Providentia

New Report Highlights Substance Abuse Dangers for Pregnant Teens

According to a new report released by the Substance Abuse and Mental Health Services Administration (SAMSHA), of the 57,000 teenage females in substance abuse treatment programs each year, as much as 2000 (4  percent) are pregnant.    The report, titled "Characteristics of Pregnant Teen Substance Abuse Treatment Admissions" is based on on SAMHSA statistics from 2007 to 2010 and focuses on females aged 12 to 19.   In exploring the problems faced by pregnant teens in substance abuse programs, the report indicates that pregnant teens are three times more likely than non-pregnant teens to require public assistance, and also less likely to be enrolled as students when not in the workforce.    Despite the risk to their unborn children, about half (51 percent) reported some use of drugs or alcohol in the month prior to their entering treatment with nearly a fifth (19.1%) reporting daily drug or alcohol use. For both pregnant and non-pregnant teens, marijuana was the most commonly used drug though pregnant teens were also more likely to abuse methamphetames.

In discussing the report findings, SAMHSA Administrator Pamela S. Hyde stressed the  treatment needs faced by pregnant teens.  “These specialized needs are even more acute for our pregnant teens. Community programs that can address the needs of pregnant teens by providing them both access to substance abuse support services and specialized pregnant and post partum services can help ensure that these future mothers and their children live healthier, happier and more productive lives." she stated.

SAMHSA has a Service Grant Program for Residential Treatment for Pregnant and Postpartum Women providing family-centred treatment in residential programs to help low-income pregnant women with substance abuse problems with all their treatment needs as helping non-residential family meembers.  They may also need referral for medical services including pre- and post-natal care and parenting courses, as well as information to correct misconceptions about birth control, substance abuse risks, and venereal disease.  Referrals also receive psychological assessment and counseling to address mental health care needs in addition to substance abuse treatment.  

The criminal justice system remains the most common source of referral for pregnant teens (41.4%) with community agencies and self-referral being the next most common.     Most pregnant teens are living in poverty with a high percentage living on Medicaid or no income at all.  Lacking access to affordable medical care represents one of the most critical barriers to safe delivery of their children and successful transition to adult life.  For pregnant teens lacking proper care, the long-term consequences for them and their children remains bleak.

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The Keeley Cure

You might  call it the "gold standard" for alcohol treatment...

At the dawn of the 20th century, treating alcoholism was one of the main cash cows for medical clinics across North America.  Actual statistics remain scarce though lectures on the destructive power of "Demon Rum" helped sustain the Temperance movement.  The drive to ban alcohol would eventually foster enough political momentum to pass the 18th Amendment and begin Prohibition in 1919 but that still lay in the future. 

Still, clinics offering "miracle cures" to treat chronic alcoholics became fairly common during the last years of the 19th century and early  20th.  Addiction was already regarded as a major social problems with "inebriates" and "dope fiends" desperate to "take the cure"  (or else forced into it by courts or family members).  Along with Charles B. Towns and his "belladonna cure",  there were other attempts at treatment using equally dubious methods.  

Which brings us to Leslie Keeley...

After serving in the U.S. Civil War as a surgeon, Keeley moved to Dwight, Illinois where he set up a private practice and eventually established his own sanatorium in 1880.  The clinic quickly became established as one of the leading facilities for treating alcoholics and opium addicts as well as the town's main source of employment.   Keeley frequently boasted that alcoholism was a disease and he had the cure for it.   The "Keeley Cure", as it would be commonly known, was a  closely-held trade secret though he hinted that his central remedy contained "bichlorate of gold" among other ingredients.   While later chemical analysis would prove that Keeley's cure actually contained ingredients such as ammonium chloride, strychnine, atropine, and and cinchona with no gold at all, it was still marketed as the "gold cure" to hopeful patients.   In his own words, Keeley described his treatmentas:

"a reconstructive Nerve Tonic having the Double Chloride of Gold and Sodium for its basis, which will in every case, without exception, forever relieve the nervous system of the acquired necessity for Alcohol, Opium, Morphine, or any other stimulant or narcotic."

