Category Archives: Substance Abuse

Rocky Mountain High or Reefer Madness? Legal pot in Colorado comes with risks

Cannabis_leaf_marijuana_potA reporter returns to his hometown and confronts the new reality of legalized marijuana.

By Marshall Allen
ProPublica, April 7, 2014

This story was co-published with The Cannabist

I walked through clouds of marijuana smoke Friday night to get to the Denver Nuggets basketball game.

The sweet smell lingering in the air reminded me less of a family event and more of the time I saw AC/DC on “The Razor’s Edge” tour at the old McNichols Sports Arena.

I grew up in Colorado, but it’s been a while since I lived in the state. When I returned for a recent conference, I found that a place settled by the Gold Rush is now mad about reefer.

In 2012, Colorado voters became the first in the nation to approve recreational pot use. The good times rolled out Jan. 1, when stores started selling it.

I’ve never tried pot, but I graduated from the University of Colorado — Boulder, which is famous for its annual “4/20″ public pot parties. At CU, you can practically get a contact high walking to class.

But I saw more public pot use in my two-day visit to Lower Downtown Denver than in years spent at Boulder.

It’s supposed to be illegal to smoke or consume pot in public. But then the day after the game, while jogging down the Speer Boulevard bike path, I passed a guy lounging under a tree lavishing his affections on a joint.

Anyone over 21 can walk into a dispensary and load up on bud, marijuana baked goods and candy. Continue reading

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Smoking Mad: Tobacco users caught up in Obamacare “glitch”

Cigarette Smokeby Charles Ornstein
ProPublica, March 24, 2014

Retired New Hampshire nurse Terry Wetherby doesn’t hide the fact that she smokes.

She checked the box on HealthCare.gov saying she uses tobacco and fully expected to pay more for her insurance policy under the Affordable Care Act. “It’s not a secret at all,” she said. 

Wetherby dutifully paid the premium Anthem Blue Cross and Blue Shield charged her for January and again for February — and believed she had coverage effective on Jan. 1.

Then when Wetherby went to pay her March premium, she was told she couldn’t. A check arrived in the mail refunding her February premium with a two-word explanation: “Contract cancelled.” Continue reading

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How to keep kids safe with the legalization of marijuana

Cannabis_leaf_marijuana_potFrom Seattle Children’s On the Pulse blog
Feb 24, 2014

The legalization of marijuana in the state of Washington, along with the impending legalization of marijuana sales this spring, has sparked concern among many parents who have questions on what this means for their children.

Leslie Walker, MD, division chief of Adolescent Medicine at Seattle Children’s Hospital, recently co-authored a guide for parents about preventing underage marijuana use. Walker says that it’s important for parents to know the facts, learn how to talk about marijuana and be aware of the messages that their children may see.  Continue reading

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Something odd about your cigarette? FDA wants to hear about it

Consumer Update from the FDA

Cigarette SmokeAre you using a tobacco product that you believe is defective or is causing an unexpected health problem?

Are you using a tobacco product that has a strange taste or smell?

The Food and Drug Administration (FDA) wants to hear from you and has a new online tool you can use to report your problem. Continue reading

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lesson one

Oregon schools use ‘behavioral vaccine’ to reduce smoking

Blackboard with "Lesson one" written on it.

Photo: Krzysztof “Kriss” Szkurlatowski

By Kristian Foden-Vencil
Oregon Public Broadcasting

Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea.

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.”

Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a study that found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership that includes NPROregon Public Broadcasting and Kaiser Health News

Photo courtesy of Krzysztof “Kriss” Szkurlatowski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Study doubles estimate of pot use in Washington state

Cannabis_leaf_marijuana_potMarijuana consumption in Washington state is about twice as large as previously estimated, according to a new RAND Corporation study.

Washington voters approved Initiative 502 in November 2012 that legalized recreational use of marijuana for those aged 21 and older, and requires the state to regulate and tax a new marijuana market.

Commercial marijuana stores and associated supply chains are scheduled to begin operating in 2014.

