In a randomized placebo-controlled trial, patients smoking cannabis experienced a 34 percent reduction in intense foot pain associated with HIV - twice the rate experienced by patients who smoked placebo.
“This placebo-controlled clinical trial showed that people with HIV who smoked cannabis had substantially greater pain reduction than those who did not smoke the cannabis,” said study lead author Donald I. Abrams, MD, UCSF professor of clinical medicine. “These results provide evidence that there is a measurable medical benefit to smoking cannabis for these patients.”
The study, published in the journal “Neurology,” looked at 50 HIV patients with HIV-associated sensory neuropathy, a painful and often debilitating condition that is the most common peripheral nerve disorder that occurs as a complication of HIV infection. Occurring usually in the feet and characterized at times by tingling, numbness, the sensation of pins and needles, burning, and sharp intense pain, severe peripheral neuropathy can make walking or standing difficult.
Patients participating in the study were randomized into two equal groups - one assigned to smoke cannabis and the other assigned to smoke identical placebo cigarettes with the cannabinoids extracted. The patients smoked the study cigarettes three times a day for five days under supervision as inpatients in the General Clinical Research Center at San Francisco General Hospital Medical Center.
“Even though antiretroviral treatments have reduced the prevalence and severity of many HIV-related neurological complications, neuropathy continues to affect up to one of every three patients,” said co-author Cheryl A. Jay, MD, UCSF professor of clinical neurology. “There are no FDA-approved treatments for HIV-related neuropathy. This study suggests new avenues to manage neuropathic pain in this setting.”
The study also incorporated a pain model developed at UCSF that provided a standardized reference point. This model allowed researchers to compare relief of chronic HIV-associated neuropathic pain simultaneously with patient response to pain and skin sensitivity induced by heating and capsaicin application.
“The beauty of this study is the use of the pain model as a neutral and physiological anchor for pain measurement. Patients’ eyes were averted during the measurements and were uninfluenced by expectations. Smoked cannabis was shown to work on the pain system by shrinking the area of painfully sensitive skin created by the model. The response was comparable to strong pain relievers we have studied, such as morphine,” said co-author Karin L. Petersen, MD, UCSF assistant adjunct professor of neurology.
This study is the first to be completed of several clinical trials of medicinal cannabis being conducted under the auspices of the University of California’s Center for Medicinal Cannabis Research.
“It has been many years since clinical trials with cannabis have been conducted in the United States,” said Igor Grant, MD, professor of psychiatry at the UC San Diego School of Medicine and director of the CMCR. “As a result there has been insufficient light shed on the possible therapeutic value of cannabis. The results of this first study indicate that cannabis may indeed be useful in the amelioration of a very distressing, disabling, and difficult to treat complication of HIV. We look forward to the results of several additional CMCR studies nearing completion to continue clarifying cannabis’ possible role as a therapeutic agent.”
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Article adapted by Medical News Today from original press release.
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Co-authors include Starley B. Shade, MPH; Hector Vizoso, RN; and Mary Ellen Kelly, MPH, from the UCSF Positive Health Program at San Francisco General Hospital Medical Center, and Michael C. Rowbotham, MD; Haatem Reda, BA; and Scott Press, BS, from the UCSF Pain Clinical Research Center.
The General Clinical Research Center at SFGH is funded by NIH.
The UCSF Positive Health Program is a program of the AIDS Research Institute at UCSF. UCSF ARI coordinates all of the HIV/AIDS research, treatment, and prevention activities at UCSF. Combining the best basic science, bench-to-bedside research, behavioral studies, direct care services, and policy development, the ARI at UCSF is one of the premier HIV/AIDS medical, education, and research institutions in the world.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Jeff Sheehy
University of California - San Francisco
Patients with Parkinson’s disease who are younger when they develop the condition, have a personality trait known as novelty-seeking or whose personal or family history includes alcohol abuse may be more likely to develop pathological gambling as a side effect of medications used to treat their condition, according to a report in the February issue of Archives of Neurology, one of the JAMA/Archives journals.
Behaviors associated with impulse control - including compulsive shopping, hypersexuality, binge eating and pathological gambling - have been associated with dopamine agonists, medications used to treat Parkinson’s disease. In studies examining the relationship between dopamine agonists and compulsive gambling, the likelihood of gambling problems was unrelated to the medication dosage. This suggests that an underlying trait may interact with the drugs and make an individual more vulnerable to this adverse effect.
