Family dinners work some kind of magic

Teenagers who have frequent family dinners are much less likely to drink and use drugs, according to a report released today. It doesn't seem to matter what food is served, the authors point out. The value appears to be in the social interaction between family members and the attention that parents give their children during a meal.

The report, titled "The Importance of Family Dinners V," summarizes research that began more than a decade ago that has found that children who have meals with their parents are less likely to smoke, drink or use drugs. In this year's survey, researchers looked at the link between the frequency of family dinners and teens' substance abuse, teens' relationships with their parents and what effect distractions such as phones and other electronic devices have at the dinner table.

Researchers from the National Center on Addiction and Substance Abuse found that teens who have family dinners fewer than three times a week -- compared with those who have family dinners five or more times a week -- were much more likely to use drugs and alcohol and have less academic success. Teens who say they have family dinners but that there are distractions at the table also have higher rates of substance abuse that teens who have frequent family dinners without interruptions.

The survey found that 59% of teens and 62% of parents reported having dinner with their families at least five times a week. Of those who didn't dine together frequently, 69% said they're too busy with work and other activities to share meals. However, two-thirds of the respondents said they would be willing to give up a weeknight activity to have dinner with their family. The average family dinners lasts about 35 minutes, according to the survey.

"The message for parents could not be any clearer: Turn off your cellphone -- and tell the kids to do the same. Make a regular date with your kids. Let them know how important they are to you. Listen to what they have to say," said Joseph A. Califano Jr., founder and chairman of the center.

The survey of 1,000 teenagers and 452 of their parents was conducted this year. The center an annual "Family Day -- A Day to Eat Dinner with Your Children," which will be held this year on Monday, Sept. 28.

-- Shari Roan

Color-coded pills often don't work for the colorblind

About 8% of men and 0.4% of women are colorblind, many of them having problems distinguishing red and green. That can be a problem for users of asthma inhalers and warfarin, among other drugs, that use different colored pills and containers to distinguish different formulations. A recent survey of 100 colorblind people found that 2% of them had mixed up their medications because of color recognition problems, researchers from the University of Melbourne reported online today in the journal Lancet.

One potential solution, the researchers said, is to use more yellow, blue and gray, which the colorblind can distinguish.

-- Thomas H. Maugh II

Photos, from top: Warfarin tablets and containers in their normal colors (A) and as seen by the colorblind (B); asthma inhalers in their normal colors (C) and as seen by individuals with a loss of red vision (D). Credit: The Lancet

Let them take heroin, study says

To improve the chances that hard-core heroin addicts will stick with their treatment for opioid dependence and forgo the use of illicit drugs, they should take … heroin.

That’s the controversial conclusion of a study being published in Thursday’s edition of the New England Journal of Medicine.

The study focused on addicts who took heroin for at least five years and had already failed two attempts at treatment. One of those attempts had to involve methadone, which helps manage heroin cravings and blocks the drug’s euphoric effects.

The goal wasn’t necessarily to get study participants to stop using heroin altogether, but to turn their addiction into a manageable fact of life instead of a source of high-risk, illegal and/or anti-social behavior.

Canadian researchers randomly assigned 115 addicts in Vancouver and Montreal to receive diacetylmorphine – the active ingredient in heroin – and 111 others to a control group that got standard methadone treatment. Those who took diacetylmorphine injected themselves up to three times a day in treatment clinics with medical supervision. Then they had to remain in the clinic for 30 minutes so they could be monitored for overdoses, seizures and other serious problems.

Overall, the addicts who took diacetylmorphine did better than the ones who took methadone.

After one year, 88% of those in the diacetylmorphine group were still in treatment, compared with 54% in the methadone group. They were also more likely to curb their illegal behavior – including use of illicit drugs – by a margin of 67% to 48%.

Patients treated with diacetylmorphine also saw bigger reductions in their illicit heroin use. They had taken the drug for an average of 26.6 days in the month before the study started, and that number fell to 5.3 days by the end of the study. In the methadone group, illicit heroin use fell from an average of 27.4 days per month to 12.0 days per month during the course of the study.

The researchers also reported that addicts who were treated with diacetylmorphine “had greater improvements with respect to medical and psychiatric status, economic status, employment situation, and family and social relations,” according to the study.

