Booster Shots

Oddities, musings and news from the health world

Category: addiction

Millions of yearly visits to the ER involve patients with mental disorders and substance abuse problems

July 9, 2010 |  3:57 pm

Not every emergency room visit involves a physical problem. Out of 95 million visits made to emergency rooms by adults in the U.S. in 2007, 12 million, or 12.5%, had to do with mental disorders, a substance abuse problem, or both.

Kzuq3knc The findings are from a report recently put out by the U.S. Agency for Healthcare Research and Quality, part of the Department of Health and Human Services.

Of those 12 million visits, about 66% involved patients with mental disorders, about 25% involved patients with substance abuse issues and the rest involved patients who had both a mental disorder and a substance abuse problem.

Almost 41% of those 12 million visits resulted in the patient being admitted to the hospital, which is more than 2.5 times the rate of hospitalizations for other conditions.

Almost 54% of the mental health/substance abuse-related visits were from women. About 47% of the visits were by people age 18 to 44, and about 35% were by  people age 45 to 64.

The top five conditions that made up 96% of all the mental health/substance abuse cases were (in order) mood disorders, anxiety disorders, alcohol disorders, drug disorders, schizophrenia and other psychoses, and intentional self-harm. One patient could have multiple diagnoses.

As for how the 12 million visits were billed, 30% went to Medicare, 26% went to private insurers, 20% went to Medicaid and 21% of patients were uninsured.

-Jeannine Stein

Photo credit: Mark Boster / Los Angeles Times


Ancestry, not just race, is important to personal medical history

July 7, 2010 |  2:00 pm

Doctors often ask patients to list their race -- white, Latino, African American, Asian, Native American -- to help them provide better healthcare. They do this because loads of medical research shows that the incidence of certain diseases and treatment success can vary somewhat from race to race.

But the more important question may be: What is your genetic ancestry?

Asthma genetic ancestry race A study released Wednesday in the New England Journal of Medicine examined the accuracy of a lung function test and how race and ancestry played a role in the test's accuracy. A lung function test measures damage to the lungs caused by asthma or other disease. However, the definition of "normal" lung function is known to vary substantially by race. For example, doctors have long known that vital lung capacity (the maximum amount of air that can be expelled after maximum inhalation) is 6% to 12% lower in blacks compared with whites and Native Americans.

Researchers looked at data from more than 3,000 patients that included their lung function test results, standard information on race and additional information on genetic ancestry that was obtained through genotyping. The study found that standard race categories don't capture the extent of ancestral diversity and, thus, may limit the amount of information available to a doctor in making a diagnosis or ordering treatment. Instead, many people have a rich and diverse genetic background that does not lend itself to a simple classification, such as "white" or "Asian."

For example, when using genetic ancestry data, the study showed a strong link between African ancestry and lung function measurement in both men and women. According to the findings, for 6.4% of people in the United States who identify themselves as African American, the actual percentage of African ancestry would be 15% higher or lower than average -- a difference that would result in an incorrect estimation of lung function test, and possibly, mistakes about the severity of lung disease. About 2.1 million self-identified African Americans have asthma. But based on the study conclusions, the severity of the asthma would be misclassified in about 4% of those patients.

"When we force patients into an individual box, such as 'African American' or 'Caucasian,' we're missing a lot of genetic information," senior author of the study Dr. Esteban G. Burchard, of UC San Francisco, said in a news release. "This study provides new evidence that genetic ancestry correlates to physiological measures. With it, we're one step closer to personalized medicine."

On a more practical level, the study points to the need for improvements in measuring lung function in some people. In an editorial accompanying the paper, authors noted: "Refinements are needed for poorly represented or misrepresented populations and for persons of mixed ancestry, who represent an increasing proportion of the U.S. population."

-- Shari Roan
 
Photo: Getty Images

 


Parenting style influences teen drinking patterns, researchers say

June 24, 2010 |  6:00 am

Teenagers alcohol parenting Some parents assume that teenagers will drink alcohol and there is little they can do to prevent it. Research does indicate that parenting has little effect on whether kids decide to try alcohol. But parenting attitudes and actions can make a big difference in how much and how often a teenager drinks.

Researchers at Brigham Young University surveyed 5,000 adolescents about their drinking habits and their relationship with their parents. They found the kids least prone to heavy drinking had parents who scored high on accountability (knowing where their kids were and with whom) and warmth. Having so-called "indulgent" parents, who were low on accountability and high on warmth, nearly tripled the risk of the teen participating in heavy drinking. The study also found that "strict" parents -- high on accountability and low on warmth -- more than doubled their teen's risk of heavy drinking. These results were apparent even when researchers controlled for other influences, such as peer pressure, religious and economic background.

