Binge Drinking

Post According to a recent study by the Centers for Disease Control and Prevention about one out of six adults in the United States is a binge drinker. Results http://www.cdc.gov/media/releases/2012/t0110_binge_drinking.html from a 2010 telephone survey show that more than 38 million U.S. adults are binge drinkers, defined as consuming five or more alcoholic drinks in a short period of time for men and four of more for women. The average frequency of binge drinking was four times a month, the study found. Key findings include: Overall, about 1 in 6 U.S. adults surveyed said they had binged on alcohol at least once in the previous month, though it was more than 1 in 4 for those ages 18 to 34. Excessive alcohol consumption, including binge drinking, accounts for an average of 80,000 deaths and 2.3 million years of life lost in the united states each year and costs the U.S. an estimated $223 billion dollars in 2006 or about $1.90 per drink. Binge drinking is responsible for over half of deaths, two-thirds of the years of potential life lost and three-quarters of the economic costs that are due to excessive drinking. Binge drinking was most common among those in the 18 to 34 age group but the frequency was higher among those over age 65. It was most common in the Midwest, New England, Washington, D.C., Alaska and Hawaii, the survey found said. Men were twice as likely as women to binge drink, according to the study Binge drinking is more common among Americans with household incomes of $75,000 or more per year. The study also found that Americans with household incomes of less than $25,000 per year consume more drinks when they binge drink, averaging eight or nine drinks per binge. Yours Bernd

Marijuana Legislation

Attached a link http://blogs.miaminewtimes.com/riptide/2012/01/medical_marijuana_bills_introd.php to an article titled "Medical Marijuana Bills Introduced In Florida Senate and House" reporting that State Sen. Larcenia Bullard (D-Miami) has " fired up a big ol' blunt of legislative reform..", , as her proposal to give Florida voters a chance to legalize medical marijuana was introduced in the Senate. Bullard's bill joins a similar proposal by Rep. Jeff Clemens (D-Lake Worth) in the House -- the first time in decades that both Florida chambers have had marijuana reform bills at the same time. Both the House and the Senate resolution would put the legalization of medical pot into the hands of voters, adding a statewide referendum later this year that would need 60 percent approval to pass. Sixteen other states around the country have already legalized some uses of marijuana; Miami Beach advocates recently collected enough signatures to force a vote on whether to decriminalize small amounts of weed, although the city attorney is still contesting that referendum. Sen. Larcenia Bullard, D-Miami, who is sponsoring the bill in the Senate, said that what started as a courtesy filing has become a cause for her, after she started looking into it. Her belief that it should pass stems from 1) wanting to de-glamorize it for young people who are looking to do something illegal, and 2) the medical relief it offers to those who need it. And it’s good for the state budget, too, she said. “The state spends $288 million of effort due to the prohibition of marijuana,” she said, adding that it could also be a source of tax revenue. For more information and the original text of both resolutions see HJR 353 at http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_h0353__.docx&DocumentType=Bill&BillNumber=0353&Session=2012 and SJR 1028 at http://www.myfloridahouse.gov/Sections/Documents/loaddoc.aspx?FileName=_s1028__.DOCX&DocumentType=Bill&BillNumber=1028&Session=2012. I strongly urge all of you to OPPOSE such initiatives to legalize and promote the medical use of marijuana!!! There is currently no conclusive evidence that marijuana, in the smoked form, has accepted medical use for treatment. Furthermore, marijuana has a high potential for abuse and lacks the safety of medical supervision. The science, though still evolving, is clear: marijuana use is harmful. Marijuana smoke contains more than 400 chemicals, including most of the harmful substances found in tobacco smoke. While marijuana may provide relief from pain, it is also associated with dependence, respiratory and mental illness, poor motor performance, and cognitive impairment, among other negative effects. According to recent surveys marijuana use among youth is on the rise. Nearly two thirds (63 percent in 2009) of the first time users of marijuana are below the age of 18. Research shows that people who used marijuana before age 15 are six times more likely to develop a substance use disorder later in life than those who did not start using until they were 18 or older. Making marijuana more available through legalization efforts will lead to greater use and increased dependence. We already know that about 10 percent of marijuana users develop marijuana dependence which costs our communities monetarily and socially. Prolonged marijuana use is associated with lower test scores and lower educational attainment. This drug affects the user’s ability to learn and process information, thus influencing attention, concentration, and short-term memory. I ask for the active support of the Florida Society of Addiction Medicine to lobby against these two House and Senate resolutions. I look forward to your comments. Yours Bernd

