Lead author of the study, Dr. Nancy C. Goler with The Permanente Medical Group in California, says they have proven their program reduces stillbirths and deaths among mothers and their infants. Goler adds that not only can they show everyone the program is a smart plan, but it will also save enormous amounts of money while serving as a possible means of intervention.

Researchers at Kaiser Permanente studied over 49,000 women by conducting tests in urine toxicology and also surveying them regarding their substance abuse history. They found the study yielded $5 million annually as a net cost benefit. If implemented nationwide, the program could save almost $2 billion for every 4 million babies born each year.

A major part of the programs’ success is because of its accessibility to patients. Early Start is located at the clinics where the pregnant women obtain their normal prenatal care. Goler says this way the appointments can be coordinated with the Early Start specialist and the women’s health care provider. She hopes this will eventually happen with all clinicians moving prevention programs to their prenatal health care sites.

Originally launched over 20 years ago, the Early Start program combines obstetric care alongside treatment for substance abuse with at-risk women where all patients and providers are informed about the dangerous effects of substance abuse during pregnancy.

• 70% of those surveyed said they spent time each day on a site doing networking
• Those who are regulars on social networking websites are five times more likely to use tobacco products, three times more apt to drink alcohol and two times more likely to use marijuana.

Social networking sites are the main avenue for teens to witness photographs of their peers using drugs, getting drunk or being passing out. Many of the teens first saw these types of photographs at just 13 years of age, while more than 90% of them were 15 or younger when they first saw these kinds of pictures.

Those who witnessed these photos were three times more likely to begin using alcohol and four times as apt to try marijuana, compared to teens who had not witnessed them. These teens also most likely had friends who abused illegal and prescription drugs. The study found they also knew how to get a hold of these types of substances as compared to those teens who hadn’t ever viewed these websites, according to the article in Medical News Today.

The bad news is that adolescents are particularly vulnerable to making the poor choices which can lead to addictions in adulthood. The CASA report notes that an alarming 75% of teenagers have experimented with alcohol, tobacco or drugs of some kind (legal or illegal). Alcohol tops the list of substances tried by teenagers at least one time with 73% of teens admitting to drinking on at least one occasion. Cigarettes were owned to being tried at least once by 46% of high school age kids. Both alcohol and cigarette use have declined slightly among teens since 1999, while reported use of smokeless tobacco, marijuana and prescription drugs appears to be on the rise. Misuse of prescription medications for ADD and Oxycontin is growing among adolescents. Of the 75% who admitted trying substances, a dismaying 20% are already addicted.

That 20% of the teens are addicted is troubling enough, but the 75% who are experimenting should cause similar concern. That is because the CASA data backs up former research strongly connecting early substance use to substance dependency in adulthood. Statistically, 90% of Americans who are addicted to alcohol, tobacco or drugs tried the substance during their teenage years, most before the age of 18. Research says that fully one fourth of those who experiment with a substance at a young age will be addicted to that substance in adulthood, while only 1 out of 25 who experiment after age 21 form an addiction.

Another reason that adolescents ought to be considered at risk for addiction is purely biological. The teenage brain is still developing in the area which carries out decision-making, judgment and self-control. Because it is not completely developed it is more susceptible to the negative effects of harmful substances. Teens who use drugs risk impaired development and greater likelihood that they will make the poor choice to continue using. For this reason, CASA researchers say that substance use of any kind is dangerous.

The good news is that teen substance use and abuse is very much preventable. Substance use and/or abuse should not be considered normal teenage behavior. It isn’t. One way to prevent it is to change the culture of expectation. The most powerful agents of change in a teens’ life are his parents. Parents who guard their children and are engaged with them on a daily basis can stand between the teen and substance use. The greatest risk factors for addiction among teens are trauma and abuse. Parents who work hard to maintain safe, loving environments with regular dialog about the dangers of substance use can have greater influence than the surrounding culture which is neglectfully unaware.

Efforts which predicated declines in alcohol and cigarette use need to continue and to extend to the new substance dangers that young people are encountering. Society has a vested interest in preventing teenagers from exposing themselves to addiction since judicial costs associated with alcohol and substance abuse run in the billions of dollars. Parents, however, cannot afford to wait for society as a whole to step in. Parents who caringly establish boundaries and expectations can prevent substance use now and addiction later in their teenager’s life.

Called psychotropic drugs, the medications – including antidepressants, hypnotics and anxiolytics – may actually further the health problems of elderly people, instead of other types of medications that may not carry the same risks.