Valerie Voon, M.D., National Institute of Neurological Disorders and Stroke, Bethesda, Md., and colleagues compared the characteristics of 21 patients with Parkinson’s disease who developed pathological gambling habits after beginning to take dopamine agonists with 42 patients with Parkinson’s disease who did not develop compulsive behaviors. The participants, who all visited a clinic in Toronto, Canada, between June 2003 and October 2005, were examined by neurologists and completed assessment scales that measured their levels of impulsivity, substance abuse, mood and anxiety disorders. An additional inventory measured the extent to which the patients displayed novelty-seeking traits, characterized by impulsive and risk-taking behavior and excitement in response to new experiences.
“In keeping with our hypothesis, patients with Parkinson’s disease who developed pathological gambling when receiving dopamine agonists had a younger age at Parkinson’s disease onset, higher novelty-seeking scores, a personal or immediate family history of alcohol use disorders and impaired planning on an impulsivity scale,” the authors write. “A robust association was found with medication-induced mania [a psychiatric disorder involving excessive physical and mental activity and impulsive behavior].” Pathological gambling was also weakly linked to younger age, Parkinson’s disease that began in the brain’s left hemisphere and a high score on a scale measuring the impulsiveness of behaviors.
“Screening for such features and advising those at higher risk may be warranted,” the authors conclude.
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Article adapted by Medical News Today from original press release.
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(Arch Neurol. 2007;64:212-216.)
Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Contact: Natalie Frazin
JAMA and Archives Journals
Opioid therapy, opioid prescribing and prescription drug diversion were provoking topics at the 23rd annual meeting of the American Academy of Pain Medicine (AAPM) at the Hilton New Orleans Riverside Hotel/Morial Convention Center, February 7-10, 2007.
Opioid treatment is an essential component of pain care for many patients and can be delivered safely and effectively, according to Frederick Burgess, M.D., Ph.D., AAPM president, who estimates that 20 to 60 million Americans live with chronic pain.
Prescription Drug Diversion
A common goal of both physicians and law enforcement is to maintain an appropriate balance between preventing the illegal diversion of drugs while safeguarding the needs of legitimate pain patients, according to the experts speaking at the “Pain Medicine and Law Enforcement: Achieving a Team Approach” session.
“Physicians have nothing to fear from the Drug Enforcement Administration (DEA) in their legitimate practice of medicine,” says Mark W. Caverly, who is chief of the liaison and policy section in the DEA Office of Diversion Control. “The DEA’s guiding principle is to prevent the diversion and abuse of pharmaceutical controlled substances without impacting the ability of patients with legitimate need to have full access to pain relief as prescribed by their physician. The DEA’s responsibility is to enforce the law, not dictate the practice of medicine,” concludes Caverly, who will represent the DEA during the Pain Medicine and Law Enforcement session.
Caverly also discussed the legal standards of prescribing as set forth in the Controlled Substances Act, the proposed rule to allow multiple prescriptions for schedule II controlled substances, and upcoming policy/regulation topics.
In the same session, John Burke, who is president of the National Association of Drug Diversion Investigators, addressed prescription drugs of abuse and related diversion scams.
“Knowing what the current drug diversion scams are can help physicians decide who is trying to take advantage of them,” says Burke, commander of the Warren County Drug Task Force in the Cincinnati area of southwest Ohio. “The vast majority of patients are not drug seekers and that is where the balance comes in. We do not want to deprive legitimate patients effective pain relief through legally prescribed medications because of the acts of a relative few.”
“Today, pain medicine specialists are concentrating on the development of the best scientific and clinical protocols for opioid use,” Dr. Burgess comments. Opioid treatment was addressed at the meeting in a number of scientific sessions, poster presentations and scientific abstracts.
Other Program Highlights:
Cannabinoids - A New Class of Analgesics
Four Decades of Neuromodulation
Pain Medicine and Law Enforcement: Achieving a Team Approach
Medical Conditions for Patients With Pain After Natural Disaster
Opioids: Good or Bad?
Ethical Medical Practice and Managed Care: An Oxymoron?
Breaking Concepts in Diagnosis and Treatment of Complex Regional Pain Syndromes
“The AAPM annual meeting is a gathering of pain medicine experts from across the country who spend three days together sharing information about the latest research, patient care, and regulatory issues that affect the practice of Pain Medicine,” says Dr. Burgess.
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Article adapted by Medical News Today from original press release.
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Founded in 1983, AAPM is the medical specialty society representing physicians practicing in the field of pain medicine. The Academy is involved in education, training, advocacy and research in the specialty of pain medicine. Information is available on the practice of pain medicine at http://www.painmed.org/.