"Authoritative parents tend to be highly demanding and highly responsive," the authors wrote. "They monitor their children closely and provide high levels of support and warmth. Our data suggest that peer encouragement to drink might have less impact when parents are both highly supportive and highly attentive."

The study is published in the July issue of the Journal of Studies on Alcohol and Drugs.

-- Shari Roan

Photo credit: Lee Romney  /  Los Angeles Times


Widely used cancer drug Avastin could save eyesight for tens of thousands of people with AMD, study finds [Updated]

June 11, 2010 | 11:46 am

The widely used cancer drug Avastin could save the eyesight of tens of thousands of people with age-related macular degeneration (AMD) of the wet form, British researchers said Friday. The drug provides an inexpensive alternative to the only drug currently licensed for treating the disorder, they found, and should be used immediately in countries with limited healthcare budgets, the researchers reported online in the journal Lancet. Avastin, known generically as bevacizumab, is already used by many physicians to treat AMD, but there has been little evidence from clinical trials to support its efficacy.

[Updated at 3:10 PM. The study was actually reported online in the journal BMJ.]

Avastin is a monoclonal antibody that targets a hormone, vascular endothelial growth factor, that stimulates the growth of blood vessels that nurture tumors. It is already used for treating bowel and lung cancer, and studies reported earlier this week show that it is also effective at keeping ovarian cancer in check. It is not licensed for treating AMD, but many physicians use it "off-label" to treat the disorder, a perfectly legal alternative.

AMD affects about 1.25 million Americans. Only about 15% of them have the wet form, which results from bleeding into the eye that impairs vision, but vision loss is far more severe with wet AMD than with the dry form. Victims of the disorder lose sight in the central portion of their eye, which is the most important portion for reading and other activities.

Roche, which manufactures Avastin, also produces a similar drug called Lucentis (known generically as ranibizumab) that is licensed to treat AMD. But the small amount of Avastin needed to treat AMD costs only about $50, compared to $1,950 for Lucentis, and some countries have not agreed to pay for the new drug because of its high cost. The U.S. National Eye Institute is now conducting a clinical trial comparing the two drugs head-to-head for treating AMD, but results from that study are not expected until the middle of next year.

Dr. Adnan Tufail of the Moorfields Eye Hospital in London and his colleagues began their study of Avastin before Lucentis was available in Britain. They enrolled 131 patients with wet AMD who were at least 50 years old. The patients were randomized to receive either injections of Avastin every six weeks or the best available medical therapy.

At the end of a year, 32% of the patients receiving Avastin had a significant improvement in vision, compared to only 3% of those in the standard care group. In contrast, those given standard care were significantly more likely to lose vision over the course of the study, the researchers found.

In an editorial accompanying the report, Dr. Usha Chakravarthy of the Royal Victoria Hospital in Belfast, Ireland, said that the trial robustly shows that Avastin is better than the treatments it was compared to, but cautioned that wider use should be limited until the results become available from the head-to-head trial with Lucentis. Tufail and his colleagues, however, argued that the vision of many patients in underdeveloped countries could be saved with Avastin while researchers are awaiting the results of that trial.

-- Thomas H. Maugh II


Young adults tending to a romance have less substance use

June 3, 2010 |  6:00 am

Marriage usually helps stabilize behavior. Studies show, for example, that people are less likely to use drugs and drink once wedded. The same behavior appears true of young adults in romantic relationships, according to a new study.

Love Researchers examined surveys of 909 people who were followed beginning in first or second grade up through two years after high school. They found the typical person of age 19 or 20 who not in a stable relationship was much more likely -- about 40% -- to use marijuana and drink heavily compared with someone who was in a relationship. The researchers controlled for other factors that affect drinking and drug use, such as employment status. The people who were not in relationships were less likely than their dating peers to have used marijuana or alcohol in high school, however.

"For these individuals, the new freedoms of early adulthood and lack of social control from a partner posed the greatest risks in terms of escalation of substance use," the authors wrote.

It could be that young people in relationships are getting support from their romantic partner that helps them avoid substances or that they are spending less time hanging out with substance-abusing friends or in bars.