In the study, researchers used data from the federal government as well as data from a survey of marijuana users in the state to estimate that state’s annual consumption of marijuana.

They conclude consumption will likely range between 134 metric tons to 225 metric tons this year, with a median of 175 metric tons, or about 385,809 pounds.

The state’s three most-populous counties (King, Snohomish and Pierce) account for about half of all use. King County accounts for about 30 percent of the marijuana users, while Snohomish and Pierce counties have roughly 11 percent each, the report found.

The Washington Office of Financial Management previously had estimated that marijuana consumption in Washington would be 85 metric tons in 2013.

The analysis was done as a part of efforts to help the Washington State Liquor Control Board prepare for commercial sales of marijuana

The RAND report, “Before the Grand Opening: Measuring Washington State’s Marijuana Market in the Last Year Before Legalized Commercial Sales,” is available at www.rand.org.

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As Washington delays, states move on e-cigarettes

eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Teens and steroids: a dangerous combo

anabolic steroids DEA

Contraband anabolic steroids seized by the Drug Enforcement Agency. (Photo: DEA)

US Food and Drug Administration
Consumer Update

The abuse of anabolic steroids can cause both temporary and permanent injury to anyone using them.

Teenagers, whose bodies are still developing, are at heightened risk. An alarming number of them are trying steroids in hopes of improving their athletic prowess or their appearance.

Ali Mohamadi, M.D., a medical officer in the Food and Drug Administration’s Division of Metabolism and Endocrinology Products, warns teens and parents about the dangers of steroid use.

Q: What are anabolic steroids and how many teens use them?

A: They are drugs that mimic the actions of the male sex hormone testosterone. This includes promoting the growth of cells, especially in muscle, and maintaining or increasing male physical characteristics. Various studies have been conducted and generally reflect the findings of a Youth Risk and Behavior Surveillance System study, which estimated that among U.S. high school students, 4.9% of males and 2.4% of females have used anabolic steroids at least once in their lives. That’s 375,000 young men and 175,000 young women.

Q. What are the side effects of taking anabolic steroids?

A: They are known to have a range of serious adverse effects on many organ systems, and in many cases the damage is not reversible. They include fertility problems, impotence, high blood pressure and cholesterol, and heart and liver abnormalities. Boys may experience shrinkage of the testes or the development of breast tissue; girls may experience menstrual irregularities and development of masculine qualities such as facial and body hair. Both may experience acne. Both boys and girls may also experience mood swings and aggressive behavior, which can impact the lives not only of those taking steroids, but of everyone around them.

Q: Are prescriptions needed to get steroids?

A: Yes, in fact anabolic steroids are classified as Schedule III Controlled Substances by the U.S. Drug Enforcement Administration with strict regulations, meaning that not only is a prescription required, but there are extra controls. For example, it is illegal to possess them without a prescription in the United States, and in most circumstances the prescription must be in written form and cannot be called in to a pharmacist. Labels on some steroids recommend testing of hormone levels during use.

The number of FDA-approved uses is limited. Most are prescribed as a replacement for sub-normal levels of steroids. They are also prescribed for conditions such as muscle wasting, poor wound healing, and very specific pulmonary or bone marrow disorders.

A health care professional can prescribe steroids off-label, meaning for conditions other than those that are FDA-approved. But children, particularly teens, are getting access to steroids and taking them for reasons far outside of their intended use.

Q: So how are teens getting access?

A: Some get prescriptions from a licensed practitioner for such purposes as introducing puberty to boys who are “late bloomers” or to stimulate growth among teens who are failing to grow. Some may be dealing with unscrupulous clinics or street dealers on the black market. Unfortunately, a number of vendors sell anabolic steroids online without a prescription. Individuals should also be aware that some dietary supplements advertised for body building may unlawfully include steroids or steroid-like substances, and the ingredient statement on the label may not include that information.

Q: What is the FDA doing to prevent those illegal sales?

A: FDA is taking a number of steps to discourage these practices. Action has been taken against illegal online distributors who sell steroids without valid prescriptions, but an ongoing problem is that you can take one site down and another pops up.