Contact: Amy Jenkins
American Academy of Pain Medicine
Several neurological and psychiatric disorders, including schizophrenia, alcoholism, and Parkinson’s disease, are associated with changes in the brain that affect the nerves that communicate with each other through the naturally-produced chemical dopamine. One protein that is crucial for dopamine-mediated neuronal communication in animals is DARPP-32. However, very little is known about the function of this protein in humans.
In a study appearing online in advance of publication in the March print issue of the Journal of Clinical Investigation, Daniel Weinberger and colleagues from the National Institutes of Health show that the gene that encodes DARPP-32 exhibits genetic variation. One particular variant that increased expression of the mRNA encoding DARPP-32 in the brain was associated with increased performance in a number of cognitive tests, including IQ and memory tests. This variant was also associated with changes in the structure and function of part of the brain known as the neostriatum, as well as changes in the ability of the neostriatum to communicate with the frontal lobe. Importantly, preliminary analysis indicated that this variant was associated with an increased risk of schizophrenia, although further studies will be necessary to confirm this association.
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Article adapted by Medical News Today from original press release.
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TITLE: Genetic evidence implicating DARPP-32 in human frontostriatal structure, function, and cognition
AUTHOR CONTACT:
Daniel R. Weinberger
National Institute for Mental Health, National Institutes of Health, Bethesda, Maryland, USA.
Contact: Karen Honey
Journal of Clinical Investigation
Alpharma Inc. (NYSE: ALO), a leading global specialty pharmaceutical company, presented results of a Phase IV study of KADIAN(R) (morphine sulfate extended-release) Capsules that demonstrate the pharmacokinetics of the long-acting opioid are not significantly affected by the consumption of alcohol. Results of this pharmacokinetic study, which Alpharma conducted in response to a request by the U.S. Food and Drug Administration (FDA) to assess whether alcohol interferes with the extended-release mechanism of action in long-acting opioids, were presented yesterday at the 23rd Annual Meeting of the American Academy of Pain Medicine (AAPM) in New Orleans, LA.
“This study demonstrated that the extended-release properties of KADIAN(R) were maintained even in the presence of a significant quantity of alcohol,” says Joseph Stauffer, DO, Vice President, Clinical Research & Medical Affairs, Alpharma Pharmaceuticals Division Inc. “We believe this information is valuable for doctors in their assessment of KADIAN(R), and we will continue to educate clinicians and patients about the appropriate use of KADIAN(R) for moderate-to-severe chronic pain. Like most medications, KADIAN(R) should not be taken with alcohol.”
These results indicate that the concomitant use of tested levels of alcohol with KADIAN(R) has no significant impact on mean morphine blood levels or the timing of morphine release.
The company has provided these data to the FDA and any future labeling implications will be determined following the completion of its review.
Study Design
In the open-label, single-dose, three-way crossover pharmacokinetic drug interaction study, 32 healthy adult male volunteers, 21 to 40 years of age, were randomized to receive:
— KADIAN(R) 100 mg with ethanol (8 ounces of 40 percent alcohol) while fasting;
— KADIAN(R) 100 mg with ethanol (8 ounces of 40 percent alcohol) while fed;
— KADIAN(R) 100 mg with 8 ounces of water while fasting;
After the three-way crossover, all subjects then received an immediate- release morphine formulation with 8 ounces of water while fasting, as a reference.
Oral naltrexone hydrochloride was administered 12 hours and 2 hours prior to treatment to counter morphine effects.
There were no serious adverse events reported during the study. Most adverse events were mild to moderate, and one was severe, chest pain. All adverse events resolved before the end of the study.
This study was supported by Alpharma Inc.’s Pharmaceuticals Division, which has a growing franchise in chronic pain treatment.
About KADIAN(R) Capsules
KADIAN(R) (morphine sulfate extended-release) Capsules are an extended- release formulation of morphine sulfate indicated for the management of moderate-to-severe chronic pain, when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. Capsules can be taken once-daily (Q24h) or twice-daily (Q12h), as prescribed, to provide up to 24 hours of pain relief.
Capsules are available in six strengths: 20 mg, 30 mg, 50 mg, 60 mg, 80 mg and 100 mg. The 100 mg capsules are for use in opioid-tolerant patients only. KADIAN(R) offers flexible dosing and administration options that allow physicians to fine-tune titration schedules and tailor treatment for individual patient needs.
KADIAN(R) may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression because respiratory depression, hypotension and profound sedation or coma may result.
KADIAN(R) side effects are generally consistent with those found with other opioids. The most common include drowsiness, constipation, nausea, dizziness and anxiety. Serious adverse reactions that may be associated with KADIAN(R) include respiratory depression, respiratory arrest, circulatory depression, cardiac arrest, low blood pressure and/or shock.
