Sober N Clean

Hydrocodone addiction is a growing crisis in the United States. While illegal drugs like cocaine, marijuana, methamphetamine, and heroin remain in the headlines many individuals may be surprised to know that hydrocodone addiction could lurk right behind them as one of the most widely-abused drugs of addiction. In fact, the federal Drug Enforcement Administration believes hydrocodone may be the most abused prescription drug in the country. Nationwide, its use has quadrupled in the last ten years, while emergency room visits attributed to hydrocodone abuse soared 500 percent.

Hydrocodone is a narcotic that can produce a calm, euphoric state similar to heroin or morphine--and despite such important and obvious benefits in pain relief, evidence is pointing to chronic addiction. Pure hydrocodone is a Schedule II substance, closely controlled with restricted use. But very few prescription drugs are pure hydrocodone. Instead, small amounts of hydrocodone are mixed with other non-narcotic ingredients to create medicines like Vicodin and Lortab. This means they can be classified under Schedule III with fewer restrictions on their use and distribution.

Vicodin, Lortab--and more than 200 other products that contain hydrocodone--are regulated by state and federal law. But they are not controlled as closely as other powerful painkillers. The lack of regulation makes them vulnerable to widespread abuse and addiction through forged prescriptions, theft, over-prescription, and "doctor shopping." Hydrocodone pills have been sold for $2 to $10 per tablet and $20 to $40 per 8 oz bottle on the street.

Subject to individual tolerance, many medical experts believe dependence or addiction can occur within one to four weeks at higher doses of Hydrocodone. Published reports of high profile movie stars, TV personalities and professional athletes who are recovering from Hydrocodone addiction are grim testimony to its debilitating effects.

Hydrocodone is structurally related to codeine and is approximately equal in strength to morphine in producing opiate-like effects. The first report that hydrocodone produced a noticeable euphoria and symptoms of addiction was published in 1923; the first report of hydrocodone addiction in the U.S. was published in 1961.

Every age group has been affected by the relative ease of hydrocodone availability and the perceived safety of these products by professionals. Sometimes seen as a "white-collar" addiction, hydrocodone abuse has increased among all ethnic and economic groups. DAWN data demographics suggest that the most likely hydrocodone abuser is a 20-40 yr old, white, female, who uses the drug because she is dependent or trying to commit suicide. However, hydrocodone-related deaths have been reported from every age grouping.

Examples of how severe Hydrocodone addiction has become:

An estimated 7 million dosage units were diverted in 1994 and over 11 million in 1997.
In 1998 there were over 56 million new prescriptions written for hydrocodone products and by 2000 there were over 89 million.
From 1990 the average consumption nationwide has increased by 300%. In the same period there has been a 500% increase in the number of Emergency Department visits attributed to hydrocodone abuse with 19,221 visits estimated in 2000.
In 1997, there were over 1.3 million hydrocodone tablets seized and analyzed by the DEA laboratory system.
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source: drug-addiction.com

Here's a multiple-choice question for parents of tweens and teens.

You're monitoring your child's cellphone and come across a text message encouraging her to try a prescription drug. Could the message be coming from:

A. a drugmaker trolling for a new customer.

B. an adolescent friend urging a raid on your medicine cabinet for a "pharm" party.

C. a trusted physician, offering a reminder to the 25 percent of teenagers who take a daily prescription for conditions ranging from allergies to cancer.

D. any one of the above.

The answer? D. These days, messages aimed at drawing teens' attention to drugs are being televised, e-mailed, texted and even downloaded with music every day.

"These new media choices create a buzz and certainly a perception of a rising trend toward targeting teens," says Jim Joseph, executive vice president of Saatchi & Saatchi Consumer Health+Wellness, a Manhattan advertising agency.

The challenge for teens, and for adults who care for them, is to figure out "how to wade through the clutter of messages they're getting about drugs -- both prescription and nonprescription ones -- in order to make safe and appropriate choices," says Wayne Snodgrass, a professor of pediatrics and pharmacology at the University of Texas Medical Branch in Galveston and chair of the American Academy of Pediatrics Committee on Drugs.

