Stoned Drivers

Attached an article http://www.sun-sentinel.com/news/nationworld/la-na-pot-drivers-20110703,0,7871314.story entitled "Stoned driving is uncharted territory" which was initially published in the Los Angeles Times highlighting the problem of impaired driving, especially as it pertains to the legal and illegal use of marijuana. The most recent assessment by the National Highway Traffic Safety Administration, based on random roadside checks, found that 16.3% of all drivers nationwide at night were on various legal and illegal impairing drugs, half them high on marijuana. The article clearly points out that "As the medical marijuana movement has gained speed — one-third of the states now allow such sales — federal officials are pursuing scientific research into the impairing effects of the drug. The issue is compounded by the lack of a national standard on the amount of the drug that drivers should be allowed to have in their blood. While 13 states have adopted zero-tolerance laws, 35 states including California have no formal standard, and instead rely on the judgment of police to determine impairment. Even the most cautious approach of zero tolerance is fraught with complex medical issues about whether residual low levels of marijuana can impair a driver days after the drug is smoked. Marijuana advocates say some state and federal officials are trying to make it impossible for individuals to use marijuana and drive legally for days or weeks afterward."
Several studies are underway to determine if marijuana can impair drivers and increases the risk for car crashes. A $6-million study in Virginia Beach, Va., is attempting to remove any doubt that users of pot and other drugs are more likely to crash. Teams of federal researchers go to accident scenes and ask drivers to voluntarily provide samples of their blood. They later return to the same location, at the same time and on the same day of the week, asking two random motorists not involved in crashes for a blood sample. The project aims to collect 7,500 blood samples to show whether drivers with specific blood levels of drugs are more likely to crash than those without the drugs, said John Lacey, a researcher at the nonprofit Pacific Institute for Research and Evaluation. In other projects, test subjects are being given marijuana to smoke and then examined under high-powered scanners or put in advanced driving simulators to gauge how it affects their brains and their ability to drive.
But questions remain: Does it mean that there is no amount of marijuana that a person can consume and drive safely immediately afterward? Can we determine whether it is possible to set limits on "safe" marijuana use with, or without, a combination of other substances such as alcohol? An open discussion is indicated to reach an evidence-based answer.

Yours
Bernd

Seroquel and Methadone

Attached a link to an article published in the New York Times (July 19th, 2011) http://www.nytimes.com/2011/07/19/health/19drug.html reporting that at the request of the Food and Drug Administration, AstraZeneca is adding a new heart warning to the labels of Seroquel, its blockbuster antipsychotic.
The revised label emphasizes that drug.Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest.The previous Seroquel labels had mentioned the risk of a prolonged QT interval, but had not identified other drugs to avoid, Stephanie Andrzejewski, a spokeswoman for AstraZeneca, said Monday. The new warning also is separated from other warnings and precautions on the label, she said, “to provide some additional guidance to physicians” treating patients ”who are already at risk of QT prolongation.”
The new label lists the other drugs to avoid as antiarrhythmic drugs like quinidine, procainamide, amiodarone and sotalel; antipsychotic drugs like ziprasidone, chlorpromazine and thioridazine; antibiotics like gatifloxacin and moxifloxacin; the anti-infective drug pentamidine; and synthetic opioids like levomethadyl acetate and methadone. The label also raises caution about use by the aged and people with heart disease. As addiction professionals we should know that Seroquel has a potentially deadly interaction with methadone in regard to the QT interval, even though the FDA is downplaying this risk!
Methadone use and deaths have increased drastically in recent years as more doctors prescribe it for chronic pain. The number of methadone prescriptions for pain in the United States rose to 4.3 million in 2010 from 2.2 million in 2006, IMS Health, an industry data firm, said Monday. The use for pain has surpassed that for heroin withdrawal and maintenance.