KADIAN(R) Capsules contain an opioid agonist which is a Schedule II controlled substance. KADIAN(R) has an abuse liability similar to other opioids. This should be considered when prescribing or dispensing KADIAN(R).
For complete prescribing information, visit http://www.KADIAN.com.
About Alpharma Inc.
Alpharma Inc. (NYSE: ALO) is a global specialty pharmaceutical company with leadership positions in products for humans and animals. Alpharma is presently active in more than 60 countries. Alpharma has a growing branded franchise in the chronic pain market with its morphine-based extended release KADIAN(R) product. In addition, Alpharma is among the world’s leading producers of several specialty pharmaceutical-grade bulk antibiotics and is internationally recognized as a leading provider of pharmaceutical products for poultry and livestock.
Statements made in this release include forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements, including those relating to future financial expectations, involve certain risks and uncertainties that could cause actual results to differ materially from those in the forward-looking statements. The 2006 outlook assumes no material adverse event contemplated by the risk factors described in the Company’s SEC filings. Information on other significant potential risks and uncertainties not discussed herein may be found in the Company’s filings with the Securities and Exchange Commission including its Form 10-K for the year ended December 31, 2005.
Alpharma Inc.
http://www.alpharma.com
Pain medicine investigators presented preliminary research findings at poster sessions held during the 23rd annual meeting of the American Academy of Pain Medicine at the Hilton New Orleans Riverside Hotel/Morial Convention Center, February 7-10, 2007. The highlights are as follows:
* Internet not Primary Source for Illegally Obtained Prescription Analgesics By Addicts Seeking Methadone Treatment
Despite media reports suggesting that the Internet is the primary source for illegally obtained prescription opioids, only a small percentage of opioid analgesic addicts who are seeking methadone maintenance treatment reported this as a direct source of their drug supply.
Illegally obtained opioid medications present an ongoing and challenging dilemma to society at large, while also impacting the legitimate prescribing of opioids for those individuals with moderate to severe chronic pain conditions. The researchers analyzed questionnaires filled out by 3,294 persons seeking treatment for addiction at 73 methadone treatment programs who indicated that a prescription opioid analgesic was the primary drug they abused to learn how opioid analgesic abusers reportedly obtained their drug. The most commonly reported sources for obtaining opioid analgesics included: dealers (79.96%), friends or relatives (51.3%), physician prescription (30.17%), emergency room visits (13.53%), theft (6.48%), forged prescription (2.48%), Internet (2.9%), and other (not specified) (2.7%).
Investigators: Ann T. Kline, MS, Purdue Pharma L.P., Stamford, CT; Meredith Y. Smith, MPA, PhD, Purdue Pharma L.P., Stamford, CT; J. David Haddox, DDS, MD, Purdue Pharma L.P., Stamford, CT; John P. Fitzgerald, MS, LPC, CAS, Purdue Pharma L.P., Stamford, CT; Andrew Rosenblum, PhD, National Development and Research Institutes (NDRI), New York, NY; Chunki Fong, MS, NDRI, New York, NY; Mark Parrino, MPA, American Association for the Treatment of Opioid Dependence (AATOD), New York, NY; and Carleen Maxwell, MPH, AATOD, New York, NY.
* Report Characterizes Opioid Analgesic Abuse
Opioid analgesic abuse is more prevalent in rural areas and is growing in popularity among teenagers.
Although numerous US surveillance systems currently report on opioid analgesic abuse, there is a need for additional descriptive and interpretive data, not only to confirm and characterize the cases, but to guide targeted intervention efforts. The researchers conducted 258 telephone interviews in 40 states with a wide range of contacts, including law enforcement officers, physicians, pharmacists, and drug abuse treatment staff. The reports from the local sources indicated that hydrocodone and oxycodone (immediate-release and extended-release) were reported to be the most frequently abused and diverted opioid analgesics; opioid analgesic abuse is not confined to rural areas; opioid analgesic abuse appears to be rising among teenagers; and abusers often perceive prescription drugs to be safer to use than illicit drugs.
Other key findings include the abuse of antidepressants to reduce the side effects of methamphetamine; abuse of prescription drugs rising in Mormon communities and on Native American reservations; and local government officials are being forced to redirect resources from diversion and abuse of prescription drugs to combat a rising methamphetamine problem. Interpretation of quantitative reports of opioid analgesic abuse and diversion are substantially enriched by the addition of detailed, descriptive field-based inquiries.