"There's been a demystification of prescription medications for teenagers," says Sharon Levy, director of the adolescent substance abuse program at Children's Hospital Boston. According to a survey published last month by the National Center for Addictions and Substance Abuse, a growing number of teenagers say it's easier to illegally obtain prescription drugs than to buy beer.

Experts blame a cavalier attitude toward drugs for a growing incidence of prescription drug abuse by teens. Every day, 2,500 kids ages 12 to 17 abuse a prescription painkiller for the first time, according to John Walters, head of the White House's Office on National Drug Control Policy; the number of teen patients treated for prescription painkiller abuse grew threefold between 1995 and 2005.

"Teens are abusing prescription drugs because many believe . . . these drugs provide a 'safe' high," Walters says.

At the same time, many teens fail to stick with a prescribed drug regimen for a chronic condition such as asthma, depression or diabetes. "Parents have a crucial role to play in all this," Snodgrass says, "by making it clear that drugs are only safe and effective when they're specifically prescribed, and when taken appropriately."
Drug Ads Just for Teens

When it comes to direct-to-consumer advertising for prescription drugs, permitted by the Food and Drug Administration since 1997, there are no specific rules for marketing to kids and teens, says Robert Temple, director of the Office of Medical Policy at the FDA's Center for Drug Evaluation and Research.

"Appropriate situations for drug companies to specifically address teens include those where the teen could benefit from a medication but might not necessarily start the conversation with an adult," says Meredith Ressi, vice president of research at Manhattan Research, a health-care market research firm in New York. She cites drugs for acne or birth control as examples.

Acne, Ressi says, is a very good example because "a parent might not bring up treatment for fear of making their child feel bad but would likely be delighted to have the teen start the conversation and then be able to help."

Tazorac, an acne drug made by Allergan, is the subject of a back-to-school ad campaign featuring situations such as high school graduation and the prom in which teens might feel particularly self-conscious about their acne. Incentives to register on the site and learn more about the drug (teens 13 to 18 need a parent's permission) include a $5 Starbucks card and a chance at winning a Nintendo Wii console, a video camcorder or a laptop computer.

Ads meant to get a teen's attention typically feature cool clothes, hip music and other teen draws. Bayer Healthcare Pharmaceuticals, the maker of Yaz, a birth control pill, hired the Veronicas, a group popular with teen girls, to record a song for one of the drug's commercials. The Web site of Galderma, the maker of Differin, another acne drug, offers teens a quiz called "The Truth About Zits."

"When marketing directly to teens, you need to be able to speak to and otherwise engage them very differently from adults," says Elizabeth Izard Apelles, CEO of digital marketing agency Greater Than One, whose clients include Novartis, which makes ADHD drug Focalin XR. "Otherwise, they won't pay a lick of attention."

Other advertising execs agree.

"We use a combination of media, trying to reach" teens, says Kathy Magnuson, executive vice president of Brand Pharm, whose clients include Galderma. In June, Galderma launched a Differin ad on ABC Family and MTV and has also bought space for the ad at movie theaters and on the Internet.

Drugmaker Sanofi Aventis used a low-tech but novel approach to reach teen girls. The company placed a full-page ad (plus another page of FDA-required consumer information) for acne drug Benzaclin in the fall catalogue of Delia's, a teen-girl clothing chain.
Msg frm yr drg cmpny

Merck is moving beyond TV ads for Gardasil, which protects against human papillomavirus infection and is recommended for adolescent girls. Because the vaccine is given in three doses, each months apart, Merck is sending out reminders by mail, e-mail and text message -- "REMIND" to "GARSL" -- telling those who got the first shot to come back for shots two and three.