The challenge is intensified by the fact that many online providers don’t accurately advertise the contents of the products they sell, they may be operating outside the U.S., and the drugs aren’t prescribed by a licensed practitioner who can help individuals weigh the risks and benefits. In such cases, individuals may have no idea what they are taking, what the appropriate dose should be, or what levels of control and safety went into the manufacturing process. These facts make the risks of taking anabolic steroids bought without a prescription even greater than they otherwise would be.

Q: What would you say to a teen you knew was tempted by steroids?

A: I would emphasize both the short and long-term potential for serious harm to their health. Rather than making you look or perform better, steroids will more likely cause unfavorable results that could affect you for life. I would also remind them that there are a number of ways to increase muscle mass and athletic performance, including a sensible regimen of exercise and diet, without resorting to extreme and dangerous therapies.

Q: What would you like to say to parents?

A: Parents tend not to believe their teens would consider taking anabolic steroids, but the truth is that the frequency of steroid use in this age group is far greater than many would guess.

During this time of year, when children are in school and getting back into their athletic routines, parents should watch for potential signs of abuse. Mood swings are among the first side effects to show up, and steroid use may lead to mania or depression. Acne is also an early side effect and can be followed by breast development in boys or increased body hair in girls. A surprising gain of muscle mass should also raise questions. It’s a problem that is as real as it is surprising.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Nov. 4, 2013

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Addressing a dangerous epidemic: Abuse of Painkillers and other prescription drugs

Tablet Thumb BlueBy Ankita Rao
KHN

About 50 Americans die every day from a prescription drug overdose — a tally that, in most states, turns out to be more than deaths from car accidents.

In a new report, “Prescription Drug Abuse: Strategies to Stop the Epidemic,” researchers at the Trust for America’s Health found that rates of overdose and addiction doubled since 1999 in most states.

In West Virginia — the state with the highest number of drug overdose deaths — the rate was six times higher than fourteen years ago.

During a conference call on Monday, the researchers said the emergence of prescription drugs like oxycodone has benefitted many people but is also marked by a corresponding rise in misuse.

“Working on this report, we were overwhelmed by the number of sad stories of tragedies that could have been averted,” said Jeff Levi, executive director of the Trust for America’s Health.

He said intervention strategies — ranging from the education of health providers to the correct disposal of unused medications — are proven solutions.

The Trust for America’s Health, along with other public health and law enforcement experts, reviewed national recommendations and examined a set of 10 indicators that were having a positive impact, including certain laws and educational initiatives.

But most states had in place six or less of the indicators that help curb the issue. Only New Mexico and Vermont had all 10 strategies touted by the report. South Dakota had the lowest number: two.

Levi also said a Medicaid expansion in the 24 states and District of Columbia that are expanding the federal-state health insurance program for low-income people will lead to expanded coverage of substance abuse and treatment.

Meghan Andreae, a senior case manager at the addiction services and consulting firm Southworth Associates, said many clients become addicted to painkillers first through legitimate prescriptions for a health concern but later seek out new doctors and methods to obtain the drugs.

This issue highlights the need for more awareness among physicians — one of the strategies outlined in the report — since only 22 states have laws that require or recommend continuing education for doctors and other health providers who prescribe prescription pain meds.

“I would certainly say that’s something that’s lacking,” Andreae said. “A small amount of their training is spent on this issue.”

While the report highlights the shortcomings of prescription drug abuse prevention, it also recognizes that many states are taking steps to address the issue.

Almost all state Medicaid programs have in place a pharmacy “lock-in” program that requires patients to use a single prescriber or pharmacy if they are suspected of abusing drugs.

And, in 44 states, health providers have to conduct a physical exam and screen for substance abuse before prescribing medication.

Other recommendations include:

  • Good Samaritan Laws — Measures that protect individuals from criminal charges for helping themselves or others experiencing an overdose.
  • ID Requirements — Laws requiring or permitting a pharmacist to require an ID before dispensing a controlled substance.
  • Rescue drug laws — Laws to expand access to the use of naloxone, a drug that can be effective in counteracting an overdose.