"Even dating relationships activate mechanisms of support and control, although to a lesser extent than more serious relationship statuses of cohabitation or marriage," the authors wrote. "These findings show how bonding, adopting the behavior patterns of a partner and the interaction between these two processes influence substance use in early adulthood."

"I'm not saying that we should set up dating services," the lead author of the study, Charles Fleming, a research scientist at the University of Washington, said in a news release. "But it's something for parents to know and it's something for other people who are working with young adults of this age to know."

The study was published Wednesday in the Journal of Health and Social Behavior.

-- Shari Roan

Photo credit: Allen J. Schaben  /  Los Angeles Times


A cautionary tale: Smart people and addiction

May 20, 2010 |  2:31 pm

Rationalization and denial are key concepts in addiction treatment. To recover, addicts admit they have rationalized their habit ("I use so much less than my friends.") and denied they have a problem ("I can handle it. It's not affecting my job.") Here's another barrier to recovery from addiction: "I'm too smart for this to become a problem."

Syringe2 This week's Journal of the American Medical Assn., contains a sad essay from a medical researcher who made headlines last year when his fiancee, also a medical researcher, died after the two injected themselves with what they thought was the narcotic buprenorphine for kicks. The author of the essay, Clinton B. McCracken, a former pharmacologist at the University of Maryland, describes how he became a user of marijuana and intravenous opioids (morphine and oxycodone) over a decade while building his career as a successful neuroscientist who studied the effects of drugs on the brain.

He notes that people who work in medicine have addiction rates that are equal to, if not higher than, rates among the public. Drugs are easier to get, McCracken said. But he said an attitude of arrogance led him, as a medical professional, to believe that he could enjoy dangerous drugs and avoid serious consequences. For example, he was careful to schedule his opioid use to prove to himself that he did not need it to get through the day, made sure he was tending to his responsibilities at work and reviewed the criteria for drug dependence to assure himself that he was not an addict.

"By intellectually addressing the official criteria for abuse and dependence, I provided myself with the illusion of total control over the situation and was able to confidently tell myself that no problems existed," he wrote in the essay.

His world came crashing down last fall when his fiancee died while injecting drugs with him. When the police arrived, they discovered McCracken's marijuana plants. He was arrested and jailed, and he later agreed to a plea bargain to avoid more serious charges. Besides losing his girlfriend, he has since lost his career, his reputation and, as a citizen of Canada and convicted felon, he expects to be deported.

Addiction may look different in different people, but it seems that, in the end, everyone, no matter the level of intelligence, looks the same -- ruined.

"The transition from my drug use having no apparent negative consequences, to both my personal and professional life being damaged possibly beyond repair, was so fast as to be instantaneous, highlighting the fact that when it comes to drug use, the perception of control is really nothing more than an illusion," he wrote.

-- Shari Roan

Photo credit: Adam Gault / Getty Images / OJO Images


Admissions for teen substance abuse treatment decline

May 12, 2010 | 11:49 am

Samhsa
A fascinating report examining the nation's battle with drug addictions released Wednesday shows marked changes over the last decade in which drugs are abused and who seeks treatment. Among the more eyebrow-raising findings is that admissions for substance abuse treatment among youths ages 12 to 17 declined 10% between 2002 and 2008. This plunge came after a 13% increase from 1998 to 2002.

The report, released by the Substance Abuse and Mental Health Services Administration, was based on data from the agency's survey of state-licensed substance abuse treatment facilities across the nation. Most of these facilities receive public funding. The survey also showed that 79% of adolescent treatment admissions involved marijuana as a primary or secondary substance and almost half of the admissions were made through the courts.

Among people of all ages, opiate admissions increased from 16% in 1998 to 20% in 2008 while cocaine admissions declined from 15% to 11%. Marijuana admissions rose from 13% to 17% during that time and stimulant admissions (mainly methamphetamine) rose from 4% to 6%.

Also:

  • The proportion of treatment admissions attributed to drug abuse alone rose from 26% in 1998 to 37% in 2008 while the proportion of admissions attributed to alcohol abuse alone fell from 27% to 23%.
  • The proportion of admissions for abuse of both alcohol and drugs declined from 44% to 38%.
  • The abuse of two or more psychoactive drugs in combination accounted for 55% of admissions, typically alcohol and opiates.

In 2000, 24% of those 16 or older in treatment were unemployed compared to 37% in 2008.

The report, entitled the National Admissions to Substance Abuse Treatment, is available on the Web.