For example, the drugs may lead to loss of balance. Falling causes brittle bones to break, resulting in a long-term inability to remain active – and can heighten the chances of hospitalization or secondary health complications. Medications to calm anxiety, such as benzodiazepines, can cause daytime sleepiness that prevents adequate nighttime sleep, contributing to a depressed state. Anxiolytics and hypnotics can also render older persons more unsteady on their feet, contributing to higher anxiety levels as well as a risk for falling.

The research findings, highlighted in a ScienceDaily report, suggest that in Sweden alone, around 20 percent who are 75 years old or older are using prescription medications that may be unsafe or inappropriate. Adding to the drugs’ complications is the fact that older persons may respond at heightened proportions to the drugs’ side effects than younger people.

While improvements have been noted, such as a decline in potentially unsafe psychotropics between 2000 and 2008, researchers still believe the problem may be worse for lower-income elderly persons and warrants larger research to address the drugs’ use as a public health problem.

Opioid prescription painkillers are the nation’s second most-often abused drug, next to marijuana. Researchers at Albert Einstein College of Medicine, Yeshiva University, recently explored physician overuse or inappropriate use of prescriptions for painkillers within primary care offices. They found that in many cases, cautionary steps for patients who may have higher chances of opioid abuse were not taken and adequate prescription monitoring systems were not in place.

During the study, the records of 1,600 non-cancer patients who had consistent prescriptions for opioid-based painkillers were evaluated over a two-year timeframe. Researchers examined whether or not the patients’s urine was tested, if they saw a physician on a consistent basis in an office appointment, and if they were able to acquire numerous prescriptions for opioid painkillers or got them before a current prescription ran out.

Less than one-fourth of patients deemed at higher likelihoods for opioid addiction were given a urine test, and only 50 percent had consistent office appointments with a doctor. Equally alarming results were shown regarding premature prescription refills. Patients at elevated risk of developing an opioid addiction acquired early prescription refills more times than did patients who did not fall into the higher-risk category for addiction.

According to the National Institute on Drug Abuse, in 2009, more than 2.2 million people in the U.S. used pain medications for non-medical reasons. Research authors in the study, published in the Journal of General Internal Medicine, say measures to prevent opioid addictions and abuse can be taken by physicians. These include encouraging doctors to establish a standard system or protocol for all patients receiving opioid prescriptions and keeping in close contact with patients on an in-office visit schedule.

The study also found that teens who have few family dinners during the week are also at greater risk to experiment with alcohol, and two times more likely to use other types of drugs later in life. Give these teens an hour, and they’re also more likely to know how to find drugs like marijuana or prescription drugs than their peers who have family dinners throughout the week.

In terms of dinnertime distractions, parents may want to cut them out. The report says in teens’ households where people are using their cell phones or computers, even though they are only making it to the table a few times a week, the teens may have a risk three times greater than their peers to try smoking or marijuana. They may also have a risk of drinking alcohol that is more than double their peers who don’t have outside activities going on during dinner.

It’s the benefits on a social level and the emotional connections that happen during dinner that can lead to a reduced risk of trying drugs, says Elizabeth Planet of CASA. Planet says there’s also a connection between adolescents who sit down to more dinners with the family and better grades and healthier parent relationships.

More than half of teenagers say they are sitting down to dinner with their family around five times weekly, a figure of 59 percent, say report researchers. However, it’s not a long meal – most dinners span about a half hour – but it’s the frequency and reducing outside distractions that seems to make an impact.

The findings are even more significant when it comes to pre-teens. The CASA report said of youth aged 12 and 13 years, those that don’t have very many family dinners during the week have a risk six times higher than their peers of trying marijuana. They have a risk four times higher than their peers with frequent family meals to try tobacco.

Joseph Califano, Jr., founder of CASA and previous U.S. Secretary of Health, Education and Welfare, says the premise is simple: ten years’ of research indicates that the act of teenagers having frequent evening meals with their families means they have a lower risk of experimenting with alcohol and drugs. The classic tradition of dinner gives kids a message that their parents are interested in them and will support them, Califano says.

Report authors say not to stress about the actual meal itself; just be there for conversation and to connect with your child. They also recommend rearranging schedules to make the meal a priority, and let teens help plan or prepare it.
 