“Given the extraordinarily rapid growth of the problem, we’re also impressed by how quickly policies have emerged to get a handle on it, and how quickly many of these are showing signs of progress,” said Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, who was a reviewer of the report.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Seattle hookah bars violating laws banning public smoking, King County health officials say

Public Health – Seattle & King County has found that six Seattle hookah bars are violating the state’s law banning public smoking and ordered them to stop allowing smoking on their premises.

Here’s the announcement from Public Health – Seattle & King County

Six Seattle hookah bars receive order for violating public smoking law

Six hookah bars in Seattle are on notice for violating Washington’s Smoking in Public Places law. Public Health – Seattle & King County sent each of the establishments a Notice and Order on Tuesday, October 1, requiring them to stop allowing smoking.

To protect public health, state law requires that all places of employment and public places are smoke-free.

Health inspectors visited the hookah bars multiple times. They found patrons smoking and each of the bars operating as a public place and/or place of employment.

“Our investigation shows that these hookah bars are violating the law, and endangering the health of their workers and patrons. We are forced to take this enforcement action because they haven’t been responsive to our previous warnings,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Secondhand smoke is a proven killer, and state law works to protect everyone from this health threat.”

Hookah bars have claimed that they are exempt from the indoor smoking law because they are private clubs. However, smoking is prohibited by law if a club has employees and/or the club is open to the public.

The investigation found that these six bars are all open to the public, operating similarly to night clubs that charge a cover for admission.

Each of the establishments received multiple warnings from inspectors, but they have not complied with Washington law. The Notice and Orders require immediate compliance plus payment of fines and fees.

The fine for each violation is $100, in addition to escalating re-inspection fees after the first warning. Subsequent violations will result in additional steps to ensure that state law is followed, including possible court action.

Hookah is a water pipe commonly used to smoke tobacco. Research shows that hookah smoking is at least as harmful as cigarette smoke, even when mixed with sweet fruit and candy flavors.

The establishments have ten days from receipt of the Notice and Order if they wish to appeal or 30 days to pay the fines and re-inspection fees.

Hookah bars receiving a Notice and Order this week include:

 

Lounge Address
Casablanca Shisha Lounge 1221 S Main St

Da Spot Hookah Lounge

1914 Minor Ave
Medina Hookah Lounge 700 S Dearborn St
The Night Owl 4745 University Way NE
Sahara Hookah Lounge 7523 Lake City Way NE
Seattle Hookah Lounge 4701 Roosevelt Way NE

 

Hookah health threat

Tobacco use remains the number one cause of preventable death and disease in King County, costing nearly 2,000 lives and $343 million dollars in health costs and lost wages locally every year.

  • Tobacco is placed inside the bowl at the top of the hookah.

    Tobacco is placed inside the bowl at the top of the hookah.

    Hookah is a water-pipe commonly used to smoke tobacco, often mixed with sweet fruit and candy flavors.

  • Research shows that hookah smoking is not a safe alternative to cigarettes and that hookah smoke is at least as harmful as cigarette smoke.
  • During a typical 45-minute session of hookah use, a person may inhale as much smoke as smoking 100 cigarettes or more.
  • Hookah smoke contains the addictive drug nicotine, along with tar, carcinogens, and heavy metals.
  • Hookah smoking has been associated with lung cancer, oral cancer, heart disease, respiratory illness, periodontal disease, and low birthweight.
  • Sharing a hookah mouthpiece can transmit infectious diseases, including tuberculosis.

Hookah and youth

Hookah use has seen a rise in popularity, especially among youth. According to the 2012 Healthy Youth Survey, hookah use among King County high school seniors is higher than cigarette use (15% and 12%, respectively).

‘We are very concerned about the high hookah use rates among youth,” said Scott Neal, Tobacco Prevention Program Manager for Public Health – Seattle & King County. “Sweet fruit and candy flavors lure youth and help fuel the misperception that hookah smoking is safer than cigarettes.”