Florida PDMP Update

Attached you find the link https://docs.google.com/viewer?url=http%3A%2F%2Fwww.eforcse.com%2Fdocs%2FPDMP_Annual_Report_2011_FINAL.pdf to the 2010-2011 Prescription Drug Monitoring Program Annual Report.The information collected in the database is available to registered health care practitioners to help guide their decisions in prescribing and dispensing certain highly abused prescription drugs. It may also assist health care practitioners in identifying patients who are “doctor shopping” or trying to obtain multiple prescriptions for the same controlled substance from multiple health care practitioners, which is a felony in the State of Florida. The PDMP became operational on September 1, 2011, when it began receiving controlled substance dispensing data from pharmacies and dispensing practitioners. Health care practitioners began accessing the data reported to the PDMP on October 17, 2011, and Law Enforcement Agencies began requesting PDMP reports during the course of active investigations on November 14, 2011 Here are some highlights: As of November 15, 2011.Number of Pharmacies/Dispensers who have reported to the PDMP 5,502. Number of prescription records reported to the PDMP 21,248,872 For this reporting period, 873,814 INDIVIDUALS filled prescriptions for Schedule II drugs and 2,567,209 for Schedule II and III drugs. The report also identified that 2,710 of the individuals died with at least one prescription drug in their system that was identified as the cause of death. Among the licensed professionals, pharmacists have the highest registration rate, with over 9.7% registering. Roughly 3.7% of all medical doctors and osteopathic physicians and 2% dentists have registered as of November 15, 2011. BUT 56,218 licensed PRESCRIBERS in Florida issued one or more controlled substance prescriptions and most probably do NOT check the PDMP. Number of PDMP Queries by Registered Users: October 2011 34,486 November 2011 71,928 TOTAL 106,414 Number of Data Request by Law Enforcement 36 !! This demonstrates that we have a wealth of data available on which we can base our prescription decisions BUT only 3.7% of all medical doctors in Florida choose to use the system!! Furthermore, the available data indicates that law enforcement is far less "trigger happy" to access the data than previously claimed. What problem(s) remain? More physicians should be encouraged to use the PDMP. Otherwise, we have to consider mandating its use prior to the issuance of a controlled substance prescription. I personally use the program each time I issue a Schedule II,III or IV prescription and have discovered quite a few surprises!! In 2009, 223,700 controlled substance prescriptions were dispensed by out-of state pharmacists in Alabama, Louisiana, North Carolina, Arizona, and Vermont for prescriptions written by Florida prescribers. Currently health care practitioners licensed outside the state of Florida are not allowed access to Florida’s PDMP prior to dispensing. Therefore, we need to allow for exchange of Florida PDMP data with other state PDMP programs which will enable health care practitioners and law enforcement officers to determine if their patient/subject has received controlled substance prescription drugs in the State of Florida. Yours Bernd

US Healthcare Costs

According to the latest edition of "Health at a Glance" http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2011_health_glance-2011-en published by the Organization for Economic Co-operation and Development (OECD) The United States stands out as performing very well in the area of cancer care, achieving higher rates of screening and survival from different types of cancer than most other developed countries. The United States does not do well in preventing costly hospital admissions for chronic conditions, such as asthma or chronic obstructive pulmonary disease, which should normally be managed through proper primary care. Avoidable hospital admissions for asthma complications and chronic obstructive pulmonary disease (COPD) are much greater in the United States than the OECD average. For asthma admissions, the rate in the United States was 121 per 100 000 adults in 2009, more than two times greater than the OECD average of 52. For COPD, hospital admission in the United States was 230 per 100 000 adults, compared with an OECD average of 198. Regarding healthcare expenditures the United States spent 17.4% of GDP on health in 2009, much more than the OECD average of 9.6%. Spending per person is two-and-a-half times higher than the OECD average. Following the United States were the Netherlands, France and Germany, which allocated respectively 12.0%, 11.8% and 11.6% of their GDP to health. Is US health spending higher due to higher prices or higher service provision? (or both?) Facts: 1) US prices for a set of hospital services is over 60% higher than the average of 12 OECD countries, 2) US prices for certain procedures (including appendectomy,coronary angioplasty, coronary artery bypass graft, hip & knee replacement) are much higher than in other OECD countries, 3) Almost DOUBLE the spending on Insurance administration expressed in terms of purchasing power parity. Its also of interest to note that in most countries, health spending is largely financed out of taxes or social security contributions, with private insurance or ‘out-of-pocket’ payments playing a significant but secondary role. This is not the case in the United States which, together with Mexico and Chile, is the only OECD country where the government plays the smallest role in financing health spending. The public share of health expenditure in the United States was 47.7% in 2009, much lower than the OECD average of 71.7%. However, the level of health spending in the United States is so high that public (i.e. government) spending on health per capita is greater than in all other OECD countries, except Norway and the Netherlands. For this amount of public expenditure in the United States, government provided in 2009 insurance coverage only for the elderly and disabled people (through Medicare) and some of the poor (through Medicaid and the State Children’s Health Insurance Program, SCHIP), whereas in most other OECD countries this was enough for government to provide universal health insurance. Public spending on health in the United States has been growing more rapidly than private spending since 1990, largely due to expansions in coverage. Private insurance accounted for 33% of total health spending in the United States in 2009, by far the largest share among OECD countries. Beside the United States, Canada and France are the only two other OECD countries where private insurance represents more than 10% of total health spending. Conclusions: we are spending more for healthcare per person than in any other country in the world utilizing an inefficient private insurance model. But also public (i.e. government) spending on health per capita is greater than in all other OECD countries but fails to provide universal coverage. We must achieve a broad based consensus on how to efficiently allocate our healthcare resource to achieve high quality healthcare for all Americans. Tinkering on the edge will not provide us with a meaningful and sustainable solution. If we do not engage in such a dialogue now we will face rationing and further economic slowdown. Yours Bernd