Kathy Woodward, a pediatrician at the adolescent health clinic at Children's National Medical Center in Washington, worries that ads aimed at adolescents often create an inappropriate sense of fun, fostering the idea that there's a pill for every ill. Woodward believes taking drugs might seem hip, for example, when Antonio Banderas, whose voice is well known from the "Shrek" movies, narrates TV commercials for the allergy drug Nasonex.

Woodward says she has been overwhelmed by the number of teenage boys who come in asking for a prescription for Lamisil, an antifungal drug. TV ads that stopped airing about a year ago said dark-colored toenails might be a fungal infection that the drug can clear up.

"It's only an infection 10 percent of the time," says Woodward, "and leaving the nail as it is poses no health risk." What's more, because of a slight risk of liver damage, Woodward notes, anybody who takes the drug needs monitoring.

"When teenage boys make [a drug they've seen advertised] the focus of their yearly office visit," she explains, "it takes away time I need to talk about crucial health issues including safe driving, alcohol and prescription drug abuse."
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source: The Washington Post

New research into the selling of drugs online has found that while the number of sites offering drugs has declined for the first time since the study began in 2004, overall availability is still too high.

Researchers at the Columbia University's National Center on Addiction and Substance Abuse (CASA) spent 210 hours online researching companies selling drugs to consumers and found 365 sites this year, compared to 581 over the same period last year.

“This decline in the number of Web sites advertising or selling controlled prescription drugs may reflect efforts of federal and state agencies and financial institutions to crack down on Internet drug trafficking. Nevertheless, in spite of those efforts, anyone of any age can obtain dangerous and addictive prescription drugs with the click of a mouse,” said Joseph A. Califano, Jr., CASA’s president and former U.S. Secretary of Health, Education, and Welfare.

“This problem is not going away. It is morphing into different outlets for controlled prescription drug trafficking like Internet script mills and membership sites that sell lists of online pharmacies, and different payment methods like eChecks, COD and money orders.”

The study found that 90 per cent of sites sold benzodiazepines (like Xanax and Valium), with 57 per cent selling opioids (like Vicodin and OxyContin), and stimulants (like Ritalin and Adderall) available at 27 percent of sites.

Overall 85 per cent of sites did not demand a prescription for the drugs, and half of those that did only required the prescription to be faxed, which makes forgery easier.

Most of the drug sites were located outside the United States, although almost a quarter are registered in the country. Worryingly the geographical location of over a third of the sites proved impossible to determine.

The group called for mandatory regulation and certification of internet drug sites, with an original prescription required and search engines should block all unregistered sites.
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source: http://www.vnunet.com

A pilot program based in Broward County would help police and doctors track prescriptions.

Broward County, scene of the most famous prescription-drug overdose this year, might become the testing ground for a new database aimed at curbing doctor-shopping.

Florida legislators are proposing a pilot program that would create a computerized system to track the prescriptions that are requested, written and filled in Broward for some of the most addictive medicines.

Certain prescription drugs -- including those like Oxycontin, Vicodin and Xanax -- were implicated in more than 300 Broward deaths last year.

Earlier this year, celebrity Anna Nicole Smith died during a stay at the Seminole Hard Rock Hotel & Casino near Hollywood. An autopsy concluded that a lethal mix of at least nine prescription drugs caused her death.

While high-profile cases like Smith's -- and that of conservative pundit Rush Limbaugh, who admitted an Oxycontin addiction in 2003 -- grab headlines, supporters of stricter prescription monitoring say the abuse of legal medication is causing a growing number of deaths, arrests and emergency-room visits. In recent months, they say, out-of-state visitors have been shopping for Florida doctors, creating a form of prescription-drug tourism.

''It's a serious problem,'' said state Rep. Jack Seiler, a Wilton Manors Democrat and House sponsor of the proposal. ``And if you think for a moment those costs aren't being borne by the taxpayer, you're wrong. The North Broward Hospital District, the South Broward Hospital District, the courts, the jails -- those are all things that we pay for.''

Supporters say they will continue to push for a statewide program as in years past, but want to present the one-county pilot as an alternative.