Report smoking law violations

To report violations, visit the Tobacco Prevention Program page for an online form; or text the establishment’s name, date of violation, and brief description of the violation to  206-745-2548.

 

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Schools Are Getting Healthier, says CDC

school-busBy Marissa Evans

Nowadays, the hub for developing healthy habits isn’t just the gym or home. For kids, at least, it’s increasingly their schools, according to a study released this week by the Centers for Disease Control and Prevention.

School districts across the country are demonstrating a range of improvements in terms of nutrition, exercise and tobacco policies.

For instance, after years of efforts to phase out junk food like candy and chips, the percentage of school districts that prohibited such food in vending machines increased from 29.8 percent in 2006 to 43.4 percent in 2012, according to the CDC’s 2012 School Health Policies and Practices Study.

Also, slightly more than half of school districts – up from about 35 percent in 2000 — made information available to families on the nutrition and caloric content of foods available to students.

“Schools play a critical role in the health and well-being of our youth,” said CDC Director Tom Frieden, in the news release. “Good news for students and parents — more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free.”

Since 2000, the number of school districts that require elementary schools to teach physical education increased. In addition, the number of districts entering into agreements with local YMCAs, Boys & Girls Clubs or local parks and recreation departments went up, according to the study.

Meanwhile, the percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

The CDC study is a periodic, national survey that examines key components of school health at the state, district, school, and classroom level, including health education; physical education and activity; health services; mental health and social services; nutrition services; healthy and safe school environment; faculty and staff health promotion; and family and community involvement.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Medicaid limiting access to meds for painkiller addiction

pills-spill-out-of-bottleBy Michael Ollove, Staff Writer
Stateline 

To Mark Publicker, a doctor in Portland, Maine, who practices addiction medicine, it’s a clear case of discrimination. You wouldn’t deprive a diabetic of insulin.

You wouldn’t stop giving hypertension drugs to a patient with high blood pressure after successful treatment. You wouldn’t hold back a statin from a patient with high cholesterol.

Yet Publicker’s patients face severe limitations on the amount and duration of medicines they take to fight their addictions to pain pills.

And the consequences of those policies by Medicaid and private insurers are at least as dire as they would be for those with other serious ailments if they were denied proven treatments, he said.

“People will die,” Publicker said.

Many private insurance companies and state Medicaid agencies across the country impose sharp limitations on access to medications used in the treatment of the addiction to prescription painkillers known as opioids.

A report commissioned by the American Society of Addiction Medicine found that Medicaid agencies in just 28 states cover all three of medications that the Food and Drug Administration has approved for opioid addiction treatment: methadone, buprenorphine and naltrexone.

The study also found that most state Medicaid agencies, even those that cover all three medications, place restrictions on getting them by requiring prior authorization and re-authorization, imposing lifetime limitations and tapering dosage strengths. The study was done by the substance abuse research firm Avisa Group.

“Now that we finally have medications that are shown to be effective and cost-effective it is shameful to throw up roadblocks to their use,” said Mady Chalk, director of the Center for Policy Research and Analysis at the Treatment Research Institute, which researches all aspects of substance abuse.

By any measure, there is an epidemic in the misuse of prescription drugs, most of it involving abuse of opioid painkillers such as OxyContin or Percocet. The Centers for Disease Control and Prevention reported that 12 million Americans acknowledged using prescription painkillers for nonmedical reasons in 2010.

While opioid addiction is on the rise in the United States, so too are the opportunities for treatment. In January, when major provisions of the Affordable Care Act go into effect, 37 million currently uninsured Americans will be enrolled in health insurance plans, an estimated 11.2 million of them in Medicaid.

Among those newly insured will be many with an opioid addiction. (One study showed a higher rate of opioid addiction among current Medicaid beneficiaries than among those on other forms of insurance.)

Yet even though the ACA holds out the possibility of new treatment options for many, restrictions on the medicines used in treating opioid addicts clouds the chances of successful recovery, treatment experts say.

