Drug Facts: High School and Youth Trends

Attached a link to an article posted onthe NIDA web site titled "DrugFacts: High School and Youth Trends" It contains a mixed bag of good and bad news including: Illicit drug use among teenagers has continued at high rates, largely due to the popularity of marijuana. Marijuana use by adolescents declined from the late 1990s until the mid-to-late 2000s, but has been on the increase since then. In 2012, 6.5 percent of 8th graders, 17.0 percent of 10th graders, and 22.9 percent of 12th graders used marijuana in the past month—an increase among 10th and 12th graders from 14.2 percent, and 18.8 percent in 2007. Daily use has also increased; 6.5 percent of 12th graders now use marijuana every day, compared to 5.1 percent in the 2007. Comment: The marijuana legalization efforts will further contribute to the acceptance of this drug as a "harmless" mood altering substance with "no" addictive potential. Synthetic marijuana is a new and major concern. Also known as Spice or K2, synthetic marijuana refers to herbal mixtures laced with synthetic cannabinoids, chemicals that act in the brain similarly to THC, the main active ingredient in marijuana. These mixtures could be obtained legally until recently and are still wrongly perceived as a safe alternative to marijuana. Synthetic marijuana was added to the MTF survey in 2011. In that year, 11.4 percent of 12th graders—one in nine—reported using it in the past year. This year 4.4 percent of 8th graders, 8.8 percent of 10th graders, and 11.3 percent of 12th graders reported past-year use. Nonmedical use of prescription and over-the-counter medicines remains a significant part of the teen drug problem. In 2012, 14.8 percent of high-school seniors used a prescription drug nonmedically in the past year. Data for specific drugs show that the most commonly abused prescription drugs by teens are the stimulant Adderall and the pain reliever Vicodin. Positive trends in the past several years include reduced use of inhalants and less use of cocaine. Inhalant use is at its lowest levels in the history of the survey. Past-year inhalant use by younger teens dropped significantly between 2007 and 2012, from 8.3 percent of 8th graders and 6.6 percent of 10th graders to 6.2 percent and 4.1 percent, respectively. Past-year use of cocaine by 12th graders dropped from 5.2 percent to 2.7 percent from 2007 to 2012. Other drugs, such as heroin, methamphetamine, and hallucinogens, are holding fairly steady. Ecstasy (MDMA) is seeing a significant drop among teens. Past-year use of ecstasy by 12th graders decreased from 5.3 percent in 2011 to 3.8 percent in 2012. Among 10th and 8th graders it dropped from 4.5 to 3.0 percent and from 1.7 to 1.1 percent, respectively. Yours Bernd

Opioid Treatment in the News

The content of the WSJ article titled "Painkiller Advocate Thinks Twice" neither shocks nor surprises me. Its a fact that in the US opioids are being prescribed by medical practitioners with little or no training in their clinical indication, application, dosing and length of treatment. As an international medical graduate from Germany and Israel I can attest to the fact that the use of prescription narcotics is far more restricted and controlled in other countries than in the US. It appears that in the US doctors are practicing on another planet, where the laws and rules of medicine do not apply: no tolerance to drugs, no drug induced hyperalgesia , no addiction. In South Florida ( another planet by itself) I routinely see patients for opiod dependence treatment who are being prescribed ungodly amounts of Oxycontin,Percocet or Lorcet for unspecified chronic pain syndromes related to "old" injuries, migraine or back pain with no, or little, documentation. Most of them I safely took off opioids and they are doing much better. The article clearly points out that the proponents of long-term opioid treatment provided little evidence for their efficacy or safety. Furthermore, the article also highlights how pharmaceutical companies such as Purdue Pharma, influenced and manipulated key decision makers and regulators including the Federation of State Medical Boards. Regarding Dr. Portenoy: after years of opioid treatment "education" and hundreds of thousands of dollars worth of paychecks by the pharmaceutical industry he still seems to struggle with the reality that opioid dependence can be induced by prescription narcotics and can be treated successfully. This article serves as an attempt by Dr. Portenoy to emulate Pilate in Matthew 27:24 in which he washes his hands in public to proclaim his own innocence. I definitely do not believe him and neither should any of the readers of this article. Happy Holidays. Yours

A Common Sense Approach

Attached a link to an article titled "UM offers community service program for students facing minor pot charges" describing a University Law Enforcement Assisted Diversion Program (U-LEAD), a first in Florida, which offers young first-time offenders facing misdemeanor marijuana possession charges an opportunity to avoid criminal charges. Personally, I fully support the decriminalization of marijuana possession which differs from legalization of marijuana as a drug. Its about time that we start focusing on addiction treatment and stop warehousing non-violent offenders in already overcrowded jails. Yours Bernd