Opponents say most tracking systems do little to reduce abuse and might discourage doctors from writing prescriptions for those who need them.

''If doctors know they're being watched, then they won't do as much,'' said David Brushwood, a professor at the University of Florida's College of Pharmacy. ``It's like going through a speed trap. When people go through a speed trap, we want them to slow down to the speed limit. We don't want them to slow down below the speed limit because that's dangerous.''

OVERDOSE DEATHS

Statewide, prescription drugs caused more than twice as many overdose deaths last year as illicit drugs, such as heroin or cocaine, said Bill Janes, director of the state's Office of Drug Control. Drugs like Oxycontin, Vicodin, Valium and Xanax were involved in more than 500 deaths in Broward and Miami-Dade counties.

''There's something more socially acceptable in taking a prescription medication than taking cocaine on the street,'' said Dr. Jeffrey N. Bernstein, medical director of the Florida Poison Control Center and an attending physician at Jackson Memorial Hospital. ``It's easier to go to a doctor and pretend you have back pain and try to get a prescription for a painkiller than it is to go into a bad neighborhood and look for an illegal drug.''

The number of cases in Broward's drug court involving doctor-shopping has at least doubled in the past few years, said Judge Marcia Beach.

A decrease in the number of cocaine arrests has helped prevent a backlog, she said. But Beach said many prescription-drug patients have built up a high tolerance for the drugs and need more-expensive care.

''It's difficult for them to detox,'' Beach said. ``And it's more difficult for them to succeed on an outpatient basis. . . . Many of them require residential treatment.''

The proposed $1.6 million Broward database would keep a record of a patient's prescriptions and could be accessed by doctors, pharmacists, patients, law-enforcement agencies and the Agency for Health Care Administration. It would be funded privately and with federal grants and would be designed to look for people who are ''doctor-shopping,'' that is, visiting multiple doctors in search of duplicate prescriptions.

''If they go to one ER, then 30 minutes later they go to another ER, then 30 minutes later they go to another ER -- that's not a person in real pain,'' said Dr. Nabil El Sanadi, chief of emergency medicine for Broward Health. ``If they were tracked in that database, we could see it better.''

About 35 states have passed legislation to create a monitoring system, and at least 24 are in use. Florida is the largest state without one, which worries law-enforcement and drug-abuse experts who say they have seen a growing number of prescription-drug tourists.

''They find it cheaper to come to Florida, stock up, have a nice vacation and head back and have enough pills to feed their habit and to sell and pay for the trip,'' said Jim Hall, director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University, which has a partnership with the Commission on Substance Abuse of the United Way of Broward County.

BUY AND SELL

Sgt. Lisa McElhaney, of the drug diversion unit of the Broward Sheriff's Office, said that in the past couple of months, the BSO has found at least 600 people trying to buy prescription medications in Broward to sell in other states.

''Florida has become a source state for prescription-drug seekers,'' she said.

Lawmakers have tried to create a statewide database for the past five years -- with powerful backers, including former Gov. Jeb Bush.

Concerns about patient privacy and how to pay for the database have stalled previous attempts at monitoring.

Brushwood questions the effectiveness of such systems. Many don't include enough personal information to tell whether prescriptions were issued to one person or several with similar names, he said. The systems could be circumvented with fake IDs.

''The question is: Does it reduce diversion and substance abuse?'' Brushwood said. ``I don't think it does.''

Opponents of the one-county Broward proposal argue that people would just move on to Miami-Dade or Palm Beach.

''Limiting it to just Broward won't capture the kinds of data and control substance abuse like we'd like to see,'' Broward Mayor Lois Wexler said. ``It's too easy to cross county lines here, so I would encourage the program to be regional.''

Bernstein, of the Florida Poison Control Center, said that the details need to be worked out, but that without better tools, doctors can be left relying on instinct.

''Nobody wants to see anybody in pain,'' he said. ``But you have no way to know that he's been to five other ERs in town.''

source: miamiherald.com