The abuse of dextromethorphan—a cough suppressant ingredient in more than 140 over-the-counter cold- and cough-medications—has nearly doubled among adolescents in the past few years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 12,584 emergency department visits involved DXM use in 2004, of which 5,581 visits were caused by nonmedical use of the substance. From these cases, 48% involved adolescents between the ages of 12 and 20. SAMHSA estimates that an average of 7.1 emergency department visits per 100,000 caused by the nonmedical use of DXM involve patients between 12 and 20 years of age. In comparison, the rate of DXM misuse among Americans of other age groups will cause an average of 2.6 emergency department visits per 100,000.

For that same year, the FDA estimates that 4,634 emergency department visits involved DXM overdose; by 2008, this figure had risen to 7,988 cases of overdose. In 2008, SAMHSA found that almost 1 million Americans between the ages of 12 to 25 had misused DXM that year: 30.5% had abused NyQuil, 18.1% had abused Coricidin, and 17.8% had abused Robitussin. Approximately 3.1 million Americans ages 12–25 have abused over-the-counter medications at some point during their lifetime. Over a third of DXM overdose cases among older adolescents also involve alcohol.

In light of these figures, the FDA’s Advisory Committee issued its first public warning regarding adolescents’ abuse of DXM, also known as "robo-tripping," by 2005. As of today, the incidences of DXM abuse and overdose have continued to escalate. In their upcoming meeting, the FDA will determine whether it should implement restrictions on the sale of over-the-counter medications containing DXM. The Advisory Committee will consider reclassifying DXM products as a controlled substance, making these medications available by prescription only. Most manufacturers of the over-the-counter medications disagree with this movement, suggesting that the restrictions will impede upon the public’s right to use DXM products, which when taken in regular dosages is quite safe. Some experts suggest restricting the sale of these products to minors to combat their misuse among adolescents, while still making them accessible to adults. Furthermore, parents should be better informed of DXM’s potential for abuse when they make their purchases.

The rate of DXM abuse among adolescents and young adults now greatly exceeds their rate of methamphetamine abuse. SAMHSA has found that adolescents who abuse DXM also have a high tendency to regularly abuse other substances, including marijuana (89.1%), hallucinogens like LSD, PCP, or ecstasy (44.2%), and inhalants (49.3%). When taken in large quantities that exceed normal dosage, DXM can produce euphoria, heightened awareness, dissociative experiences, and hallucinations, similar to PCP or ketamine abuse. When overdose occurs, DXM can cause severe adverse effects including loss of physical coordination, severe abdominal pain, nausea/vomiting, blurred vision, violent uncontrolled muscle spasms, delirium, heart arrhythmia, and death.

Source: Los Angeles Times, FDA weighs how to stop abuse of over-the-counter cough and cold drugs, August 31, 2010

Erica Weintraub Austin, director of the Murrow Center for Media and Health Promotion at Washington State University and lead author of the study, and her colleagues found that a two-week course helped third, fourth, and fifth graders reduce their intentions to try alcohol and tobacco, and increased their belief that they could resist the substances. 

Austin said that people underestimate children’s ability to understand advertising messages, as well as the fact that marketing methods can affect their decisions later in life. If children associate smoking with popularity and maturity, they might want to try cigarettes when they’re older. Marketing specialists tend to make their messages appealing to young people, so it’s important that children understand that some of these messages may not be in their best interest.

The researchers found that people internalize or reject advertising messages through a partly logical, partly emotional process. By teaching children that advertisers want them to react emotionally, they can learn to react more logically.

North Carolina-based Innovation Research Training, Inc. conducted the study, in which elementary schools either received the Media Detective program or were part of a control group. The 344 children who received Media Detective lessons were less interested in alcohol merchandise than the 335 children in the control group. Students in the Media Detective group who had already used alcohol or tobacco said their intentions to use the substances were lower, and they believed they had a better ability to refuse the substances than children in the control group. The researchers found that the lessons were most helpful to boys.

Prior studies by Austin and researchers with The Edward R. Murrow College of Communication’s Center for Media & Health Promotion found that programs such as Media Detective can help prevent substance abuse, teach sex education, and instill an interest in voting and public affairs among teens. The new study is the first to show that these programs can be helpful for children, as well.

Source: Science Daily, ‘Media Detective’ Tool Empowers Children to Skirt Alcohol and Tobacco Marketing Messages, August 24, 2010
 

The problem is pervasive. Over one-half of all high school students will have taken a drink of alcohol during any given one-month period. Most get the alcohol from home or from someone they know. Almost one-third of high school seniors will engage in binge drinking (five or more drinks in any given period) in any two-week period. Given the major role that parents play in shaping the actions of their children, they are in the best position to regulate drinking behavior and prevent tragedy.

