loathing have gone…I’m surprised that I’ve survived my own dysfunction, really."