One patient from the methadone group died of an opioid overdose during the 12-month trial. But overall, serious adverse events were more than 2½ times more common among the diacetylemorphine group. Sixteen of those participants experienced a life-threatening seizure or overdose; all received prompt treatment at their clinic and recovered. 

The researchers emphasized that most heroin addicts should continue to be treated with methadone. But when methadone doesn’t cut it, they concluded, “prescribed, supervised use of diacetylmorphine appears to be a safe and effective adjuctive treatment for this severely affected population of patients who would otherwise remain outside the health care system.”

That advice may sound radical, but it has already been followed in several European countries. Switzerland, the Netherlands and Great Britain currently treat some heroin addicts with diacetylmorphine, according to an editorial accompanying the study.

In the United States, only methadone has the imprimatur of a “medical” drug, writes Virginia Berridge of the London School of Hygiene and Tropical Medicine at the University of London. That bias may help explain why the Canadian researchers were unable to collaborate with their colleagues south of the border. Perhaps, Berridge speculates, the Canadian results will have more influence on American policymakers since the study was practically “homegrown.”

-- Karen Kaplan

Photo: Methadone helps many heroin users stay off the drug, but it’s not powerful enough for all addicts. Credit:  Los Angeles Times

Doctors familiar with death by propofol

The inquiry into singer Michael Jackson's death centers on his use of the anesthetic propofol to help him sleep. Three months before Jackson's death, a group of anesthesiologists in Florida warned their colleagues about the inappropriate and dangerous use of the drug.

In their report -- titled "Death From Propofol: Accident, Suicide or Murder?" -- the University of Florida doctors detailed the 2005 death of a 24-year-old woman from propofol toxicity. The woman had no history of drug abuse. But an acquaintance, a registered nurse, did have access to the drug. The suspect fled the country, but investigators found him in Senegal and he was returned to the country, tried and convicted of first-degree murder.

The report was published in the April edition of Anesthesia & Analgesia, a journal for anesthesiologists.

"Propofol is not intrinsically more dangerous than other intravenous sedatives," Dr. Steven L. Shafer, the editor of the journal, said in a news release. "We have known since the days of Paracelsus that it is the dose that renders a drug toxic. Propofol is dispensed in doses intended to produce general anesthesia. Administration of an anesthetic dose of any hypnotic by an untrained individual, or in a setting in which general anesthesia cannot be properly managed, is a recipe for disaster."

The authors of the report cautioned that, since the early 1990s, occasional reports of abuse, accidental overdose and suicide linked to propofol have surfaced. In 2007, a forensic sciences journal reported the death of a female anesthesiologist in Greece who abused the drug. They noted that the toxic effects of the drug differ in non-intubated patients compared to intubated patients who are on an operating table. A report in 2006 described the death in Germany of a drug abuser who bought the intravenous medical supplies to self-administer propofol on Ebay.

-- Shari Roan

Photo: A granite headstone at a Jackson memorial site at Woodlawn Cemetery in Detroit. Credit: Carlos Osorio  /  Associated Press.

One drug for the novice, and one drug for the hard-core

Inhalants and propofol. The two would seem to have little in common, but both were profiled recently in the L.A. Times. One portrait offers a glimpse into middle-school life; the other portrait provides a glimpse into a medical world reliant on pharmaceuticals. Together, they begin to paint a picture of drug use in America.

In the first story, staff writer Carla Rivera documents rising concern about inhalant use among local middle school students: Los Angeles youths' nitrous oxide use has adults taking action

Some parents are particularly worried about whippets -- small containers of nitrous oxide -- but obviously inhalant use doesn't stop there. From that story: "Recently, three students at Madison Middle School in North Hollywood who allegedly had been abusing inhalants were hospitalized. At Roosevelt High, a student who had allegedly been huffing inhalants lost consciousness and had to be resuscitated."

For a closer look at inhalants, here are some numbers from the National Survey on Drug Use and Health. It states: "Inhalants were the most frequently reported class of illicit drugs used in the past year among adolescents aged 12 or 13 (3.4 and 4.8 percent, respectively)."

That may not be surprising. Inhalants are common -- easily obtainable by 12- and 13-year-olds whose access to other drugs is often limited.

But, of note, the choice of inhalant seems to be affected by gender.