The CDC says that the number of overdose deaths from opioids tripled between 1999 and 2008, when it reached 14,800 deaths. That is more than the number of overdoses from heroin and cocaine combined.

Prescription painkillers bind receptors in the brain to decrease the perception of pain. But they can also produce a feeling of euphoria, cause physical dependence and lead to addiction. These opioids can also cause sedation and slow breathing, sometimes to the point of stopping it altogether.

History of Addiction

Opioid addiction has existed in the United States at least as far back as the Civil War when opioids were given to wounded soldiers to relieve pain.

Later in the century, it was common for women to become addicted to the laudanum, opium and morphine they were prescribed for the discomforts caused by menstruation or menopause.

By 1900, 300,000 Americans were addicted to opioids, according to the federal Substance Abuse and Mental Health Services Administration.

Early in the 20th century there were aborted attempts to detoxify addicts with decreasing doses of heroin and morphine, but it wasn’t until the 1960s that an effective drug was developed for the treatment of opioid addiction. T

hat medicine was methadone, itself an opioid that has to be taken daily but doesn’t create the euphoria of other opioids and also provides relief from the craving for opioids.

Eventually, two other drugs were developed and proved effective for opioid addiction, buprenorphine and naltrexone, the latter of which can be injected and is effective for a month. Both of these drugs can be prescribed by a doctor and filled at pharmacies.

Research has shown successful treatment reduces the rates of disease associated with illicit drug use, including HIV/AIDS and hepatitis. It also reduces crime while enabling addicts to join the workforce and resume their roles within families.

Research also shows that detoxification without continued medicinal treatment results in a high rate of relapse. Without the medicine, addicts return to drug use.

Yet, most state Medicaid agencies have found ways to reduce access to these drugs in an effort to cut costs. “For these limitations to be imposed by the government is particularly odious and would not be accepted by any other disease,” said Publicker, who waged a losing battle in the Maine legislature in 2011 to fend off a two-year limitation on treatment drugs to Medicaid patients.

Maine state Rep. Elizabeth Dickerson, a Democrat who introduced a bill this year to continue lifetime restrictions on methadone, denied that she was targeting addicts.

Methadone is an expensive program for the state, she said, and it concerned her that addicts were simply replacing one addictive drug for another. She said addicts should be able to achieve a drug-free existence. She pegged the cost in Maine at $15 million a year.

“Maybe they should have to pay for it themselves,” Dickerson told Stateline.

“A Stigmatized Illness”

“The reality is that government exists to live within a lot of parameters,” said Matt Salo, executive director of the National Association of Medicaid Directors. “That’s the nature of government and health care. Decisions have to be made.”

Carol McDaid, co-founder of Capitol Decisions, a consulting firm that specializes in substance abuse policy, said it’s common to those who draft state budgets to target this treatment first “because it is a voiceless, under-represented constituency.”

“This is a stigmatized illness,” McDaid said. “It’s a chronic illness just like diabetes and asthma, but people with those diseases often don’t commit crimes. But that’s another reason why these treatment drugs need to be fully funded. Unlike those other illnesses, with this one there is a public safety issue.”

Addiction experts are hopeful that the federal Mental Health Parity and Addiction Equity Act will even the playing field between opioid treatment drugs and other medications. The law says that patients with mental illness and substance abuse issues are entitled to the same level of care as those with other illnesses or conditions.

But even though the act was passed in 2008, the federal government has yet to write specific rules that would make it enforceable.

It could take years – and lawsuits – before the law removes the restrictive policies on medicines used in opioid treatments.  In the meantime, addiction specialists are focusing on making the case that these medicines work, and limiting their usage makes no sense.

“This just hasn’t been thought out well enough,” said Mark L. Kraus, who practices addiction medicine in Connecticut. “They think they are saving money, but that isn’t true. The cost for not treating is far higher to the state than treating.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Lifestyle changes can lower heart attack, stroke risk in patients with coronary artery disease

Salad in BowlBy Sarah Jorgenson, HBNS Contributing Writer
Research Source: American Journal of Preventive Medicine

Lifestyle modification programs that addressed at least two health behaviors lowered the risk of a fatal heart attack or stroke in people with coronary heart disease, finds a new systematic review in the American Journal of Preventive Medicine.

