Investigators at Massachusetts General Hospital have determined that stimulant medication misuse increases the risk of conduct problems, substance abuse, and ADHD among college students when compared to peers who did not misuse stimulant medication. The investigators also discovered that the extended versions of this class of drug was misused less often than the immediate release versions. The investigative results of the study can be found in the Journal of Clinical Psychiatry. According to the report corresponding author Timothy Wilens, M.D., “Our data suggest that college students who misuse prescription stimulant medication are more likely to exhibit clinically relevant psychiatric dysfunction. In addition to higher levels of ADHD, conduct disorder, and alcohol or drug use disorders, the majority of those misusing stimulants met or approached criteria for stimulant-use disorder.”
The fact that stimulant medications are typically used to treat ADHD is ironic because stimulant medication misuse can actually cause this disorder, as well as making the person more likely to engage in other forms of substance abuse and to develop conduct disorders. Dr. Wilens explained that “Someone may report on a survey that they misused stimulants on ‘a handful of occasions’ and have never been diagnosed with a substance-use disorder. While that misuser may deny having a stimulant-use disorder, when systematically queried, it may be found that he or she met or approached the criteria for a full disorder. Some misusers may be pressured to use a friend’s prescription if they believe it will improve academic performance, which is not likely if combined with alcohol or other drugs. We know that untreated ADHD is associated with increased risk of alcohol- and drug-use disorders, so it is not surprising that we found high rates of co-occurring ADHD and of stimulant-use and overall substance-use disorders in those misusing stimulants. It’s possible that pre-existing cognitive deficits may lead some individuals to develop stimulant misuse as they try to self-medicate.”
Prescription drug abuse is one of the biggest threats facing North America today, and another is the epidemic of heroin abuse and overdose deaths in recent years. Many people who start to use heroin do not start with this drug, they begin with prescription opioid use and then progress to heroin as time goes on and the prescription drugs become harder to obtain. When an individual is given opioid medications these can cause a tolerance to develop and the user may start taking more than prescribed or taking doses earlier than directed. Eventually a new prescription is needed, and doctors are becoming more wary of giving out these drugs because they have such a high potential for abuse. This can lead to doctor shopping as the person tries to get a legitimate prescription for the drugs they are seeking.
Over time the prescription drug abuse gets worse, and the opioids may not be available. Purchasing these drugs illegally off the street is the next step, but the high demand means that opioids can be very expensive especially in larger doses when they are even available on the street market. In contrast heroin use is a much less expensive habit, with a packet of the drug selling for as low as $10 in some areas compared to $1-$2 per milligram for oxycontin and other powerful opioids in some areas. A 100 mg oxycontin pill may fetch between $75-$200 while the same strength of heroin costs a small fraction of this price.
Opioid abuse is on the rise across North America, and recent research shows that common surgical procedures include a standard practice of opioid prescribing. First time opioid exposure after one of these procedures could make some patients more vulnerable to opioid abuse in the future. The suggestion from researchers is that opioid use needs to be monitored more closely for a period of up to a year after many of these common surgical procedures. Early detection can increase the odds of a full recovery, but abuse of these drugs may not be detected right away. Monitoring could prevent the abuse from continuing and provide early treatment resources to patients who end up abusing opioid drugs.
According to the conclusions reached by the researchers who performed the study on common surgical procedures and opioid abuse “Our results have several clinical implications. First, while we found that surgical patients are at an increased risk for chronic opioid use, the overall risk for chronic opioid use remains low among these patients, at less than 0.5 percent for most of the procedures that we examined. Thus, our results should not be taken as advocating that patients forgo surgery out of concerns for chronic opioid use. Rather, our results suggest that primary care clinicians and surgeons should monitor opioid use closely in the postsurgical period.” Some of the common surgeries that were associated with a higher risk for opioid abuse included simple mastectomy, traditional gall bladder surgery, total knee replacements, and total hip replacements.