Yours
Bernd

Bath Salts Abuse Increasing

Attached a link to an interesting article http://www.nytimes.com/2011/07/17/us/17salts.html entitled "An Alarming New Stimulant, Legal in Many States" highlighting the growing abuse of bath salts containing  chemicals like mephedrone and methylenedioxypyrovalerone, or MDPV, also known as substituted cathinones. Both drugs are related to khat, an organic stimulant found in Arab and East African countries that is illegal in the United States. Bath salt users so agitated that they often do  not respond to large doses of sedatives.Poison control centers around the country received 3,470 calls about bath salts from January through June, according to the American Association of Poison Control Centers, up from 303 in all of 2010. 
At least 28 states have banned bath salts, which are typically sold for $25 to $50 per 50-milligram packet at convenience stores and head shops under names like Aura, Ivory Wave, Loco-Motion and Vanilla Sky. Most of the bans are in the South and the Midwest, where the drugs have grown quickly in popularity. But states like Maine, New Jersey and New York have also outlawed them after seeing evidence that their use was spreading. Law enforcement officials said they had been shocked by how quickly bath salts turned into a major problem. As addiction professionals we need to stay informed on how to diagnose and treat patients who are under the influence of these powerful synthetic drugs. We also should call for tough regulatory measures including, whether to make MDPV and mephedrone controlled Schedule I drugs like heroin and ecstasy, to stop the sale and consumption of these drugs.
Yours
Bernd

Heroin Use Surges

Attached a link to an article http://www.miamiherald.com/2011/06/30/2292618/as-poppy-fields-flourish-in-mexico.html#storylink=misearch published on the Miami Herald web site pointing out that that Mexico has surpassed Myanmar as the world's second-largest poppy cultivator and produces 7 percent of the world's heroin, mostly for the U.S. market. The State Department and the United Nations say that Mexican poppy production has nearly tripled since 2007, though Mexico strongly disputes that estimate. "They brought in experts, chemists, folks from Asia who taught them how to produce better heroin," said a U.S. law enforcement official based in Mexico City, who spoke only on the condition of anonymity for security reasons. "You saw purity levels climb from 40 to 50 percent up to 90 percent." He said Mexican heroin now might hold two-thirds of the U.S. market. "You're seeing it everywhere. It's cheap. The market base is teenagers. They are the target consumers," the official said. At about $15 a hit, heroin is a lot cheaper than prescription painkillers such as oxycodone (known by its brand name, OxyContin), which can cost $50 to $80 a tablet on the black market. Both opiates, they have similar highs and Heroin can be snorted and inhaled, too.
As addiction professionals we should get prepared for an avalanche of new opioid users who switch from prescription drugs to Heroin and teenagers who start their using "career" with Heroin.
Yours
Bernd

Drug Testing for Welfare Recipients

Drug Test Law May Face Costly Legal Challenges:

Attached a link http://www.orlandosentinel.com/health/os-drug-tests-welfare-20110630,0,5410762.story to an article published in today's Orlando Sentinel pointing out that a new state law requiring welfare applicants to be drug-tested goes into effect today.

The law stipulates that parents with minor children who request temporary cash assistance must undergo a drug test. The average benefit check per family is $240 a month with a lifetime limit of 48 months.

About 4,000 Floridians each month may be affected by the new law. The 93,000 state residents already receiving such benefits would not be affected unless they reapply. In addition all parents who test positive for drugs — including legal drugs not prescribed for the parent — will be reported automatically to the state's abuse hotline. Applicants will have to pay for the drug tests themselves, though those who test negative will be reimbursed in the first benefit check they receive. Those who test positive also would have the chance to get a second, more-sophisticated screening — at their own expense of up to $100 — and have an official medical review of the testing (MRO) . It is still unclear whether those expenses would be reimbursed if the applicant is ultimately cleared. The law may violate the constitutional standard requiring that the government must have reason to believe an individual is using drugs before demanding a test. Michigan, the only other state to pass a similar law, had it struck down in court. Therefore, it most probably will face a costly legal challenge on taxpayers expense!! Furthermore, by implementing this policy the state government should have provided drug treatment options for those welfare recipients with children who test positive for drugs. The new law falls shot of this option, too.

In my opinion this new law is a bad idea which will face a long and costly court battle and will further divert scarce state resources from more important issues such as drug use prevention and treatment programs.

Happy 4th of July,


Yours

Bernd