Investigators: John P. Fitzgerald, MS, LPC, CAS, Meredith Y. Smith, Ann T. Kline, and J. David Haddox, DDS, MD, Purdue Pharma L.P., Stamford, CT.
* Spinal Cord Stimulation Can Relieve Low Back Pain
Careful patient selection and stimulation programming can improve management of axial low back pain with spinal cord stimulation. The researchers note that axial low back pain is a novel indication for spinal cord stimulation. Technological capabilities of the spinal cord stimulation system, particularly fractionalized current across contacts, uniquely provide the type of stimulation needed to relieve axial back pain.
Spinal cord stimulation effectively manages a range of painful etiologies, but little published evidence supports its use for axial low back pain. The researchers studied 226 spinal cord stimulators (Precision™, Advanced Bionics) implanted in patients with axial low back pain to assess the therapeutic value of spinal cord stimulation in treating axial back pain associated with failed back surgery syndrome. Pain scores, quality of life, and disability assessments were gathered at three, six, and 12 months after activation of the spinal cord stimulation system and compared to baseline measures. Additional assessments were made at 3.5 months after a two-week period of no stimulation. The investigators found that spinal cord stimulation significantly reduced axial low back pain, and when present, leg and foot pain, from baseline at all time points. With stimulation off, pain scores returned to near baseline. Quality of life and disability also significantly improved with spinal cord stimulation. Of 226 temporary trials, 172 (76%) were successful, and 159 subjects (70%) received permanent implants. Reported here are outcome data for all subjects through 3.5 months, and for those subjects who have completed six- and 12-month evaluations. A subsequent report will include all 12-month data. This study represents the largest prospective experience reported to date for spinal cord stimulation in axial low back pain.
Investigators: Benchmark Clinical Study Working Group, Advanced Bionics, Valencia, CA; Jim Thacker, MS, Enteromedics, St. Paul, MN; Todd Gross, PhD, Advanced Bionics, Valencia, CA; and Allison Foster, PhD, Advanced Bionics, Valencia, CA.
* More Patient Education Necessary to Manage Sickle Cell Pain
A significant number of people with sickle cell disease reported significant pain and currently use a combination of pharmacological and non-pharmacological methods to manage pain events.
A number of sickle cell patients manage a great deal of their pain episodes at home. The researchers studied 46 questionnaires completed by sickle cell patients to determine if provision of increased knowledge and skills in the use of pharmacologic and non-pharmacologic methods will provide sickle cell patients with greater self-management of pain, improved quality of life and decreased hospitalizations. The investigators found that the average age of respondents was 30 years and the majority were females (58.4%). 57.9% have a diagnosis of sickle cell anemia (hemoglobin SS), while 38.6% had hemoglobin SC disease, and 5% have other hemoglobinopathies. About 22.2% of the respondents were taking opioids analgesics for pain control. About 44% reported experiencing mild-moderate pain events within the last six months. 60.0% had experienced moderate-severe pain requiring a visit to a medical facility within the past six months. More than 75% reported pain greater than 5 on a 0 - 10 point scale when asked to rate their pain during these events.
Relaxation was reported as being used by 77.8% of respondents to help control pain, heating pad was used by 3.7%, and 14.8% report using other techniques to help manage pain events. The researchers conclude that there are opportunities for education and other interventions to improve such techniques and empower patients to achieve improved pain control. As a corollary, this will decrease health care utilization and improve patients’ well being and family life for this group of patients.
Investigators: Arleen Anderson, Wendy Thompson, Stephen Tafor, and Ike Eriator, from the University of Mississippi, Jackson, MS.
* Novel Radiofrequency Treatment Shows Promise for Lumbar Pain
Intradiscal biacuplasty is an effective procedure to treat chronic discogenic pain. Improvement in pain scores and functional capacity can be observed much earlier with intradiscal biacuplasty than with intradiscal electrothermal therapy suggesting some additional or/and different mechanisms of action. It also appears to be more effective than intradiscal electrothermal therapy producing more than 50% of the pain relief in more than 50% of patients.