Success in Florida

Miami, October 25th, 2012: Attached an article published in yesterday's Sun Sentinel highlighting the significant decrease in prescription narcotics overdose deaths as a result of the crackdown on pain clinics and the availability of the Prescription Drug Monitoring Program. Deaths related to oxycodone, the widely abused prescription painkiller, dropped by 17.7 percent in 2011. Overall, prescription drug overdoses fell by slightly more than 6 percent. But despite the decline in deaths due to painkillers, overall drug-related deaths increased by 134 last year, to 9,135.The increase was largely due to more fatalities linked to cocaine, alcohol and benzodiazepines, normally prescribed for anxiety or insomnia. Florida Attorney General Bondi said that she was "shocked" at how quickly the reforms had reduced oxycodone deaths. The new laws were in effect for only about six months last year. And the state prescription drug monitoring database was operational for only about three months. Finally, we are making progress and I thank all of you who work so hard to make our great State of Florida a safer place to live for us and our children. Yours Bernd =============================================================================================== Prescription drug overdoses fall in Florida October 24, 2012|By Kathleen Haughney, Tallahassee Bureau TALLAHASSEE -- Deaths related to oxycodone, the widely abused prescription painkiller, dropped by 17.7 percent in 2011, state officials announced today. The drop, they say, is a direct result of the state's battle to root out pain clinics and crack down on pill pushers. Overall, prescription drug overdoses fell by slightly more than 6 percent. "This is a milestone," said Attorney General Pam Bondi. "We know we have a long way to go. We have so far to go in this fight against drugs, but these numbers to us in such a short time are truly remarkable." Still, Wednesday's report by the Florida Department of Law Enforcement was a jarring reminder of the severity of Florida's overdose problem. It showed that, despite the decline in deaths due to painkillers, overall drug-related deaths increased by 134 last year, to 9,135. The increase was largely due to more fatalities linked to cocaine, alcohol and benzodiazepines, normally prescribed for anxiety or insomnia. FDLE Commissioner Guy Bailey acknowledged that the state's effort to target oxycodone and other painkillers sold through "pill mills" may have had the effect of diverting addicts to other drugs. "I will tell you there is speculation that it is a supply and demand issue, that some of the addicts, if you will, that we've blocked from the oxycodone have turned to these other drugs in the place, but we don't know that," he said. "At this point, it's speculation." In March 2011, Bondi and Gov. Rick Scott created strike force teams, partly funded by a federal grant, to target prescription-drug dealers in "pill mills," amid reports that Florida doctors prescribed more oxycodone than any other state. That spring, lawmakers also passed a comprehensive measure to crack down on pain clinics and the following fall, pharmacists began logging prescriptions for most controlled substances in a state database. Bondi said that she was "shocked" at how quickly the reforms had reduced oxycodone deaths. The new laws were in effect for only about six months last year. And the state prescription drug monitoring database was operational for only about three months. However, the oft-repeated statistic that seven people per day are dying of prescription-drug overdoses still holds true, Bailey said. Though there has been a decrease, it hasn't been quite enough to get the number down by even one person. "There was a very slight downtick," he said. "It's a little less than seven." Added Dr. Jan Garavaglia, the medical examiner for Orange and Osceola Counties: "To me, [the report] just shows there's still a lot of deaths from prescription drugs." The report showed that benzodiazapenes, like Xanax, were found to have at least contributed to the death of 1,879 people, and were the principal cause of death of 39 of them. Easier to obtain than oxycodone, the medications are increasingly showing up mixed in a cocktail with other drugs. Bailey said the state hasn't been "flag flying" on benzodiazapenes the way agents have been highlighting oxycodone abuse. Bondi said that she is hopeful that next year, when the laws have been in place longer, the numbers will go down even further. She said that her office, combined with law enforcement, is also working on more prevention programs.