Almost immediately, Keeley battled with the American Medical Association which flatly refused to endorse any treatment with unknown ingredients.   While Keeley and his defenders insisted that secrecy was necessary to protect his business and prevent bootleg copies of his cure, he also played on public suspicion of doctors.  "If I should throw open my formula to the world it would not cheapen the cure to the patient one cent," he said in 1891. "Reputable physicians would charge their regular rates, disreputable physicians would charge less in money, but by their dishonest practices would rob the poor drinking man of the thing dearest to him in this world --the chance of complete reform."

Keeley's respected medical credentials and his claim that the cure was 95% effective in treating alcoholism ensured a steady stream of customers.   He also insisted that his treatment represented a complete cure from alcoholism and that his patients could even drink voluntarily afterward since their alcohol use was no longer habitual.  Perhaps the greatest boost for his claims to curing alcoholism came in 1879 when Joseph Medill, editor of the Chicago Tribune decided to challenge Keeley in a novel way.  Medill found six of the most hopeless alcoholics in Chicago and anonymously sent them to Keeley's clinic for treatment.    After the former alcoholics returned to Chicago, Medill publicly ackowledged that Keeley had succeeded.  "The change for the better was so great that I scarcely recognized them,"  Medill wrote.  "They went away sots - and returned gentlemen." 

With Medill's endorsement, Keeley's clinic became so popular that he and his associates,  J.B. Oughton and Major Curtis J. Judd, found themselves at a loss over how to invest the profits from their clinic.  From the one clinic in Dwight, Illinois, Keeley would eventually sell franchises that ranged across the United States, Canada and Mexico (200 Keeley centres in all).    Along with his clinics and numerous patients, Keeley was also a popular writer whose books and pamphlets on alcholism and dug addiction helped boost his public reputation.   Temperance societies praised Keeley's cure and frequently referred new patients to his clinics.  The demand for Keeley's services was so great that his Dwight clinic alone handled over 700 patients a day at the peak of his popularity.  Along with the patients who came in person to Keeley's clinics to "seek the cure", Keeley and his partners also operated a prosperous mail-order business where patients could send away for for the bottles of his patented cure which they could take in the privacy of their own homes.  

Still, Leslie Keeley had more than his fair share of critics.  He had a forceful personality and insisted on absolute control over his clinic as well as ensuring that his name was prominently displayed on all advertising.  According to Frederick Hargreaves, a former supporter who later became one of Keeley's fiercest critics, "he was a man of strong personality. He dominated everybody, or ruled everybody, and made them do as he wanted to do, and if they would not do it, he would make them do it, or have nothing to do with them at all. That was Keeley's character."   Another former associate described Keeley as a "born autocrat."   Still, he was also generous with his time and often took on patients who were too poor to pay his regular fees.  Not that this was too much of a hardship for him given his tremendous success.    He slowly withdrew for the regular daily operation of his clinics during the last years of his life and devoted more time to semi-retirement at the large house he had built in Los Angeles.  By the time of his death from heart failure on February 21, 1900, he was already a millionaire.

Despite the loss of their founder, the Keeley clinics continued to operate for decades in many places though things slowly went downhill after his death.   Oughton and Judd took over the clinic and continue to run things following Keeley's general treatment model.   In the years that followed, the routine for Keeley's patients would be largely unchanged at his different clinics.   According to a 1939 news story published in Time magazine, "Unvarying is the traditional Keeley routine. An incoming inebriate pays $160, plus room and board, must stay for 31 days. His weekly whiskey ration is gradually tapered off: eight ounces the first day, six ounces the second, four ounces the third, none from there on. Four times a day he gets gold chloride injections; every two hours he takes a tonic."   Between 1900 and 1939 alone, more than 100,000 patients were treated at the Keeley clinics although medical doctors became increasingly skeptical of the actual value of Keeley's "cure".   The rise of Alcoholics Anonymous and other self-help organizations also meant a drop in patients as treatment options became available and more questions were raised about the Keeley method's actual validity.