Opioid use disorder is a form of substance abuse that involves opioid drugs and medications. This is a pattern of problematic opioid use that leads to distress or impairment, making it impossible for the user to perform daily tasks or function normally. Between 2012 and 2013 the National Institute on Alcohol Abuse and Alcoholism reports that around 10 million adults in the United States misused prescription opioid medications. This does not take into account individuals who used heroin, which is also an opioid but which is never legally prescribed because of the addiction risks and other problems associated with this specific drug. Someone who is under continuous medical supervision and who only uses the opioid drugs as needed and prescribed can build up a tolerance and even have withdrawal symptoms when the drug is stopped but these individuals do not have opioid use disorder.
Some signs that opioid use disorder is a problem can include some symptoms of other forms of substance abuse. Some things to watch for include:
Taking legally prescribed opioid drugs in larger amounts, for longer than intended, or more often than prescribed.
Efforts to cut down on opioid use are unsuccessful.
A considerable amount of time, effort, or money is spent trying to find and get the drugs.
Cravings for the opioid drugs.
Failing to fulfill responsibilities at work, home, or school because of the substance abuse.
Lost interest in friends, social activities, hobbies, and recreation so that the drug can be used.
According to a recent article in the journal Current Pain and Headache Reports there is no substitute for education when it comes to opioid abuse prevention strategies. The article titled “Current State of Opioid Therapy and Abuse” points out that there are limits to what newer medical technologies designed to thwart opioid abuse can do. According to the author of the article, University of the Pacific professor of pharmacy Dr. Adam Kaye “Education is the foremost strategy. We must educate primary care providers, surgeons, pharmacists, and other health professionals, as well as patients. That education must take place prior to the starting point of opioid therapy — and it needs to be independent of the pharmaceutical industry. Pharmacists have a big responsibility for cutting down opioid abuse and deaths, whether it’s Prince or other celebrities or the guy down the street. We have to be part of primary education efforts.”
The article on opioid abuse prevention strategies looked at 3 medical technologies designed to prevent abuse of these drugs. There are physical barriers, sequestered aversion agents, and sequestered opioid antagonists. There are limits for each type of strategy covered, and education can be the most effective way of preventing a patient from abusing this category of drugs. Both physical barriers and sequestered aversion agents can prevent accidental overdose but these will not stop someone intent on abusing the drug if they are motivated to do so. The opioid antagonist method can prevent intentional misuse but it could also result in severe withdrawal symptoms for anyone who is already addicted to these drugs.
Pharmaceutical grade heroin, diacetylmorphine, is being considered as an option for opioid dependence treatment under a new proposal in Canada. According to a news release from federal health agency Health Canada there are plans in the works which would amend regulations to allow certain people who need opioid dependence treatment to receive a prescription for diacetylmorphine. The release explained that “A significant body of scientific evidence supports the medical use of diacetylmorphine, also known as pharmaceutical-grade heroin, for the treatment of chronic relapsing opioid dependence. Diacetylmorphine is permitted in a number of other jurisdictions, such as Germany, the Netherlands, Denmark, and Switzerland, to support a small percentage of patients who have not responded to other treatment options, such as methadone and buprenorphine.” The change would move heroin into a lower controlled substance category so that the medical equivalent can be considered for use using a Special Access Programme. This would allow patients who have not responded to more conventional drug treatment and approaches to request emergency access to specific drugs.
Allowing pharmaceutical grade heroin or diacetylmorphine for heroin addiction treatment may seem like a drastic move but something must be done to fight the growing opiod crisis in Canada and other countries. The war on drugs has failed and alternative treatment methods are being sought. Crosstown Clinic operator Providence Health Care is supportive of the change, and the clinic has already been involved in a clinical study heroin maintenance program. According to a release from Providence to the Vancouver Sun “Allowing access to diacetylmorphine, or medical heroin, to patients who need it, ensures that life-saving treatments get delivered to vulnerable people suffering from chronic opioid use.”