Pharmacies and Pill Mills

Attached a link http://www.miamiherald.com/2011/12/24/2560690/painkiller-peddlers-pharmacies.html to an important article you might have missed titled "Painkiller peddlers: Pharmacies targeted in pill-mill crackdown" published in the Miami herald on December 24th, 2011. The article reports that according to a federal indictment an ordinary mom-and-pop pharmacy, conveniently located on the first floor of the Stephen P. Clark Government Center, the 28-story heart of Miami-Dade County government, steps from a heavily used Metromover stop, was actually operating as a pill mill illegally trafficking in painkillers, part of a wave of rogue pharmacies that have become the new front line in the continuing war on prescription drug abuse in Florida. In the emergency order suspending the owner's pharmacy permit based on the U.S. Drug Enforcement Administration investigation, the Florida Department of Health said he posed a serious danger to the public health and showed reckless disregard for pharmacy laws and rules by dispensing excessive or inappropriate dosages of oxycodone and oxymorphone. The four Robert’s Drug stores purchased a total of 1,692,700 tablets of oxycodone between Jan. 1 and June 1 this year, according to the DEA. A state expert said in state documents that an 80-mg. daily dose of oxycodone “is potentially lethal” for some people but that Aryan’s customers routinely received far more. But there aslo good news to report: After a three-year investigation, federal authorities dismantled four of the nation’s largest pain clinics in August along with two pharmacies and one pharmaceutical supplier. Thirty-two people from across South Florida were indicted. Over the years, the enterprise doled out 20 million pills and profited $40 million from illegal sales of controlled substances. In July, federal authorities arrested a family of five charged as part of a drug and money laundering enterprise based at a Plantation pharmacy. From April, 2009 to May, 2010, the pharmacy ordered 1,038,560 tablets of oxycodone, more than 28 times the national average for dispensing pharmacies, according to federal documents. The profits: nearly $2 million.Last month, CVS — with more than 700 stores in the state — notified a small number of Florida physicians that it will no longer fill their prescriptions written for Schedule II narcotics, including oxycodone, a measure to “prevent drug abuse and keep controlled substances out of the wrong hands,’’ according to a statement. Looking forward to your comments. Happy New Year Yours Bernd

Oxycontin in the News

Attached a link http://www.pressdisplay.com/pressdisplay/viewer.aspx to an interesting article titled "Stronger form of Oxycodone means more pain for the US" published in the Sun Sentinel on December 29th, 2011. In this commentary the author points out that "several drug companies are completing FDA trials to introduce a new, much stronger form of Oxycodone to the $10 billion opiate prescription drug market in 2013. Unlike the more than 400 opiate pain killers already on the market that blend the powerful narcotic with other medications, the new drug is solely composed of pure Oxycodone. It will be very potent, delivering up to 10 times more pain relief than present prescriptions." Whereas all of us are struggling to contain the prescription drug epidemic, pharmaceutical companies, driven by the profit motive, seem to have found a business opportunity to sell more powerful narcotics to the ever growing number of opioid dependent addicts. Therefore, I agree with the authors conclusion: "If tobacco companies are forced to contribute a portion of each sale of a cigarette pack to pay for the effort to curb tobacco use and the financial and medical consequences cause by American smoking cigarettes, why not the manufacturers of the most abused addictive prescriptive drug in the United States? It is time to make politically powerful drug companies responsible and accountable for their destructive products. They, not U.S. taxpayers, should have to bear the brunt of the financial and social burdens from rampant illegal misuse of Oxycodone." Looking forward to your comments. Happy New Year Yours Bernd