As the demand for the Keeley clinics slowly faded (and skeptics kept raising pesky questions about the "secret" ingredients in the Keeley cure), branch clinics eventually began going out of business.   The last remaining Keeley clinic which, fittingly enough was the flagship treatment facility in Dwight, Illinois, finally closed its doors in 1966.   While the Keeley building that housed the clinic is still standing, there are few other traces left of the industry that had once made Dwight, Illinois famous.  Still, many of the town's older residents can still recall the clinic's glory days.

Was Leslie Keeley a quack?   While his "gold cure" likely worked purely through the placebo effect, he was still a pioneer in the treatment of drug and alcohol abuse.    As one of the first medical doctors to regard alcoholism as a disease rather than a moral problem, he gave alcohol treatment the respectability it never really had before.   His mysterious cure and his autocratic manner may have generated fierce criticism,  but Leslie Keeley still offered hope to thousands of people desperate for a cure and, in many cases, actually succeeded.  It's hard to offer much of a defense of his mystery cure though and he behaved much the same way that modern day purveyors of alternative medicine do.   In Keeley's case however, his success came from filling a treatment niche that was tragically neglected by other medical doctors.   Sometimes, even a "gold cure" is better than no cure at all.

 

 

 

 

 

 

LSD Psychiatrist Dead at 86

One of the early pioneers in the medical use of lysergic acid diethylamide (LSD) has died in Maryland at the age of 86.   Dr. Gerald D'Arcy Klee died March 10 of complications following surgery according to a statement issued by his family.    A prominent psychiatrist and medical educator, Dr. Klee is best-known as one of the  researchers working on the Edgewood Arsenal experiments conducted at the Edgewood Arsenal north of Baltimore, Maryland between 1952 and 1959.   The experiments, which are believed to have been linked to CIA research into mind control along with the more notorious MKULTRA project, involved testing LSD and other hallucinogenics on willing military subjects.  

Though the results were classified until 1975,  hundreds of U.S. soldiers were given LSD and THC as well as chemical and biological agents to study their effect on mental and physical functioning.    Due to the many claims filed by veterans during the 1970s indicating significant health problems resulting from the experiments, Congress launched a formal investigation to determine whether proper informed consent had been obtained from the soldiers who participated in the research.

Dr. Klee's involvement in the experiments came to light when he confirmed media reports that the University of Maryland School of Medicine's Psychiatric Institute had conducted the research.   "A large proportion of the people who have gotten involved in research in this area have been harebrained and irresponsible — Timothy Leary being the most notorious example — and a lot of the stuff that has been published reflects that," Dr. Klee  said in a 1975 interview with the Baltimore Evening Sun.  "We didn't have any axes to grind, and the university's role was to conduct scientific experimentation," he said. "The interests of the University of Maryland group were purely scientific, and the military was just there", he added.   He also admitted to using LSD himself prior to conducting the research.  "I felt obliged to take it for experimental reasons and also because I didn't think it would be fair to administer a drug to someone else that I hadn't taken myself,"  he said in the same interview.

According to Dr. Klee, the soldiers who participated were primarily enlisted men who received bonus leave time to take part in the research.   Though some "bad trips" had been observed in soldiers following LSD ingestion,  Dr. Klee denied any long-term ill effects,  However,  he admitted there was no follow-up after the soldiers completed their one-month participation at Edgewood Arsenal.    While the army would later admit to administering LSD to more than 1500 people between 1956 and 1967, Dr. Klee denied any knowledge of these later experiments.  He led an unsuccessful campaign to have then-President Richard Nixon renounce the use of LSD as a military weapon.  

Into the Mind of Marilyn Monroe

The death of movie actress Marilyn Monroe on August 5, 1962 is still controversial despite being ruled a "probable suicide" by Los Angeles coroner Thomas Noguchi. While the cause of death was due to acute barbiturate poisoning and Monroe had made previous suicide attempts using prescription drugs in the past, questions about her involvement with then-President John F. Kennedy continue to be raised.

Several police officers who arrived at the scene of her death, including Los Angeles police officer Jack Clemmons, openly speculated on the possibility that the star had actually been murdered. Clemmons even accused members of the LAPD with staging a cover-up and that the death scene had been deliberately staged.

