Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This blog post is a follow up to last week’s post on the Surgeon General’s Report on Alcohol, Drugs, and Health.
This article includes information from reports by the Washington Post-Kaiser Family Foundation, the Center for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The article highlights how addicting prescription medications are, the rise in deaths attributable to opioids, including prescription pain relievers, and demographic information on vulnerable populations including Medicaid recipients and women.
A Washington Post-Kaiser Family Foundation survey published in the Washington Post’s December 9 Health & Science section reported that, “One-third of Americans who have taken prescription opioids for at least two months say they became addicted to, or physically dependent on, the powerful painkillers.”
The article added that “Virtually all long-term users surveyed said that they were introduced to the drugs by a doctor’s prescription, not by friends or through illicit means. But more than 6 in 10 said doctors offered no advice on how or when to stop taking the drugs. And 1 in 5 said doctors provided insufficient information about the risk of side effects, including addiction.”
The Center for Disease Control and Prevention (CDC) reported in March 2016, “More people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid. And since 1999, the number of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled. From 2000 to 2014 nearly half a million people died from drug overdoses. 78 Americans die every day from an opioid overdose.”
The CDC report added “We now know that overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have also quadrupled since 1999.”
The Substance Abuse and Mental Health Services Administration (SAMHSA) published in August 2016, A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare and Collaborating Service Providers.
The section titled Opioid Use Trends reported “Opioid use and related consequences also vary by several key demographics. For example, the Medicaid patient population is more likely to receive prescriptions for opioid pain medications and to have opioids prescribed at higher doses and for longer periods of time than the non-Medicaid patient population. Opioid medication overdose deaths are also more common among Medicaid-eligible populations.”
The demographic section described the increase in opioid use among women. “The overall rate of first time heroin use increased among all women, from 0.06 percent in 2002–2004 to 0.10 percent in 2009–2011, estimated to be an increase from 43,000 women to 77,000 women (SAMHSA, 2013). Among women, the number of overdose deaths due to the use of prescription opioid pain medications has increased significantly since 2007, surpassing deaths from motor vehicle-related injuries. Overdose deaths due to opioid medication increased among women more than 5-fold between 1999 and 2010, totaling 47,935 during that period (CDC, 2013).”
There has been a similar increase in opioid use among pregnant women leading to a rise in the Neonatal Abstinence Syndrome. This syndrome and its consequences will be addressed in a future article.
Our Medical Director, Richard Margolis MD, helps us make sense of new information in psychiatry, addiction, and behavioral health. This article summarizes the Facing Addiction in America, a report on alcohol, drugs, and health issued by the Surgeon General.
Facing Addiction in America, the Surgeon General’s Report on Alcohol, Drugs, and Health was published last fall. This report provides an extremely thorough and definitive public health report on substance use in America.
The report is organized into 7 chapters that present an overview, a description of the neurobiology of substance use, prevention programs and policies, early intervention/treatment/management, recovery, health care systems, and a vision for the future.
In Chapter 3, Prevention Programs and Policies, risk factors and protective factors are defined. Risk factors are “factors that increase the likelihood of beginning substance use, of regular and harmful use, and of other behavioral health problems associated with use.” Protective factors are “factors that directly decrease the likelihood of substance use and behavioral health problems or reduce the impact of risk factors on behavioral health problems.”
The report explains, “Although there are exceptions, most risk and protective factors associated with substance use also predict other problems affecting youth, including delinquency, psychiatric conditions, violence, and school dropout. Therefore, programs and policies addressing those common or overlapping predictors of problems have the potential to simultaneously prevent substance misuse as well as other undesired outcomes.”
Table 3.1: Risk Factors for Adolescent and Young Adult Substance Use lists individual/peer, family and community risks which are summarized below.
o Early initiation of substance use defined as engaging in alcohol or drug use at a young age.
o Early and persistent problem behavior defined as emotional distress, aggressiveness, and “difficult” temperaments in adolescents.
o Rebelliousness defined as high tolerance for deviance and rebellious activities.
o Favorable attitudes toward substance use defined as positive feelings towards alcohol or drug use, low perception of risk.
o Peer substance use defined as friends and peers who engage in alcohol or drug use.
o Genetic predictors defined as genetic susceptibility to alcohol or drug use.
o Family management problems defined as poor management practices, including parents’ failure to set clear expectations for children’s behavior, failure to supervise and monitor children, and excessively severe, harsh, or inconsistent punishment.
o Family conflict defined as conflict between parents or between parents and children, including abuse or neglect.
o Favorable parental attitudes defined as parental attitudes that are favorable to drug use and parental approval of drinking and drug use.
o Family history of substance misuse defined as persistent, progressive, and generalized substance use, misuse, and use disorders by family members.
o Academic failure beginning in late elementary school defined as poor grades in school.
o Lack of commitment to school defined as when a young person no longer considers the role of the student as meaningful and rewarding, or lacks investment or commitment to school.
o Low cost of alcohol defined as low alcohol sales tax, happy hour specials, and other price discounting.
o High availability of substances defined as high number of alcohol outlets in a defined geographical area or per a sector of the population.
o Community laws and norms favorable to substance use defined as community reinforcement of norms suggesting alcohol and drug use is acceptable for youth, including low tax rates on alcohol or tobacco or community beer tasting events.
o Media portrayal of alcohol use defined as exposure to actors using alcohol in movies or television.
o Low neighborhood attachment defined as low level of bonding to the neighborhood.
o Community disorganization defined as living in neighborhoods with high population density, lack of natural surveillance of public places, physical deterioration, and high rates of adult crime.
o Low socioeconomic status defined as a parent’s low socioeconomic status, as measured through a combination of education, income, and occupation.
o Transitions and mobility defined as communities with high rates of mobility within or between communities.
An understanding and identification of risk factors and protective factors can help guide our prevention, direct care and care management services.
You can review the full report, and additional materials on the Surgeon General website, by visiting https://addiction.surgeongeneral.gov/