Hydromorphone, a strong opioid pain medication, could be used as one method of treatment for heroin addiction according to a new study out of Canada. Over 200 heroin addicts from the Vancouver area were involved in the study and these individuals did not respond well to other common treatments including suboxone or methadone. This study was the first ever to look at how effective hydromorphone can be for heroin addiction treatment. Study subjects received either a pharmaceutical-grade prescription heroin product called diacetylmorphine or hydromorphone, and both drugs were delivered via supervised injection in a clinical setting. According to University of British Columbia lead study investigator Eugenia Oviedo-Joekes “Providing injectable opioids in specialized clinics under supervision ensures safety of both the patients and the community, and the provision of comprehensive care.”
During the study on hydromorphine as a possible treatment for heroin addiction over 88,000 injections were given by the medical professionals, and there were just 14 cases of overdose reported and 11 incidents of seizures. No deaths resulted because the medical professionals successfully managed these complications, but the outcome would have been far different if the problems had occurred outside of a medical setting on the street. In a news release from the school Oviedo-Joekes explained “Hydromorphone is a widely available licensed pain medication. Our study shows that hydromorphone is as effective as diacetylmorphine, providing a licensed alternative to treat severe opioid use disorder.” According to Vancouver Coastal Health chief medical officer Dr. Patricia Daly “Diacetylmorphine isn’t available in many countries. Hydromorphone has a significant advantage as a legal, licensed pain medication. No single treatment is effective for all individuals. Every person with severe opioid use disorder left untreated is at high risk of serious illness and premature death.”
Headlines in newspapers across North America, especially the USA and Canada, detail an opioid crisis that seems to be steadily growing. Experts debate on how to stop this problem from growing and there are many possible solutions that have been discussed. While everyone points out the increase in overdose deaths from heroin and prescription opioid drugs few address the lack of suitable substance abuse treatment programs and other resources that are needed to overcome addiction. Outpatient programs are usually not very effective when it comes to this type of addiction but there are few inpatient programs available in many areas and these often have long waiting lists. When a user actually wants help they are frequently told that it will be weeks or even months before they can get into the treatment program.
There really is an opioid crisis in North America, but this crisis could be addressed with the proper substance abuse treatment programs which are available on demand. Physicians would not dream of telling someone with appendicitis that they must wait for a month or two to have the treatment that they need but this is often exactly what happens when someone with a full blown addiction seeks help. Any delay could lead to further use of these drugs, and that can mean an overdose which could cause death. Opioid addiction should be classified as an emergency and the individual should be able to receive effective substance abuse treatment in a reasonable amount of time. The shortage of quality substance abuse treatment programs makes this impossible though, and those who sought help often go back to using when they do not receive it right away.
Opioid treatment is a common medical treatment for cancer, severe pain, and certain other conditions. The use of opioid drugs could lead to other problems and conditions though, even depression according to a recent research study that examined a link between treatment with these narcotic drugs and the onset of depression. Not only are these drugs very addictive and carefully controlled but new guidelines have been released about patient monitoring and the possibility of drug dependence when opioids are used for any extended period of time. The new study shows that the length of the use of the opioid drug is a more important factor in developing depression than the strength of the narcotic that is prescribed. The research study review was performed by researchers at the St Louis University School of Medicine, Missouri, and the data for over 100,000 patients was examined and evaluated.
The study on opioid treatment and depression had some alarming findings. The researchers concluded that individuals who had never previously been diagnosed with depression developed this condition after they started treatment that involved opioid drugs. This can lead to a dangerous cycle, where opiods are needed for pain and medications for depression are needed because of the effect that the opioid drugs have on the individual. Right now the number of antidepressant drugs prescribed in North America is enormous, and the same is true of opioid drugs as well. Patients could end up needing to take a number of drugs just to keep an even keel, and this is not an ideal situation or even one that should be allowed to continue. Any chemical or drug can have an impact on various areas of health and well being, and these substances can start a cascade of changes in the body that can lead to the development of other conditions that may then require treatment as well.