Though Clemmons and other conspiracy theorists continue to insist that she had been murdered, one of the first psychological autopsies to be carried out ruled that the death had been suicide. Psychiatrist Robert E. Litman, a Los Angeles-based suicide authority had been the chief psychiatrist on the autopsy team examining the Monroe case would later describe the evidence used to determine that she had committed suicide.

This included the telephone calls that Monroe had made after taking the pills in which she insisted that she was "in deep trouble". According to Litman, her death could be considered "a self-inflicted death, where there is a great risk but also a good chance for rescue." He concluded that she had staged the suicide with the hope of rescue which came too late.

But could Marilyn Monroe's own writings provide clues about her suicidal intentions? Many of the letters, poems, and personal notes that Monroe wrote in the years leading up to her death were recently collected in a single book, Marilyn Monroe's Fragments, published last year.

To read more about the recent research study looking at Fragments and the linguistic evidence into her death, check out my new Huffington Post contribution. 

Kicking the Caffeine Habit

How dangerous is caffeine addiction?     Easily the most widely used recreational drug in the world, caffeine is regularly consumed by 85% of all adults and children in the United States according to one recent study and that figure is likely the same in most other countries.   Average daily caffeine intake is estimated to be about 280 milligrams a day,  the equivalent of two cups of coffee or seven 12-ounce cans of caffeinated soft drinks.   

Usually considered harmless in low doses, caffeine can lead to serious health problems as well as complications in pregnancy.   Caffeine intake greater than 400 milligrams can lead to symptoms such as “jitters”, increased heartbeat, nausea, anxiety,  dizziness and even heart failure in cardiac cases.    The symptoms can be even more severe in people with a caffeine allergy.   While cases of caffeine overdose are relatively rare, there have been documented cases in countries around the world.    Like any other drug, regular caffeine use can also lead to physical dependence which makes it hard to quit, even for health reasons.

To read more, check out my new Psychology Today blog post here.

Seeking the Belladonna Cure

For alcoholics and drug addicts at the beginning of the 20th century, Charles B. Towns must have seemed like a gift from Heaven.  That his famous cure seemed like utter quackery to legitimate medical experts of the time hardly seemed to matter to the countless patients who flocked to Towns' hospital.   At least, they did for a while...

Born on a small Georgia farm in 1862, Charles B. Towns had a wide range of careers ranging from farm hand to insurance salesman. In 1901, he moved to New York City where he became a partner in a brokerage firm (which failed). At some point, he launched himself into a new crusade to combat the twin problems of alcoholism and drug abuse. During this same period, temperance workers like Carry Nation were drumming up support for the anti-alcohol movement that would eventually lead to Prohibition. Drug and alcohol treatment centers sprang up around the United States and substance abuse experts, even ones without medical credentials, could establish themselves as dominant players in the growing field.  Town’s description of his early life is rather vague (likely deliberately).   As a result, it’s hard to say when he came into contact with the mystery benefactor who provided him with the recipe for what was later described as a "sure-fire cure" for alcoholism and drug abuse.  As Towns later described this fateful meeting, he was approached by the still-unnamed source who offered him the cure and announced that they could both "make a lot of money out of it."  Although his own physician told Towns that the "cure" was just a quack remedy, Towns placed newspaper advertisements to recruit drug addicts to take part in his informal testing of the miracle cure. 

Using hotel rooms for his test subjects, Towns even went so far as to restrain the more-or-less willing guinea pigs to keep them from leaving while he worked the kinks out of his formula.  While he remained mum about actual failures, Towns eventually perfected his treatment approach to reduce the suffering involved.   After establishing that his treatment was nearly 100 per cent effective (largely based on the assumption that the unsuccessfully treated ones would return for more treatments), Towns was mystified over the cold reception that he received from the local medical community, most of whom regarded him as a quack.  That failed to stop Towns from establishing the Charles B. Towns Hospital in New York City in 1901.  Located at 293 Central Park West, the hospital became one of the most expensive detoxification hospitals in New York and  a favourite "drying out" spot for the rich and famous (alcoholism and drug use crossed all social boundaries).