Intradiscal electrothermal therapy has produced variable results in the pain reduction and functional improvement in patients with axial discogenic pain. A new procedure called intradiscal biacuplasty utilizes two radiofrequency electrodes placed on the opposite posterolateral sides of the treated annulus. This procedure is minimally invasive and provides an alternative to lumbar fusion or disc replacement surgery. The researchers completed a pilot study of 13 patients who received intradiscal biacuplasty and were followed for six months. Following provocative discography patients underwent intradiscal biacuplasty. There were significant improvements of all of the indices (SF-36, Oswestry, Visual Analog Scale pain scores and opioid use) at the first follow-up at one month. Those improvements were maintained throughout six months of follow-up. At six months after intradiscal biacuplasty, patient’s median pain scores measured by Visual Analog Scale decreased from 7 to 3. Functional capacity significantly improved with Oswestry scores median decrease from 25 to 18, and SF-36 PF median increase from 55 to 70. Median SF-36 BP score increased from 35 to 58. Median opioid use expressed in morphine sulphate mg equivalents decreased from 40 to 5 mg. There were no significant differences in any of the indices from first to sixth month after intradiscal biacuplasty. There were eight of 13 patients who had Visual Analog Scale pain scores decreased by three or more points. There were no complications perioperatively or during follow-up.
Investigators: Leonardo Kapural, MD, PhD, Alan Ng, MD, and Nagy Mekhail, MD, PhD., from Cleveland Clinic Foundation, Cleveland, OH.
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Article adapted by Medical News Today from original press release.
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Founded in 1983, AAPM is a medical specialty society representing physicians practicing in the field of pain medicine. Information is available on the practice of pain medicine at http://www.painmed.org/.
Contact: Amy Jenkins
American Academy of Pain Medicine
Almost one-fourth of all stays in U.S. community hospitals for patients age 18 and older — 7.6 million of nearly 32 million stays — involved depressive, bipolar, schizophrenia and other mental health disorders or substance use related disorders in 2004, according to a new report by HHS’ Agency for Healthcare Research and Quality.
This study presents the first documentation of the full impact of mental health and substance abuse disorders on U.S. community hospitals. According to the report, about 1.9 million of the 7.6 million stays were for patients who were hospitalized primarily because of a mental health or substance abuse problem. In the other 5.7 million stays, patients were admitted for another condition but they also were diagnosed as having a mental health or substance abuse disorder.
Nearly two-thirds of costs were billed to the government: Medicare covered nearly half of the stays, and 18 percent were billed to Medicaid. Roughly 8 percent of the patients were uninsured. Private insurers were billed for the balance. The study also found that one of every three stays of uninsured patients was related to a mental health or substance abuse disorder.
“Community hospitals play an important role in the treatment of people with mental health and substance abuse disorders,” said AHRQ Director Carolyn M. Clancy, M.D. “This report gives health care policymakers an in-depth look at the impact of mental health and substance abuse care on the health care system.”
Substance Abuse and Mental Health Services Administration Administrator Terry Cline, Ph.D., said, “The significant number of hospital stays related to mental health and substance use disorders signals the need for an increased national effort to identify and intervene early before the conditions require a hospital stay. Too often because of social stigma or lack of understanding, individuals and health care providers don’t recognize the signs or treat mental health or substance use disorders with the same urgency as other medical conditions.”
AHRQ found that most patients with mental health and substance abuse disorders were older. For example, although people age 80 and older comprised only 5 percent of the U.S. population in 2004, they accounted for nearly 21 percent of all hospital stays for these conditions — principally for dementia. There were also gender differences. The most frequent admitting diagnosis for women was mood disorders, while that for men was substance abuse.
AHRQ also found that patients who have been diagnosed with both a mental health condition and a substance abuse disorder — those with “dual diagnoses” — accounted for 1 million of the nearly 8 million stays. Nearly half of these cases with dual diagnoses involved drug abuse, a third involved alcohol abuse, and one in five involved both drug and alcohol abuse.
In addition, 240,000 women hospitalized for childbirth or pregnancy also had mental health or substance abuse problems. Four of every 10 of these patients were between 18 and 24 years of age.
Suicide attempts accounted for nearly 179,000 hospital stays. Of these, 93 percent involved a mental health condition — most commonly mood disorders — and/or substance abuse. Nearly three-quarters of these patients were between ages 18 and 44 and more than half were women. Poisoning, by overdosing prescription medicines or ingesting a toxic substance was the most common way patients attempted suicide.
The report is based on 2004 data — the latest currently available — from AHRQ’s Healthcare Cost and Utilization Project Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of all short-term, non-federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured. For details, see Care of Adults with Mental Health and Substance Abuse Disorders in U.S. Community Hospitals, 2004 at http://www.ahrq.gov/data/hcup/factbk10/.
Agency for Healthcare Research and Quality
http://www.ahrq.gov
Parental alcoholism and family stress can also facilitate the development of alcohol problems
* Prior research has shown that children with ADHD can develop alcohol problems later in life.
* Two studies confirm this association, indicating that drinking problems begin around age 15.
* Parental alcoholism and family stress appear to add to the risk of children with ADHD developing alcohol problems themselves.
