drug wars

Benzo Update 02.25.18

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Between 1996 and 2013, the number of adults who filled a benzodiazepine prescription increased by 67 percent, from 8.1 million to 13.5 million. Unlike opioid prescribing, which peaked in 2012 and has decreased nearly 20 percent since then, benzodiazepine prescribing continues to rise. The risk of overdose death goes up nearly fourfold when benzodiazepines are combined with opioids, yet rates of co-prescribing benzodiazepines and opioids nearly doubled between 2001 and 2013. Overdose deaths involving benzodiazepines increased more than sevenfold between 1999 and 2015.

Anna Lembke, M.D., is associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, chief of the Stanford Addiction Medicine Dual Diagnosis Clinic, and author of “Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop” (Johns Hopkins University Press, 2016).

You can read the full article here.

Gabapentin Misuse and Abuse

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Last December, Ohio’s Board of Pharmacy began reporting sales of gabapentin prescriptions in its regular monitoring of controlled substances. The drug, which is not an opioid nor designated a controlled substance by federal authorities, is used to treat nerve pain. But the board found that it was the most prescribed medication on its list that month, surpassing oxycodone by more than 9 million doses. In February, the Ohio Substance Abuse Monitoring Network issued an alert regarding increasing misuse across the state.

A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse gabapentin. A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused gabapentin in the past six months “to get high.”

In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.

Read the article.

Now slowly focus on the following sentences:

Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery.

Tom Petty’s COD Lesson for Underwriters

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Good article from The Dose Makes the Poison blog.  You can read the entire article here.

I found the following excerpt fascinating.  The bold lines are my highlights.

From a general forensic toxicology standpoint, the real takeaway is that this is a dangerous combination of substances to use concurrently. He was consuming two powerful opioid and two potent benzodiazepines which when used together can create synergistic effects and exaggerated central nervous system depression. Add that situation to an already compromised cardiovascular and respiratory system, and it’s a recipe for disaster.  For my own information, I would love to see the full toxicology report with quantitative measures of drug, etc. How much fentanyl was present? How much temazepam and alprazolam were detected? Not that any of that really matters though.

With the detection of acetylfentanyl and despropionylfentanyl, it seems as if Tom Petty was supplementing his pharmaceutical medications with illicitly manufactured substances. Acetylfentanyl is not a pharmaceutical medication anywhere in the world and is only found as a designer opioid/analog meant to skirt the controlled substances act in the USA. Fentanyl does not metabolize to acetylfentanyl. As despropionylfentanyl is a precursor/intermediate used in the illicit (non-pharmaceutical) synthesis of fentanyl, it generally used as a marker for exposure to illicitly manufactured fentanyl. The presence of this substance has also been associated with the use of various fentanyl analogs including acetylfentanyl, acrylfentanyl, and furanylfentanyl. No one knows if the use of illicit opioid was intentional or not. Remember the situation surrounding Prince’s death. Multiple pills were found in his residence that looked like pharmaceutical hydrocodone/acetaminophen but turned out to be counterfeit tablets containing fentanyl and the opioid research chemical U-47700.

As a conclusion, I’ll say, please do not mix depressant drugs. Do not mix opioids with benzodiazepines. Do not mix either of them with ethanol. Stay safe, folks.

Pay attention to those medications.

Didn’t I mention this previously when writing about Heath Ledger’s death?

The Battleground of Prime Time Media, Disease, and Death

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I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and non-healing wounds, as well as other dire medical complications.

Read the full article here.

 

Gastric Cancer Risk Doubled With Long-term PPI Use

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Source: Gastric Cancer Risk Doubled With Long-term PPI Use

The study was published online October 31 in Gut.

The researchers point out, however, that this was an observational study, which can’t prove cause and effect.

A strength of the study is its use of data from a large population-based database with complete information on subsequent diagnoses and drug prescriptions, which minimizes selection, information, and recall biases, the researchers say. Use of strict exclusion criteria as well as propensity score adjustment to control for potential confounders and restricting the sample to patients with successful H pylori eradication are other strengths.

In terms of study weaknesses, the researchers  lacked information on some risk factors, such as diet, family history, and socioeconomic status.  And despite the large sample of more than 63,000 H pylori–infected patients, the small number of gastric cancer cases did not allow for any “meaningful evaluation of the dosage effect and role of different PPIs,” the researchers say.

Benzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management – emDOCs.net – Emergency Medicine Education

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Prescription benzodiazepines continue to be commonly prescribed drugs for treatment of mood and anxiety disorders. In 2015, more than 32 million people over the age of 12 reported use of benzodiazepines in the previous year. Of these, nearly 20% used benzodiazepines in a pattern of misuse (Figure 1).1 Benzodiazepines also ranked second among misused/abused drug related visits to the ED by patients aged 65 and older in 2011.2 The rates of long term benzodiazepine use have steadily increased over time. A retrospective study showed an age-related increase in the percentage of benzodiazepine use with higher rates of any benzodiazepine use in women at any age.3 Most of the patients with long term benzodiazepine use received their prescriptions from prescribers who were not psychiatrists.4 Benzodiazepine dependence can be seen within just 3-6 weeks of regular use at therapeutic doses.3

Source: emDOCs.net – Emergency Medicine EducationBenzodiazepine Withdrawal Syndrome: Presentations and Emergency Department Management – emDOCs.net – Emergency Medicine Education

Trends in Prescription Opioids Detected in Fatally Injured Drivers in 6 US States: 1995–2015 | AJPH | Ahead of Print

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Results. The prevalence of prescription opioids detected in fatally injured drivers increased from 1.0% (95% confidence interval [CI] = 0.5, 1.4) in 1995 to 7.2% (95% CI = 5.7, 8.8) in 2015 (Z = −9.04; P < .001). Prescription opioid prevalence was higher in female than in male drivers (4.4% vs 2.9%; P < .001). Of the drivers testing positive for prescription opioids, 30.0% had elevated blood alcohol concentrations (≥ 0.01 g/dL), and 66.9% tested positive for other drugs.

Source: Trends in Prescription Opioids Detected in Fatally Injured Drivers in 6 US States: 1995–2015 | AJPH | Ahead of Print

Houston…we have a problem.

Listen and Learn – Drugs and Death in Mexico

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The U.S.-Mexican Border: A Changing Frontier : NPR

Several posts ago I wrote briefly about some of the problems our neighbor to the South is having with the illegal drug trade.  I did extensive work in this area while advising a US based life company on its possible entry into the Latin life markets.  This is a quick audio series that provides a good overview of what’s happening.   If you’re writing business on the border or in Mexico you need to know what’s happening in order to keep your risk assessment brain cells sharp.

I’ve been to Mexico quite a few times.  Bogota is safer now.