Unfortunately, even with his enthusiastic praise for a “cure” that he regarded as being effective in over 90 % of cases, there was still the pesky problem of his lacking medical credentials.

Which brings us to Dr. Alexander Lambert…

One of the most eminent medical doctors in New York City, Dr. Lambert was a professor of medicine at Cornell University and the personal physician of then-President Theodore Roosevelt.   He was also one of the foremost authorities on treating drug addicts and alcoholics with decades of experiencing dealing with alcoholics at New York's Bellevue Hospital.  Exactly why such a respected physician would associated himsef with someone like Towns remains a mystery.   Still, 0nce Lambert lent his name to Towns' miracle remedy, the Towns-Lambert treatment (as it would be called from then on) became the dominant treatment for alcoholics in "drunk wards" across the United States.   And that began with Dr. Lambert's own patients at Bellevue.

In describing the effectiveness of the new treatment, he stated that:  "The obliteration of the craving for narcotics is not a matter of months or weeks . . . but is accomplished in less than five days. The result is often so dramatic that one hesitates to believe it possible."   Though other medical experts were still leery, Lambert's testimonial and his willingness to stake his own professional reputation over something that had been dismissed as a quack remedy was enough for them to take a serious look at Towns' remedy.

Part of the problem was that Charles B. Towns continued to insist that the formula remain his own personal secret.   While the formula eventually became public knowledge, the actual ingredients were enough to make the skeptics leery all over again.  Particularly since the main ingredient was belladonna.   Extracted from the berries of the atropa belladonna bush (also known as deadly nightshade), belladonna is an extremely toxic hallucinogenic.   Among the different alkaloid toxins that would later be derived from belladonna are scopolamine and hyoscyamine.   Though known since ancient times as a deadly poison, it also gained a strange fame as a beauty aid (belladonna takes its name from the Italian phrase for "beautiful woman" and relates to the custom of using belladonna to dilate a woman's pupils to make her appear more alluring).    While also used as a traditional pain reliever for centuries, belladonna was usually mixed in with other ingredients to dilute its toxicity. 

Towns' own recipe called for fifteen percent tincture of belladonna mixed in with with fluid extract of xanthoxylum (prickly ash) and the extract from  hyoscyamus niger.   Since hyoscyamus niger was also toxic (being another nightshade alkaloid), the patients needed to be carefully monitored to make sure they were not poisoned by the belladonna mixture.   The Towns-Lambert cure was usually administered on an hourly basis over two days or more and patients had to be watched for side effects such as a flushed face, dilated pupils, hallucinations, or delirum.   These symptoms were often hard to gauge in many patients since they were frequently  experiencing delirium tremens as well due to alcohol withdrawal.   As part of the  treatment, patients also received cathartics and mercury pills (which were an all-purpose purgative to prevent constipation).  

Once patients were admitted to hospital, Lambert often prescribed chloral hydrate and morphine to put them to sleep before starting them on the Towns-Lambert cure.    After the two-day treatment was completed, it was followed up with a heavy dose of castor oil and and tonics to help patients return to regular foods (the entire course of the treatment, often accompanied by heavy vomitting, was known as "puke and purge").  

Gross as it might have seemed to observers, Lambert was filled with praise for Towns' belladonna cure and he introduced Charles B. Towns to government officials as "an honest man.   No faker".    With Lambert's backing, Towns traveled to China to sell his cure for dealing with opium addicts there.    Lambert wrote to Assistant Secretary of State Robert  Bacon and asked him to make all the arrangements.    By 1908, Charles B. Towns was able to meet with the American delegation to the Shanghai Opium Commission to announce that he had cured more than 4,000 opium addicts  which, along with the political backing that Lambert provided, gave his treatment essentially official  endorsement by the U.S. government.  

