Appalachia Addresses Appalling Abuse of Prescription Drugs

While prescription drug abuse affects all walks of life— urban, suburban, and rural— residents of rural counties are nearly twice as likely to overdose on painkillers as people in larger cities. And this fact rings true in Appalachia.

Coalitions throughout Appalachia have been working on strategies to solve the epidemic. For example, a state-wide conference “The Different Faces of Substance Abuse” took place recently in Kentucky. Catherine Brunson, a CADCA trainer, conducted a training on CADCA’s Rx Abuse Prevention Toolkit.

And the federal government is taking notice of the problem. Recently Gil Kerlikowske, Director of National Drug Control Policy at the Office of National Drug Control Policy, met with seven governors who are members of the Appalachian Regional Commission (Alabama, Kentucky, Mississippi, North Carolina, Pennsylvania, Tennessee, and West Virginia) to discuss the serious threat of prescription drug abuse to Appalachian communities and the Obama administration’s efforts to reduce drug use and its consequences through a public health and safety approach. During the meeting, Alabama governor Robert Bentley, Kentucky governor Steven Beshear, Mississippi governor Phil Bryant, North Carolina governor Beverly Perdue, Pennsylvania governor Tom Corbett, Tennessee governor Bill Haslam, and West Virginia governor Earl Ray Tomblin discussed the toll that prescription drug abuse has taken on Appalachian communities and actions state leaders are taking to prevent abuse and trafficking through education, information-sharing, interstate task force cooperation to crack down on “pill mills,” and treatment programs.

“The devastation wrought by prescription drug abuse on Appalachian communities is simply heartbreaking,” Kerlikowske told the group. “Prescription drug abuse is claiming too many lives, threatening public safety, and placing unnecessary obstacles in the way of economic prosperity in Appalachia. While we must ensure that Americans have legitimate access to lifesaving prescription medications, the Obama administration also remains laser focused on addressing this epidemic through a comprehensive public health and safety approach. All of us have a role to play in this effort, and I commend Governors from Appalachia for leading the way in recognizing the severity of this challenge and implementing evidence-based reforms to protect their communities from the misery caused by this epidemic.”

CADCA’s Chairman and CEO, Gen. Arthur Dean, will be addressing public and private stakeholders from across the country in sessions that highlight prevention, education, treatment and law enforcement efforts in addressing the prescription drug epidemic, particularly hard-hit Appalachia, at the inaugural National Rx Drug Abuse Summit. Organized by CADCA member Operation UNITE, headquartered in Kentucky. The Summit will take place April 10-12 in Florida. Other headliners include Florida Attorney General Pam Bondi, Director Kerlikowske and the Surgeon General Dr. Regina Benjamin.

According to the Centers for Disease Control and Prevention, deaths from prescription painkillers have reached epidemic levels in the past decade and now exceed deaths from heroin and cocaine combined. Prescription painkiller overdoses killed nearly 15,000 people in the U.S. in 2008—a rate of 4.8 deaths per 100,000 population. This rate is nearly four times the rate for 1999.

There is still a lot of work to do, but Bondi told attendees at the “Faces” conference that the "pill pipeline" between her state and Kentucky has been significantly reduced thanks to tougher regulations and the launch of a prescription monitoring program.

Kentucky Attorney General Jack Conway also spoke at the conference. He announced that he and House Speaker Greg Stumbo are close to finalizing a broad legislative package focused on pain management clinics and KASPER, the state's electronic prescription monitoring program, including: requiring prescribers who write scripts for certain controlled drugs to be registered; requiring KASPER reports be run on patients before pills are given out in emergency rooms; strengthening mandatory penalties for doctors who over-prescribe pills; and expediting the process of reviewing doctors who over-prescribe.

“It was amazing to have the attorney generals from both Kentucky and Florida at our conference,” said Sheila D. Barnard, Director of CADCA-member coalition Ohio County Together We Care in Beaver Dam, Ky. “As part of the planning committee for the conference, I thought it was important to have them there, as the Rx pipeline goes straight from Kentucky to Florida.”

Barnard said that 60 percent of the pills on the street in her state come from Florida.