Researchers believe that children with attention deficit hyperactivity disorder (ADHD) are at risk for alcohol- as well as other substance-related problems as they grow older. Yet the research is not always consistent. Two new studies help to confirm that ADHD is a risk factor for alcohol problems; adding that parental alcoholism and stressful experiences in the family play an important role in this risk.
Results are published in the April issue of Alcoholism: Clinical & Experimental Research.
“Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems,” explained Brooke Molina, associate professor of psychiatry and psychology at the University of Pittsburgh, and corresponding author for both studies.
In the first study, on “Age specificity,” Molina and her colleagues interviewed participants in the larger Pittsburgh ADHD Longitudinal Study. Children diagnosed with ADHD (n=364) were interviewed either as adolescents (11 to 17 years of age) or as young adults (18 to 28 years of age). Demographically and age-matched individuals without ADHD were also recruited as adolescents (n=120) or as adults (n=120) to serve as a comparison. Alcohol use was determined through questionnaires and interviews.
“We found that the children with ADHD were more likely than the comparison group to drink heavily and to have enough problems related to their drinking that they were diagnosed with alcohol abuse or dependence,” said Molina. “This means that their drinking caused problems such as fights with their parents or friends, a drop in their grades at school, or difficulty with controlling the amount of alcohol that they drank.”
Drinking problems began around age 15, said Molina. “The 15-to-17-year olds with childhood ADHD reported being drunk an average of 14 times in the previous year, versus only 1.8 times for 15-to-17-year olds in the study who did not have childhood ADHD. Whereas 14 percent of the 15-to-17-year olds with childhood ADHD were diagnosed with alcohol abuse or dependence, none of the 15-to-17-year olds without childhood ADHD were.”
“It appears that one of the reasons for the past inconsistencies in research is that the ADHD-alcohol relationship does not become solid until at least mid-adolescence,” observed Stephen Hinshaw, professor and chair of the department of psychology at UC Berkeley. “Later on, it may be that only a subset of kids with ADHD - namely, those with more aggressive or antisocial behavior patterns - are at risk by young adulthood.”
Molina says her findings support this theory. “For example, 42 percent of those children with ADHD who also had serious, persistent behavior problems [later] had alcohol abuse or dependence by the age of 18 to 25.” Molina also says, however, that researchers know little about the risk for alcoholism for children with ADHD beyond this age range. “Most young adults drink less after they settle into jobs and family life,” she said. “We will be following the young adults in the Pittsburgh study to see if this happens or not.”
In the second study, on “Life stress,” Molina and her colleagues interviewed 142 adolescents (133 males, 9 females) who had been diagnosed with childhood ADHD, as well as 100 demographically matched adolescents without childhood ADHD. All participants were asked about their drinking behavior and negative life events; in addition, parents reported their drinking histories.
“One of the reasons that children with ADHD might be at risk for alcohol problems is that alcoholism and ADHD tend to run together in families,” said Molina. “We found that parental alcoholism predicted heavy problem drinking among the teenagers, that the association was partly explained by higher rates of stress in these families, and these connections were stronger when the adolescent had ADHD in childhood. So, the bottom line is that when the child has ADHD and the parent has suffered from alcoholism, either currently or in the past, the child will have an increased risk for alcohol problems himself or herself.”
“In other words,” added Hinshaw, “when a youngster has ADHD, he or she is more likely to either provoke higher rates of drinking in parents, exacerbating overall stress levels; or be more confused and upset by parental drinking, then reverting to this pattern himself or herself.”
However, noted Molina, “we need to put these findings in perspective; it is important to recognize that not all children with ADHD will have problems with alcohol.”
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Article adapted by Medical News Today from original press release.
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Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper called “ADHD Risk for Heavy Drinking and Alcohol Use Disorder is Age-Specific” were: William E. Pelham, Jr. and Elizabeth M. Gnagy of the Departments of Psychology & Pediatrics at the State University of New York at Buffalo; Amanda L. Thompson of the Department of Psychology at the University of Pittsburgh; and Michael P. Marshal of the Department of Psychiatry at the University of Pittsburgh School of Medicine. Co-authors of the ACER paper called “ADHD Moderates the Life Stress Pathway to Alcohol Problems in Children of Alcoholics” were: Michael P. Marshal of the Department of Psychiatry at the University of Pittsburgh; William.E. Pelham, Jr. of the Departments of Psychology & Pediatrics at the State University of New York at Buffalo; and JeeWon Cheong of the Department of Psychology at the University of Pittsburgh. The studies were funded by the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the National Institute on Mental Health, and the National Institute of Environmental Health Sciences.