Along with  writing three popular books on substance abuse, Towns also became influential in drafting some of the most far-reaching drug and alcohol bills, including the Harrison Narcotics Tax Act of 1914.    Despite Lambert's backing, there were still skeptics who warned that the Towns-Lambert treatment was potentially more dangerous than the disease it was supposed to cure.   Advertising the effectiveness of their cure, Towns and Lambert downplayed the extreme physical distress they caused their patients, and the deaths that could occur.   In one year alone, 130 patients were treated and there were six deaths (suggesting a fatality rate as high as four or five percent).    

Whether because of the death toll or simply due to the increasingly elaborate claims that Towns was making (including using his belladonna cure to treat kleptomania and bedwetting), Charles Lambert eventually broke off all association with Towns and his hospital.   There was also the troubling fact that the "cure" was not as effective as he and Towns had hoped and that numerous patients were returning after failing to quit their drug and alcohol habits.    During the 1920s, much of the hospital's revenue came from repeat business.   Even that repeat business largely ended with the Stock Market crash of 1929 and the resulting Depression since most of their well-to-do repeat patients were wiped out financially. 

After Towns lost his medical expert, his cure lost most of the respectability it enjoyed in the medical community.   Other medical experts weighed in on the problems with the belladonna cure and Charles B. Towns eventually faded into obscurity.    Despite his former fame as an addictions expert, Charles B. Towns would be largely forgotten today except for the identity of one of his patients.

William Griffith Wilson, a.k.a. "Bill W.", had been a severe alcoholic who was admitted to Towns' hospital on four occasions.   Along with his chronic alcoholism, Wilson also suffered from severe depression and had largely hit rock bottom by 1933 when he entered the Towns hospital under the care of Dr. William Silkworth.   Gaining hope from his doctor's theory that alcoholism was a disease instead of a moral weakness,  Wilson eventually realized that he needed to conquer his alcoholism before it destroyed his health and sanity.   Inspired by Ebby Thatcher and other alcoholics who had recovered successfully from drinking problems,  Wilson would later describe how he "saw the light" and underwent a spiritual conversion (how much of that experience was linked to the belladonna and other hallucinogenics he was being treated with at Towns' hospital is open to question). 

Whatever the reason for his spiritual conversion, it was profound enough to inspire an increasing number of alcoholics in New York and the surrounding area to join with Wilson in renouncing alcohol.  By 1938, Wilson and his fellow alcoholics published a book titled "Alcoholics Anonymous" which became the The Big Book for their growing movement (Wilson was the book's lead author).  Charles B. Towns was impressed enough by Wilson to lend him and his supporters $2500 to help publish the book ( a princely sum in those days).    Though Towns' own reputation as a substance abuse expert was on the decline, his support was still crucial during the early days of the AA movement.  Along with offering the unemployed Wilson a job as a lay therapist (which Wilson refused), Towns also helped publicize AA and helped sell hundreds of copies of The Big Book. 

Charles B. Towns died in 1947 and his belladonna cure died with him.   His only lasting legacy is the role he played in launching Alcoholics Anonymous and the various Twelve Step programs founded on AA principles.   Whether that would have been enough for a man who hoped to provide the world with a medical miracle is anybody's guess.

 

 

Can Ecstasy Help Treat PTSD?

Michael and Ann Mitthoefer likely never expected the reaction they received after their research study was published online in the Journal of Psychopharmacology.  

A husband and wife team,   the Mitthoefers had developed a treatment combining psychotherapy with a maintenance regimen of MDMA (better known as “Ecstasy”) to treat posttraumatic stress in victims of violence.   Michael Mitthoefer is a psychiatrist while his wife Ann is a registered nurse and they began using MDMA to treat trauma patients in collaboration with the Multidisciplinary Association for Psychedelic Studies. 

To read more, check out my new blog post on the Psychology Today site. 

How Safe is Methadone?

 Yes, I'm still in Nashville and CSICon is an awesome experience that I'll be writing about eventually.   In the meantime, here is another post to tide you over.

While methadone clinics are a familiar sight in most cities these days,the synthetic opioid's reputation as a safe treatment for heroin and morphine addiction has been shaken by the rising number of overdose deaths linked to its use.  