State officials seek to remind parents that tragedy resulting from teen drinking at parties can be avoided. Most importantly, minors under the age of 21 should not be permitted to drink alcohol, whether they are under the supervision of an adult or not. However, even the most well-intentioned adult host can quickly land him or herself in hot water if underage guests get their hands on alcohol. Even when hosts notify underage participants that they are not permitted to drink at the party, failure to actually supervise the possession of alcohol by party guests often leads to tragedy, as many teens are likely to disregard the warning and drink anyway. Like waiving a red flag in front of a bull, placing alcohol within reach of teen party participants is just asking for trouble.

Given that teens often prefer to keep to themselves at functions, largely to avoid having to hang with the boring adults, a host may not realize that minors have been drinking alcohol until it is too late. The consequences can, indeed, be tragic.
Younger people are typically smaller in size than an average adult and become intoxicated much more quickly than the normal of-age party-goer. Alcohol poisoning (the inability of the body to safely process alcohol as it is ingested) among teen drinkers is very common, as they do not have the experience with alcohol to know when to stop drinking. Alcohol poisoning, or overdose, can lead to permanent organ damage or death.

Another risk for hosting parties where teens will be in attendance is motor vehicle incidents. The most obvious consequence of teen drinking at parties is that one will get behind the wheel and cause an accident. Another consequence is that he or she will be driving one or more friends, thus subjecting others to serious injury or death.
While state authorities have little control over whether parents and guardians will allow teens to drink at parties, a behavior that could subject the adults to criminal and civil liability, the state can take steps to ensure that law enforcement is prepared to handle the ramifications of teen drinking.

New York’s OASAS has aggressively implemented the Party Patrol and Controlled Party Dispersal training program with an eye toward reducing alcohol abuse, driving under the influence, and underage drinking. Using prevention professionals, the PPCPD has trained over one thousand law enforcement officers on how to safely break up underage drinking gatherings at parties, in college dorms and frat houses, in residential settings, during outdoor parties, and in large concert arenas. Law enforcement agencies use intelligence gathering, work with community leaders, and disseminate information through media outlets in order to stop teen drinking. Officials believe, and research has shown, that young people are less likely to engage in underage drinking if they think there is a possibility that they will be caught doing so by police. Research has also shown that parents will be more likely to adopt a zero-tolerance policy for teen drinking at parties and at home if they believe that they could be held accountable, either criminally or civilly, for underage drinking.

Lawmakers in New York have also started holding social hosts accountable for teen drinking incidents. Nearly fifty local governments across New York have “social host” laws that impose liability for serving alcohol or drugs to teens at home. There are also penalties for those supply alcohol to minors for a fee.

For party planning, officials recommend that adults establish firm regulations and expectations prior to party day and to make sure they are clearly understood by attendees, especially teen children and their friends. Obviously, the most important rule is that teen guests cannot ingest alcohol or other drugs before, during or after the party. Hosts should have a plan in place to monitor the grounds during the event, and to ensure that off-limit areas cannot be accessed. In addition, teens who arrive at the event driving their own vehicles should turn in keys to the host and be expected to interact with the host prior to key return, to ensure that he or she is ok to drive. Hosts are also reminded to have plenty of non-alcoholic beverages available.

This question was posted to a panel of presenters during the American Pain Society’s 29th Annual Scientific Session. The challenge in addressing this question is that routes of administration vary by agent which can make it difficult to determine the best way to deter abuse.

A database used to capture routes of administration of prescription opioids found that hydrocodone was mostly taken orally, while fentayl was primarily smoked. A study in this field found that a subset of people who abuse opioids often begin taking the drug orally, but tamper with the medication so it can be snorted.

The U.S. Food and Drug Administration issued a memo recently that cautioned, “that language in a product’s label for a claim of abuse resistance would require long-term epidemiological data from community-based observational studies that document changes in abuse and addiction and the consequences of those behaviors.”

At the same time, populations exposed to opioids happen to be very broad and human abuse liability studies, which are required for all opioid agents, must increasingly serve as surrogates for “real world” behaviors. This observation was made by Lynn Webster, MD, of Lifetree Clinical Research & Pain Clinic in Salt Lake City, Utah.

Robert Bianchi, of the Prescription Drug Research Center, Fairfax, Va., noted that the more difficult it is to extract an active ingredient from an opioid, the less likely people are to do so. One unpublished study found that 80 percent of subjects would spend a maximum of 3 to 10 minutes tampering with an agent with abuse as the goal.