The Food and Drug Administration provides guidelines for the proper disposal of unused or expired medicines, and ONDCP encourages the proper disposal of prescription drugs in an effort to reduce diversion. On April 28, the Drug Enforcement Administration will host another National Prescription Drug Take-Back Day. At last fall’s Take-Back Day, Barnard’s coalition collected 183 pounds of unused medications. She plans to participate in the event next month. The coalition is also close to securing a permanent drop box in their community. Barnard worked in a pharmacy before she worked in a coalition and saw some of the worst prescribing behavior, but now sees some of the best.

At the sold-out conference, Barnard said there were representatives from all aspects of their Rx abuse problem: public health, coalitions, University of Kentucky, clinicians, law enforcement and pharmacists.

“I do think physicians and hospitals are stopping the unnecessary prescriptions. A lot of education needs to get into the right hands and the coalitions are doing that. We’re all (going to) have to work together to combat this, though. It’s not just a Kentucky or Florida problem. It’s an interstate problem,” Barnard said.

To participate in a take-back event, visit www.DEA.gov.

Research Reveals New Information about “Bath Salts”

Drugs known as “bath salts” are one of a growing list of synthetic and unevenly regulated narcotics that are found across the United States and on the Internet. New research on this potent drug paints an alarming picture, revealing that bath salts pack a powerful double punch, producing combined effects similar to both methamphetamine and cocaine, Medical News Today reports.

"This combination of effects is particularly novel and unexpected," said Louis J. De Felice of Virginia Commonwealth University's School of Medicine in Richmond, Va. "Methamphetamine and cocaine operate in the brain in completely opposite ways. It would be atypical that both drugs would be taken together, but that's the effect that occurs with bath salts."

De Felice and his colleagues presented their research this week at the 56th Annual Meeting of the Biophysical Society in San Diego, Calif.

The team's research reveals that bath salts contain two structurally similar chemicals that produce quite dissimilar effects on the brain's dopamine transport system. Dopamine is a neurotransmitter that plays an important role in the brain's pleasure and reward centers. Though bath salts' chemicals are structurally similar, both acting as potent psycho-stimulants, they use completely opposite mechanisms in the brain.

The first component is a dopamine-releasing agent known as mephedrone, which, like meth, causes the brain to release more dopamine. The other chemical is methylenedioxypyrovalerone, which, like cocaine, is a dopamine reuptake inhibitor. Both compounds increase dopamine availability to receptors, and both, through different mechanisms, produce feelings of euphoria.

The surprising finding is that rather than canceling each other out, as would be anticipated, the chemicals combine to enhance the effects of the other.

"The two drugs have different kinetics, so rather than cancel each other they exacerbate the effect of either drug applied alone," De Felice told Medical News Today.

The researchers began this particular project as part of a larger study on how amphetamine and meth affect the human dopamine transporter molecule. They made the novel finding that both chemicals create long-lasting effects that endure 30 minutes or more after the drugs are removed. This initial research continued with cathinone, which is a naturally occurring compound found in the khat shrub (Catha edulis). The drugs found in bath salts are synthetic derivatives of cathinone.

"The stimulant and blocker features of these drugs have been studied previously," De Felice said, "but the evidence for long-lasting stimulation by MEPH and inhibition by MDPV is novel. It also is in some sense unexpected that two structurally similar agents could act oppositely at the dopamine transporter."

The researchers do not yet know why these drugs have a persistent effect. They also don't understand the fundamental reason why two structurally similar drugs act oppositely on the dopamine transporter.

"There also are many questions on the meaning of these findings for the dozens of other illicit synthetic drugs that have found their way to the street," concludes De Felice. "We do suspect, however, that the combination that is found in bath salts could be behind its powerful physiological and neurological effect on users."

CADCA and the DEA recently produced a CADCA TV show on this topic highlighting the success of our coalitions on reducing bath salts in their communities. Watch the show anytime at http://www.cadca.org/cadca_tv/designer-drugs-new-frontier.

Help Educate Your Community about the Dangers of Inhalant Use During National Inhalants and Poisons Awareness Week

Mark your calendars for National Inhalants and Poisons Awareness Week (NIPAW), observed March 18 – 24. NIPAW is an opportunity to raise awareness of the dangers of inhalants and to get your community engaged on this issue. This year celebrates the 20th anniversary of the event.