Since it was first developed in Germany during the 1930s, the analgesic that eventually became known as methadone has been praised as a safe and effective pain medication with fewer dependency issues than more powerful opiates such as heroin.   While going under a range of different names (including Dolophine, Symoron and Amydone), the drug was rechristened as "methadone" in 1947 when it became generic.  Although methadone treatment was eventually phased out during the 1950s as better analgesics came along, everything changed in 1964 when Doctors Marie Nyswander and Vincent Dole began using methadone to treat heroin addicts.   Since methadone has cross-tolerance with other opioids with a long effect duration and very similar effects,  addicts were successful in weaning themselves off more dangerous opioids such as morphine and heroin and methadone maintenance programs became widely used in many countries.  Higher doses of methadone can even block the euphoric "highs" that addicts experience with heroin and other addictive opiates. 

Physicians typically require specialized licensing and training to prescribe methadone safely and precautions are usually needed to prevent potential abuse.   Given the potential for methadone to be diverted for use as a street drug, methadone clinics often require added security and safety procedures for proper dispensing.   Some clinics provide methadone in concentrated form to reduce the number of daily doses needed although safeguards need to be in place to avoid the possibility of overdose.   With careful management, methadone maintenance treatment (MMT) can be maintained for months or years depending on the policies of the clinic administering the medication.   MMT use is still controversial though and many countries ban its use  (Russia for example).   In the United States and Canada, conservative politicians have advocated against MMT and argue in favour of total abstinence programs instead.  

In recent years, methadone has also become more popular as an analgesic as well as a way of weaning chronic pain patients off other pain medications to which they have become addicted.   That includes Oxycontin and codeine which have become major street drugs in their own right.   Along with methadone's (largely exaggerated) reputation for being non-addictive, or at least less addictive than other alternatives, methadone is also low-cost due to being generic.  It is also more effective against neuropathic pain since methadone acts directly on the NMDA receptor.   Unfortunately, methadone has a longer half-life than other analgesics (remains in the system longer) which causes it to build up in the system over time.   This leads to an increased risk of breathing and cardiac problems.    Due to cautions over methadone use and the continuing need for special licensing to prescribe it, methadone is still not as common as other analgesics.  In 2009 alone, only two percent of all pain prescriptions were for methadone in the United States. 

While not as popular as other pain medications, recent statistics issued by the Center for Disease Control's Vital Signs report show that methadone has been implicated in nearly a third of all overdose deaths linked to prescription pain relievers.   National data covering the years from 1999 to 2010 shows that four out of every overdose deaths from a single pain medication implicated methadone in some way.   With the rise in methadone use as an analgesic unfortunately, there has also been a corresponding rise in its popularity as a street drug.    According to CDC director, Dr. Thomas R. Frieden:

Deaths from opioid overdose have increased four-fold in the past decade, and methadone now accounts for nearly a third of opioid-associated deaths ... Methadone used for heroin substitution treatment does not appear to be a major part of this problem. However, the amount of methadone prescribed to people in pain has increased dramatically. There are many safer alternatives to methadone for chronic non-cancer pain.

To curb the rising trend of methadone-related deaths, the CDC recommends the following:

• screening potential methadone patients for substance abuse and other mental health problems
• prescribing only the amount needed based on the expected duration of pain
• using patient-provider agreements in conjunction with regular urine testing to monitor people taking methadone for  long-term treatment
• using prescription drug monitoring programs to flag patients abusing methadone or other pain relievers
• educating patients on the proper dosage, safe use and storage of prescription pain

While methadone is available in tablet or ampoule form, the U.S. Department of Health has strongly warned against prescribing them to patients due to the added risk of illicit sales and/or vein damage if they are injected directly in veins.  The U.S. Drug Enforcement Agency has been particularly militant in shutting down "pill mills" in Florida and other states producing methadone pills for illegal use.   

Along with a Federal bill signed into law by President Barack Obama in 2010 making it easier for local authorities to dispose of unneeded or expired pharmaceuticals, most U.S. states have also passed laws against "doctor shopping".   Since many prescription drug abusers often see multiple doctors with the pain symptoms, they are able to accumulate large hoards of prescription drugs through repeated prescriptions.  Patient registries allow physicians to check drug histories of prospiective pain patients to identify the abusers.