Governor Scott May Reconsider PDMP Funding

Attached a link to an article titled " Scott, lawmakers may consider state dollars for drug database" reporting that Florida Governor Scott may agree to fund the important Prescription Drug Monitoring Program after all. As of September, 52 million records had been uploaded into the database, and more than 2.2 million patient reports had been generated for review by officials. With the launch of the database last fall and implementation of other reforms, law enforcement has seen a major reduction in street sales of oxycodone, one of the most widely abused prescription drugs. Last January, the Drug Enforcement Administration said oxycodone sales in Florida dropped 20 percent from 2010 to 2011. Lets keep up the pressure on Governor Scott to guarantee the financial sustainability of this important program which protects public health and saves lives. Yours Bernd ============================================================================================== Attached a link http://articles.sun-sentinel.com/2012-10-03/news/fl-editorialdrugs-td1003-20121003_1_prescription-drug-abuse-drug-database-oxycodone to an article titled " Drug Database Must Be Funded" published in the Sun Sentinel and my response in the form of a letter to the editor. I encourage you to act now by writing to your legislator and the Governors office supporting sustainable PDMP funding. Yours Bernd Letter to the Editor RE: Drug Database must be funded, Sun Sentinel, October 3rd 2012 I am a family physician and addiction specialist and use the Prescription Drug Monitoring Program (PDMP) as an essential tool in my daily medical practice. Having access to the history of prescribed controlled substances increases transparency and accountability and helps me to protect patients from inadvertent drug interactions which can often lead to accidental overdose and death. Yes, the program is imperfect and requires improvement. Real time drug dispensing reporting is still lacking and pharmacies have up to 7 days to enter dispensing data into the database. Physicians are not mandated to use the program when prescribing controlled substances and less than 900 physicians in Dade and Broward county are registered user. Therefore, we should double our efforts to increase PDMP access and use which requires funding and legislative support. Unfortunately, government officials are more interested in scoring political correctness points than providing the resources to protect public health by preventing accidental overdose deaths. There is no time for complacency. We need to act now to protect the PDMP. Bernd Wollschlaeger,MD,FAAFP,FASAM Former member of the Prescription Drug Monitoring Program Implementation and Oversight Taskforce

Drug database Must Be Funded

Attached a link to an article titled " Drug Database Must Be Funded" published in the Sun Sentinel and my response in the form of a letter to the editor. I encourage you to act now by writing to your legislator and the Governors office supporting sustainable PDMP funding. Yours Bernd Letter to the Editor RE: Drug Database must be funded, Sun Sentinel, October 3rd 2012 I am a family physician and addiction specialist and use the Prescription Drug Monitoring Program (PDMP) as an essential tool in my daily medical practice. Having access to the history of prescribed controlled substances increases transparency and accountability and helps me to protect patients from inadvertent drug interactions which can often lead to accidental overdose and death. Yes, the program is imperfect and requires improvement. Real time drug dispensing reporting is still lacking and pharmacies have up to 7 days to enter dispensing data into the database. Physicians are not mandated to use the program when prescribing controlled substances and less than 900 physicians in Dade and Broward county are registered user. Therefore, we should double our efforts to increase PDMP access and use which requires funding and legislative support. Unfortunately, government officials are more interested in scoring political correctness points than providing the resources to protect public health by preventing accidental overdose deaths. There is no time for complacency. We need to act now to protect the PDMP. Bernd Wollschlaeger,MD,FAAFP,FASAM Former member of the Prescription Drug Monitoring Program Implementation and Oversight Taskforce

DEA Blocks The Distribution of Controlled Substances

Attached a link to an interesting article titled "DEA blocks controlled-substance distribution at Florida Walgreens facility" reporting that " U.S. Drug Enforcement Administration on Friday banned a Walgreens distribution center in Jupiter from dispensing controlled substances to its pharmacies in Florida and the East Coast, saying the business constituted an "imminent danger" to the public. The DEA said that since 2009, the Jupiter distribution center has been the single-largest distributor of oxycodone products in Florida. An immediate suspension order alleges the distribution center did not have effective controls against the illegal use of controlled substances, DEA reports." The Jupiter facility is one of 12 Walgreens distribution centers, the DEA reports. The DEA served an administrative inspection warrant at the facility in April, as well as its top six retail pharmacies in Florida. One of those was at the Walgreens on Lockwood Boulevard in Oviedo. DEA said the Oviedo pharmacy ordered about 80,900 oxycodone units from the Jupiter distribution center in 2009. By 2011, that spiked to nearly 1.7 million units. In 2010, three Walgreens pharmacies were in the top 100 purchasers of oxycodone in Florida, DEA reports. Last year, 38 Walgreens pharmacies made the top 100, and six of those were in the top 10. A Walgreen spokesman responded that Walgreens has taken steps since mid-2011 to enhance monitoring and reporting criteria and that these actions have resulted in a 35 percent drop in the number of tablets dispensed by our pharmacies in Florida for the most commonly abused pain management drug between June 2011 and March 2012. In my opinion the DEA is correct in taking this drastic measures in order to curb the flood of Oxycodone prescriptions on the open market. Nevertheless, we also should ascertain the continuous supply of Oxycodone containing products for those patients with legitimate medical. This could be achieved by enrolling those patients in a chronic pain management program monitored by the prescribing physician to assure appropriate dosing, and the prevention of abuse and diversion. This would include the mandatory use of the Florida Prescription Drug Monitoring Program. This epidemic can be contained and the quality and safety of medical care must be assured. Yours Bernd Happy and Sweet New Year Shana Tova ve Metukah