NIPAW is designed to mobilize people and communities in a public health campaign to reduce and prevent instances of experimentation with or misuse of common household, school and office products and chemicals.

One in five students in America has used an inhalant to get high by the time he or she reaches the eighth grade. Parents don't know that inhalants, cheap, legal and accessible products, are as popular among middle school students as marijuana. Even fewer know the deadly effects the poisons in these products have on the brain and body when they are inhaled or "huffed." Both dusting and huffing can result in damage to the brain, lungs, heart, kidneys and liver, and can cause “sudden sniffing” death. Experts say death can happen even the first time someone huffs.

Some common products abused as inhalants include model airplane glue, rubber cement, household glue, spray paint, hairspray, air freshener, deodorant, fabric protector, computer keyboard cleaner, nail polish remover, paint thinner, toxic markers, pure toluene, cigar lighter fluid, gasoline, carburetor cleaner, octane booster, spot remover, degreaser, vegetable cooking spray, dessert topping spray (whipped cream), nitrous oxide, butane, propane, helium and especially computer keyboard cleaner, referred to as “dusting.”

Harvey Weiss, Director of the National Inhalant Prevention Coalition (NIPC) in Chattanooga, Tenn. that organizes the campaign, said, “We must note that most professionals appreciate that inhalant deaths may go unnoted and underreported.”

To get your coalition involved in the campaign, visit www.inhalants.org.

New Online Marijuana Resource Center Available to Coalitions

Marijuana is a topic of significant public discourse in the United States, and while many are familiar with the discussions, it is not always easy to find the latest, research-based information on marijuana to answer to the common questions about its health effects, or the differences between Federal and state laws concerning the drug.

Confusing messages being presented by popular culture, media, proponents of “medical” marijuana, and political campaigns to legalize all marijuana use perpetuate the false notion that marijuana is harmless. This significantly diminishes efforts to keep young people drug free and hampers the struggle of those recovering from addiction.

The Office of National Drug Control Policy opposes legalization of marijuana and other drugs because legalization would increase the availability and use of illicit drugs, and pose significant health and safety risks to all Americans, particularly young people. This Web-based resource center provides the general public, community leaders, and other interested people with the facts, knowledge, and tools to better understand and address marijuana in their communities.

This resource center will be regularly updated and expanded to address emerging issues, research, and prevention tools, and highlight successful local efforts to reduce marijuana use.

For more information, visit

http://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana

Early Intervention Proven to be Best Strategy for College Binge Drinking

The Penn State Live website this week reported on new “early intervention” research conducted by their own scholars that may help students from becoming binge drinkers.

"Research shows there is a spike in alcohol-related consequences that occur in the first few weeks of the semester, especially with college freshmen," said Michael J. Cleveland, research associate at the university’s Prevention Research Center and the Methodology Center. "If you can buffer that and get beyond that point and safely navigate through that passage, you reduce the risk of later problems occurring."

The researchers tested two different methods of intervention on incoming freshmen— parent-based intervention and peer-based intervention. Cleveland and his colleagues found that students who were nondrinkers before starting college, and who received the parent-based intervention, were unlikely to escalate to heavy drinking when surveyed again during the fall semester of their first year.

Students who were heavy drinkers during the summer before college were more likely to transition out of that group if they received either parent-based intervention or peer-based intervention. However, if a heavy-drinker received both interventions, there was no enhanced effect.

Cleveland also reported online in Psychology of Addictive Behaviors that 8 percent of the incoming freshmen were heavy drinkers the summer before starting college. The researchers surveyed the students again during the fall semester and found 28 percent of the freshmen now drank heavily.

The results of the study were based on a study of 1,275 high-risk matriculating college students originally conducted in 2006 by Rob Turrisi, professor of biobehavioral health. Turrisi and his colleagues randomly assigned students to one of four intervention groups—parent-based intervention only, peer-based intervention only, both parent- and peer-based intervention or no intervention—and then surveyed the students on their drinking behaviors the summer before they entered college and then again during their first fall semester.

To read more about this research, visit Penn State’s website.

The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism both supported this research.