"Combined data from 2002 to 2005 indicate that recent female inhalant initiates aged 12 to 17 were more likely than their male counterparts to have used glue, shoe polish, or toluene; spray paints; aerosol sprays other than spray paints; correction fluid, degreaser, or cleaning fluid; and amyl nitrite, 'poppers,' locker room odorizers, or 'rush.' Recent male inhalant initiates were more likely than their female counterparts to have used nitrous oxide or whippets." Here's that breakdown.

The  cheap and easy high of inhalants can be had not just by the traditional model-airplane glue but also via cooking sprays, nail polish remover, markers and more. The National Inhalant Prevention Coalition lists an array of potential problems.

In the second story, staffers Jeff Gottlieb and Rong-Gong Lin II profile the anesthetic recently linked to Michael Jackson: Diprivan, the drug found in Michael Jackson's home, may be more tightly restricted.

From that story: "Also known by the generic name propofol, the drug is among the most widely used general anesthetics in the U.S. Its purpose is to quickly knock out patients or make them semi-conscious during uncomfortable procedures, such as colonoscopies. The drug can be so dangerous that the U.S. Food and Drug Administration says only those trained in general anesthesia should administer it."

The story also notes: "Diprivan is not a drug people can buy on the street. Someone would have to take it from a hospital, surgery center or other medical facility or somehow obtain it from a distributor or manufacturer." And, it points out, most abuse occurs among doctors and other medical workers.

An account of the problem from Anesthesiology News begins:

"One addict fell asleep at his desk so often that his lolling forehead became a perpetual bruise. Another was so desperate for a fix that he started trolling through sharps bins for discarded needles with traces of drug to inject. The addicts were two doctors, an anesthesiologist and a family physician. Their drug of choice: propofol. If that’s surprising, consider this: One in five academic anesthesiology training programs reported at least one case of abuse by physicians or other healthcare workers over the past decade, new research shows. The incidence of propofol abuse has risen fivefold over the last 10 years."

Two drugs. Two types of users. Two worlds. ... One culture.

-- Tami Dennis

Photo: A whippets, at top, is a small canister of nitrous oxide; propofol, below, is an anesthetic.

Credit: Mark Boster / Los Angeles Times (top); Getty Images (below)

Meth use among L.A. workforce twice the national average

Drug use by employees continues to be a major problem for employers. But new statistics show the picture is changing in Los Angeles.

Data from Quest Diagnostics show that cocaine use has decreased in recent years while amphetamine use is up. In particular, the rate of positive workplace drug tests for methamphetamine in Los Angeles is more than twice the national average: 23 positive tests per 10,000 people versus 11 per 10,000 nationwide.

Positive tests for cocaine were found in 27 per 10,000 workers in Los Angeles compared with 39 per 10,000 workers nationwide. Overall, screening shows a decline in positive drug tests in Los Angeles from 320 per 10,000 workers in 2006 to 269 per 10,000 last year. Nationwide, 380 per 10,000 workers tested positive for drug in 2006 compared with 360 per 10,000 last year.

The data are from the annual Quest Diagnostics Drug Testing Index, based on 5.7 million urine drug tests performed by the company.

-- Shari Roan

Photo: A pipe used to smoke crystal meth. Credit: Ann Heisenfelt / AP
 

Rodent of the Week: How the brain gets hooked on drugs

A study in which researchers got mice hooked on drugs without using drugs may yield clues to a key part of the brain involved in drug addiction.

The study, published online today in the journal Science, shows that a naturally occurring protein called brain-derived neurotrophic factor, or BDNF, acts on a part of the brain called the ventral tegmental area and switches the cells in this area from a dopamine-independent system to a dopamine-dependent system, thus causing addiction.

Researchers have known that drug addiction is a disease that disrupts the brain's dopamine response, which is involved in feelings of pleasure and reward. Chronic exposure to drugs increases levels of BDNF in the ventral tegmental area, which is where dopamine circuitry is located. The researchers gave rats who were not dependent on drugs a single injection of BDNF into the ventral tegmental area of the brain. The injection made the rats behave as if they were dependent, causing them to prefer certain smells, lighting and textures and to seek this stimulation for a "fix." The BDNF injection caused specific chemicals that normally inhibit neurons in this part of the brain to instead excite them.

"When someone chronically uses drugs, this system changes. This is the mechanism that makes you feel like you need that drug," said the lead author of the study, Hector Vargas-Perez, of the University of Toronto.

"If we can understand how the brain's circuitry changes in association with drug abuse, it could potentially suggest ways to medically counteract the effects of dependency," Scott Steffensen, a Brigham Young University neuroscientist and co-author of the study, said in a news release.