In a meta-analysis of nine studies, with population sample sizes ranging from 57 to 1,621 patients, the researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle programs while receiving standard care versus people who received standard care alone.

“When you look at healthy lifestyles, you should be comprehensive in doing it because it is not enough to quit smoking if you have very bad dietary habits. So, the combination of lifestyle interventions could be more beneficial,” said lead author Chiara de Waure, M.D., M.Sc., an assistant professor at the Institute of Public Health at the Catholic University of Sacred Heart in Rome, Italy.

Studies varied in program duration with follow-up periods from one to nineteen years. All of the lifestyle intervention programs included diet and nutrition advice and exercise advice or sessions. A number of the studies also provided smoking cessation advice or programs, while other studies also included stress management.

“These interventions that the authors discuss may also subsequently reduce the risk of cancer, respiratory disease, and diabetes, among other chronic diseases…If anything, they were likely to underestimate the potential benefit of lifestyle change in terms of chronic disease,” commented Barry Franklin, Ph.D., professor of physiology at Wayne State University School of Medicine and director of the cardiac rehabilitation program and exercise laboratories at William Beaumont Hospital in Royal Oak, Michigan.

Franklin added, “The study reiterates that the first line of defense for heart disease, that is, the most proximal risk factors, involves addressing poor diet, physical inactivity and cigarette smoking.”

Researchers found an 18 percent reduction in the risk of death from coronary heart disease in people who participated in healthy lifestyle program.

The review finds that lifestyle interventions are effective even in patients with established coronary heart disease, whether they had symptoms or not, and may lower the risk of non-fatal heart attack and stroke and hospital readmission.

“Sometimes when a patient develops a disease, he may think that his world is over, that there is no way to improve through lifestyles because he has already had the event, but we are showing that healthy lifestyles continue to be important even after the onset of disease,” said de Waure.
Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Prescription painkiller overdoses soar among women

Pills-red-and-whitePrescription Painkiller Overdoses

A growing epidemic, especially among women

Vital Signs, a publication of the US Centers for Disease Control and Prevention

The numbers

48,000: Nearly 48,000 women died of prescription painkiller* overdoses between 1999 and 2010

400%: Deaths from prescription painkiller overdoses among women have increased more than 400% since 1999, compared to 265% among men.

30: For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.

About 18 women die every day of a prescription painkiller overdose in the US, more than 6,600 deaths in 2010. Prescription painkiller overdoses are an under-recognized and growing problem for women.

Although men are still more likely to die of prescription painkiller overdoses (more than 10,000 deaths in 2010), the gap between men and women is closing.

Deaths from prescription painkiller overdose among women have risen more sharply than among men; since 1999 the percentage increase in deaths was more than 400% among women compared to 265% in men.

This rise relates closely to increased prescribing of these drugs during the past decade. Health care providers can help improve the way painkillers are prescribed while making sure women have access to safe, effective pain treatment.

When prescribing painkillers, health care providers can

  • Recognize that women are at risk of prescription painkiller overdose.
  • Follow guidelines for responsible prescribing, including screening and monitoring for substance abuse and mental health problems.
  • Use prescription drug monitoring programs to identify patients who may be improperly obtaining or using prescription painkillers and other drugs.

*”Prescription painkillers” refers to opioid or narcotic pain relievers, including drugs such as Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone), and methadone.

Problem

Prescription painkiller overdoses are a serious and growing problem among women.

  • More than 5 times as many women died from prescription painkiller overdoses in 2010 as in 1999.
  • Women between the ages of 25 and 54 are more likely than other age groups to go to the emergency department from prescription painkiller misuse or abuse. Women ages 45 to 54 have the highest risk of dying from a prescription painkiller overdose.*
  • Non-Hispanic white and American Indian or Alaska Native women have the highest risk of dying from a prescription painkiller overdose.
  • Prescription painkillers are involved in 1 in 10 suicides among women.