-- Shari Roan

Photo credit: SAMHSA


Australia proposes selling cigarettes in plain packages

May 4, 2010 | 11:08 am

By law, cigarette packages must contain written warnings regarding the health dangers of smoking. However, governments around the world are expressing discontent with that strategy and are proposing more stringent regulations. Last week, Australian Prime Minister Kevin Rudd unveiled comprehensive antismoking legislation that includes requiring manufacturers to sell cigarettes in plain packaging. Fancy packaging is a marketing tool that is thought to persuade young people to take up smoking.

Cigs Under Australia's measure, the first such in the world, all cigarettes would be sold in plain packaging by July 2012, according to a news release from Rudd's office. The legislation would restrict or prohibit tobacco-industry logos, brand imagery, colors and promotional text other than the brand and product name in a standard color, position, font style and size.

"There can be no justification for allowing any form of promotion for this uniquely dangerous and addictive product, which is illegal to sell to children," said officials in a statement from the country's National Preventative Health Taskforce.

Other countries are considering changes to cigarette packaging too. Many propose adding graphic picture warnings that convey the dangers of smoking, such as a picture of a premature infant born to a woman who smoked during pregnancy.

All these measures will be challenged by the tobacco industry. But it seems clear that exasperation is mounting with the high medical and economic costs to society wrought by smoking.

-- Shari Roan

Photo: Emile Wamsteker  /  Bloomberg News


Prism Awards spotlight addiction, mental health

April 23, 2010 |  3:25 pm

No industry likes to give itself accolades more than Hollywood, but an award ceremony last night was a little different. The Prism Awards honored actors, television shows and movies that honestly portray depictions of mental health issues and addiction, plus tobacco, drug and alcohol use.

L1b8pjnc Among the winners were Jeff Bridges and Maggie Gyllenhaal, stars of the film "Crazy Heart," Hector Elizondo and Tony Shalhoub for the TV show "Monk," and the film "The Soloist." Television shows singled out included "How I Met Your Mother," "Breaking Bad" and "The Celebrity Apprentice." You can read more about the winners in the Envelope. The awards are produced by the Entertainment Industries Council Inc. in collaboration with the Substance Abuse and Mental Health Services Administration and the FX Network. The awards took place at the Beverly Hills Hotel.

"The Prism Awards recognizes and applauds the remarkable efforts that have been contributed by our creative community," said EIC's President and Chief Executive Brian Dyak, in a news release. "We salute those in the entertainment industry that promote informational truths in their work to improve the lives of the audiences they entertain. Through accurate character portrayals and inspired storytelling, our industry reinforces the importance of those individuals within the care giving and health fields."

Considering how often Hollywood is criticized for its portrayal of issues such as substance abuse and mental health, no doubt the celebs, producers, etc. welcomed this bit of good publicity.

-- Jeannine Stein

Photo: Jeff Bridges and Maggie Gyllenhaal in "Crazy Heart." Credit: Lorey Sebastian / Associated Press


States are cracking down on indoor tanning practices

April 20, 2010 |  8:34 am

Tanning As many as a third of college-age people who use indoor tanning beds or booths show signs of being addicted to the behavior, according to a study reported Tuesday in the Los Angeles Times. These people know that ultraviolet light is harmful, increasing the risk of skin cancer. Yet they continue to tan excessively -- some as much as 100 times a year. Researchers say that excessive exposure to UV light may activate parts of the brain involved in substance abuse.

The cancer risk and overuse of tanning salons has not escaped the attention of lawmakers. According to the National Conference of State Legislatures, 32 states regulate indoor tanning salons, such as by banning tanning among people younger than 14 or requiring parental permission for people younger than 18.

Those restrictions are likely to get tighter. Last month, an advisory panel to the Food and Drug Administration recommended rules requiring teenagers to have parental permission to visit a salon and making health warnings on tanning beds and booths more noticeable.

More than 20 states have introduced legislation this year. Florida, for example, has proposed prohibiting tanning for people younger than 16 and requiring parental consent for people younger than 18, with the parent specifying exactly how many tanning sessions would be permitted in a given year. Hawaii's proposed legislation would ban tanning to people younger than 18 and require proof-of-age identification for everyone else.

The Indoor Tanning Assn. said in a recent statement that U.S. tanning industry practices are already sufficiently protective of consumer health and safety and any decisions on government restrictions should be based "on sound science and fact."

-- Shari Roan

Photo credit: Seth Wenig / Associated Press



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