— Shari Roan

Photo: Courtesy of Advanced Cell Technology Inc.

Some teens smoke pot for their health

Numerous studies and surveys show that adults sometimes use marijuana as relief from medical symptoms. It appears teenagers may occasionally do the same. A study published today found one-third of the adolescents interviewed said they don't smoke pot to get high but to treat health problems.

The study was small -- only 63 teenagers in Canada -- but it raises the question of whether kids smoke pot only to act out or to get high. The researchers, from the University of British Columbia, conducted in-depth interviews with adolescents who said they used marijuana. Twenty of the teens said they used it to relieve or manage health problems, such as emotion problems (depression or stress), sleep difficulties, problems concentrating or pain.

Many of the teens had unsatisfactory experiences with the healthcare system. For example, some had been prescribed medications for sleep problems or attention disorders but didn't like how the drugs made them feel or felt they weren't helpful. The teenagers said they were not worried about using marijuana for their health problems and said they did not use it excessively. In general, they were "thoughtful and prescriptive with their marijuana use," according to the researchers.

"They were adamant and confident that marijuana provided relief from their health problems," the authors wrote. "The decision to smoke marijuana was stated in a straight-forward fashion (e.g. 'I started it to make myself feel better') and justified because they had a 'reason for it.' "

Parents and doctors need to consider whether teenagers with health problems feel standard medical care is helping them. These teens said they felt they had little recourse for help with their health problems. Regular use of marijuana puts people at risk, the authors note, something that the adolescents in the study seemed to be unaware of. For example, smoking pot to alleviate depression actually increases the risk for depression.

The paper is published today in BioMed Central's open access journal Substance Abuse, Treatment, Prevention, and Policy.

 -- Shari Roan

 Photo credit: Don Bartletti / Los Angeles Times

Brain drugs won't go away, so best give them some thought

If pills can make us better mentally -- and it seems clear they can -- it's time to answer the question of whether we should let them. 

For some people, the question is already moot. In the April 27 issue of the New Yorker, writer Margaret Talbot explores the issue of brain medications in "Brain Gain: The underground world of 'neuroenhancing' drugs."

She writes: "In recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted."

She tells her story in some part through a recent Harvard graduate named Alex. He makes a compelling case for what can be accomplished with a little help.

Some neuroscientists and ethicists have already answered the bigger question among themselves. Says a recent blog post from Times staff writer Melissa Healy: "Pop a smart pill? Why not, says a group of neuroethicists"

-- Tami Dennis

Photo: Ritalin -- the little helper for people with attention deficit hyperactivity disorder and overworked, over-stressed students -- is going mainstream.

Credit: Keith Beaty/Toronto Star/ZUMA Press

Fetal development and the flu, epilepsy, meth exposure ...

As researchers learn more about in utero exposure and the effects on the unborn, pregnant women could be excused for trying to shut themselves off from the rest of the world. Sometimes, that might not even seem like an overreaction. In this week's news alone:

From UPI: Prenatal Hong Kong flu linked to lower IQ

The story states: "The intelligence scores of men born in July through October of that year, 6-9 months after the main outbreak of the Hong Kong flu in Norway, were lower than the mean values for those born in the same months during the preceding and following years." Here's the abstract from the Annals of Neurology.

From WebMD, among others: Epilepsy drug linked to babies' lower IQ

The story states: "Women with epilepsy who took the drug valproate ( Depakote) during pregnancy gave birth to children whose IQ at age 3 averaged up to 9 points lower than the scores of children exposed to other epilepsy drugs, according to a new study." Here's the abstract from the New England Journal of Medicine.

And from Reuters: Prenatal meth exposure may harm baby's brain

The story states: "Brain scans on a group of 3- and 4-year-old children showed abnormal development in the white matter, which carries messages across the brain, compared with children who did not have prenatal exposure to the drug, often called 'meth.' " Here's the abstract, from Neurology.

For a broader look at the issue of in utero exposure, check out these stories from Times staff writer Shari Roan:

Living for two: Mounting evidence suggests that fetuses are surprisingly susceptible to outside influences such as food, environmental pollutants, even stress.

Poor nutrition in utero, heavy child tomorrow?

-- Tami Dennis

Photo: An infant is fitted for a ventilator mask.

Credit: Associated Press