*Death data include unintentional, suicide, and other deaths. Emergency department visits only include suicide attempts if an illicit drug was involved in the attempt.

More than 5 times as many women died from prescription painkiller overdoses in 2010 as in 1999.

  • Women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them for longer time periods than men.
  • Women may become dependent on prescription painkillers more quickly than men.
  • Women may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).
  • Abuse of prescription painkillers by pregnant women can put an infant at risk. Cases of neonatal abstinence syndrome (NAS)—which is a group of problems that can occur in newborns exposed to prescription painkillers or other drugs while in the womb—grew by almost 300% in the US between 2000 and 2009.
If you take mental health drugs and prescription painkillers, discuss the combination with your health care provider.

Prescription painkiller overdose deaths are a growing problem among women.

Prescription painkiller overdose deaths are a growing problem among women.
SOURCE: National Vital Statistics System, 1999-2010 (deaths include suicides)Every 3 minutes, a woman goes to the emergency department for prescription painkiller misuse or abuse.

SOURCE: Drug Abuse Warning Network, 2010. (Suicide attempts are included for the cases (.03% of total) where opioids were combined with illicit drugs in the attempt.)

What Can Be Done

Icon: Federal government

The US government is:

  • Tracking prescription drug overdose trends to better understand the epidemic.
  • Educating health care providers and the public about prescription drug misuse, abuse, suicide, and overdose, and the risks for women.
  • Developing and evaluating programs and policies that prevent and treat prescription drug abuse and overdose, while making sure patients have access to safe, effective pain treatment.
  • Working to improve access to mental health and substance abuse treatment through implementation of the Affordable Care Act.

Icon: Health care providers

Health care providers can:

  • Recognize that women can be at risk of prescription drug overdose.
  • Discuss pain treatment options, including ones that do not involve prescription drugs.
  • Discuss the risks and benefits of taking prescription painkillers, especially during pregnancy. This includes when painkillers are taken for chronic conditions.
  • Follow guidelines for responsible painkiller prescribing, including:
    • Screening and monitoring for substance abuse and mental health problems.
    • Prescribing only the quantity needed based on appropriate pain diagnosis.
    • Using patient-provider agreements combined with urine drug tests for people using prescription painkillers long term.
    • Teaching patients how to safely use, store, and dispose of drugs.
  • Avoiding combinations of prescription painkillers and benzodiazepines (such as Xanax and Valium) unless there is a specific medical indication.
  • Talk with pregnant women who are dependent on prescription painkillers about treatment options, such as opioid agonist therapy.
  • Use prescription drug monitoring programs (PDMPs)—electronic databases that track all controlled substance prescriptions in the state—to identify patients who may be improperly using prescription painkillers and other drugs.

Icon: Building

States can:

  • Take steps to improve PDMPs, such as real time data reporting and access, integration with electronic health records, proactive unsolicited reporting, incentives for provider use, and interoperability with other states.
  • Identify improper prescribing of painkillers and other prescription drugs by using PDMPs and other data.
  • Increase access to substance abuse treatment, including getting immediate treatment help for pregnant women.
  • Consider steps that can reduce barriers (such as lack of childcare) to substance abuse treatment for women.

Icon: Women

Women can:

  • Discuss all medications they are taking (including over-the-counter) with their health care provider.
  • Use prescription drugs only as directed by a health care provider, and store them in a secure place.
  • Dispose of medications properly, as soon as the course of treatment is done. Do not keep prescription medications around “just in case.” (Seewww.cdc.gov/HomeandRecreationalSafety/Poisoning/preventiontips.htm)
  • Help prevent misuse and abuse by not selling or sharing prescription drugs. Never use another person’s prescription drugs.
  • Discuss pregnancy plans with their health care provider before taking prescription painkillers.
  • Get help for substance abuse problems (1-800- 662-HELP); call Poison Help (1-800-222-1222) for questions about medicines.

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