Although these measures are promising, the grim toll of methadone-related deaths is unlikely to change in the forseeable future.   While the current safeguards in methadone drug treatment programs appear to be working (few methadone deaths have been linked to formal clinic practices), patients receiving methadone for pain should only take it as prescribed by their doctors.   Those patients wishing to go off methadone should follow medical instructions carefully since "cold turkey" withdrawal can have devastating consequences as well.

Patients should also store methadone safely to ensure that no one else in their household can take it, either accidentally or on purpose.   Consult your pharmacist for advice on safe disposal (not in the nearest trashcan!).

For more information.

 

 

 

 

 

 

Can Neuroimaging Help Understand Sex Differences in Cocaine Abuse?

A consistent observation in drug abuse research is that males and females show differences in their response to drugs of abuse. In order to understand the neurobiology underlying cocaine abuse and effective treatments, it is important to consider the role of sex differences. Sex hormones have been investigated in both behavioral and molecular studies, but further evidence addressing drug abuse and dependence in both sexes would expand our knowledge of sex differences in response to drugs of abuse. Neuroimaging is a powerful tool that can offer insight into the biological bases of these differences and meet the challenges of directly examining drug-induced changes in brain function. As such, neuroimaging has drawn much interest in recent years. Specifically, positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) technology have emerged as effective noninvasive approaches for human and animal models. Studies have revealed sex-specific changes in patterns of brain activity in response to acute cocaine injection and after prolonged cocaine use. SPECT and PET studies have demonstrated changes in the dopamine transporter but are less clear on other components of the dopaminergic system. A recent review published in Experimental and Clinical Psychopharmacology   highlights contributions of neuroimaging toward understanding the role of sex differences in the drug abuse field, specifically regarding cocaine, and identifies relevant questions that neuroimaging can effectively address.

For the abstract

 

More Calgary Drug Deaths Linked to Tainted Ecstasy

Calgary police have confirmed that the death of 23-year old Cody Gorlick was caused by an overdose of ecstasy tainted with a dangerous additive.  Gorlick, a student at the Southern Alberta Institute of Technology (SAIT) died at the SAIT residence on January 21.  He is the the most recent known fatality in the Calgary area involving ecstasy laced with para-methoxymethamphetamine (PMMA).

A powerful stimulant drug, PMMA has been linked to pharmacologist Alexander Shulgin, who also helped popularize MDMA ("ecstasy") along with numerous other psychoactive drugs.    Although Shulgin initially described PMMA as having no psychoactive effects, it has since become popular as a street drug in its own right and has been implicated in numerous overdose deaths in recent years.  While information on PMMA's  toxicity and pharmacological properties is still limited,  symptoms of PMMA overdose can include hypothermia, hallucinations, and psychological effects similar to MDMA   As a result, drug distributors have been using PMMA as an ecstasy additive to increase its potency.  PMMA-related deaths have been reported in British Columbia, Alberta, the Netherlands, Iceland, and Israel. 

While ecstasy use has traditionally been associated with younger people taking it during all-night raves, its popularity has broadened in recent years and many older adults have been taking it as well.

Cody Gorlick's death brings the number of PMMA deaths in Calgary up to seven so far and provincial officials are warning that "there is no quick fix" to the PMMA epidemic.   Calgary police have suggested that tainted ecstasy may be involved in a recent "black weekend" that left one 35-year old man dead and four others hospitalized.    While PMMA has been linked to ecstasy in powdered form, pills or capsules containing ecstasy may also be tainted.   Local health authorities have stepped up warnings concerning the danger involving ecstasy use in any form.  Police superintendent Kevan Stuart has stated that, "Let's not sugar-coat this.  It's very simple: taking ecstasy is very risky.   You're playing Russian roulette".   

Police have yet to identify the source of the tainted ecstasy which is little comfort to Cody Gorlick's mother, Deborah.  In a recent statement, she said that "Now we know it was poison.  I hope the people who made it are scared.  They've got to catch these people".

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