Contact: Jocelyn Uhl Duffy
University of Pittsburgh
Stephen Hinshaw, Ph.D.
University of California Berkeley
Alcoholism: Clinical & Experimental Research
The United Nations World Food Programme has announced that nine trucks carrying 225 metric tons of food have begun to cross the border into Gaza today. The food convoy follows the arrival yesterday of seven WFP trucks carrying 200 metric tons of food assistance into the occupied Palestinian territory (oPt).
The trucks will cross into Gaza through Kerem Shalom, the southern border crossing from Israel that has been opened after a consensus was reached by all parties to allow emergency relief supplies through. WHO also sent one truckload of urgently-needed medical supplies to Gaza through the crossing yesterday.
“There is a serious humanitarian crisis developing in Gaza as a result of the recent turmoil and closure of the border crossings. It is crucial that food and other humanitarian assistance continue to reach the increasingly desperate population,” said Arnold Vercken, WFP Country Director in the occupied Palestinian territory.
Gaza relies on the importation of all basic commodities, however, with the recent border closures, commercial food stocks in Gaza are quickly being depleted and are expected to run extremely low within two weeks as people panic buy flour, sugar and oil. Already in the past few days wheat flour prices have shot up by 40 percent and commercial food stocks have already run out in some areas.
The purchasing power of the population in Gaza has been heavily affected by the closures, violence, the destruction of property, looting and the inability to go to work. Overall, there is a growing dependency on humanitarian assistance.
WFP has managed to continue its food assistance but the challenges of providing such assistance are numerous in terms of logistics, security and growing needs of the population.
WFP is assisting 275,000 beneficiaries in Gaza out of 1.4 million population or 60 percent of the non-refugee Palestinians in the Strip. Over the past week the UN agency is also supplying fresh bread to 10 hospitals in Gaza. In total 80 percent of Gaza’s population rely on food aid from WFP or UNRWA.
WFP is the world’s largest humanitarian agency: on average, each year, we give food to 90 million poor people to meet their nutritional needs, including 58 million hungry children, in 80 of the world’s poorest countries. WFP — We Feed People.
http://www.wfp.org
The death rate between January and June 2006 in the greater New Orleans area was nearly 50 percent higher than pre-Hurricane Katrina rates, due in part to a compromised public health infrastructure after Hurricane Katrina, which hit the Gulf Coast on August 29, 2005, according to a study in the inaugural issue of the AMA journal, Disaster Medicine and Public Health Preparedness.
Reports that death notices in the New Orleans Times-Picayune newspaper increased dramatically in 2006 prompted local health officials to determine whether death notice surveillance could serve as a valid alternative means to confirm suspicions of excess mortality requiring immediate preventive actions and intervention. Under normal circumstance, death rates are derived from death certificates registered at a state’s office of vital records. But for several reasons — including relocation and a reduced workforce after Hurricane Katrina, the data was not available for a timely review and analysis.
Kevin U. Stephens Sr., M.D., J.D., Director of the New Orleans Health Department, and colleagues used monthly totals from the New Orleans Times- Picayune to obtain the frequency and proportion of deaths from January to June 2006. They compared these figures with deaths notices from 2002 to 2003. They also compared death notice figures with data from the state Health Statistics Center on the top ten causes of death in the greater New Orleans area from 2002 to 2003.
“The post-Katrina mortality rate for the first six months of 2006 was approximately 91.37 deaths per 100,000 population. Compared to the pre-Katrina population mortality rate of 62.17 deaths per 100,000 population, this represents an average 47 percent increase from the baseline mortality, suggesting a marked increase in indirect (excess) deaths post-disaster,” the authors report.
“This disaster severely compromised the public health infrastructure,” they continue. “It is suggested that a destroyed or poorly recovered public health infrastructure, which normally would be able to identify health problems and protect the health of a population, has in fact contributed to excess mortality.”
Death notices published in the daily Times-Picayune were found to correlate highly with mortality data from the conventional state health information system in the pre-Katrina population. The authors believe their study validates this alternative source of information, and reveals an urgent need for states to adopt electronic reporting systems.
“Furthermore, death notice monitoring provides real-time mortality information well ahead of official state health information mortality data, giving impetus to the Louisiana health departments to adopt an interoperable statewide EDRS [electronic death registration system] to rapidly assess and monitor mortality,” the authors write. More specifically, there is no accurate or well-coordinated methodology to track out of state deaths. Currently, it is estimated that more than 150,000 residents have not returned to their homes in New Orleans.
American Medical Association
http://www.ama-assn.org