Archive for March, 2011

Heavy drinking linked to death from pancreatic cancer

Heavy alcohol consumption, specifically three or more glasses of liquor a day, is associated with an increased risk of death from pancreatic cancer, according to a report in the March 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Alcoholic beverage consumption – a modifiable lifestyle factor – is causally related to several cancers, including oral cavity, pharynx, larynx, esophagus, liver, colorectum and female breast,” the authors write as background information in the article. “Heavy alcohol consumption causes acute and chronic pancreatitis but has never been linked definitively to pancreatic cancer.”

1 Million Patients Studied

Using data from the Cancer Prevention Study II (CPS-II), Susan M. Gapstur, Ph.D., M.P.H., and colleagues from the American Cancer Society, Atlanta, examined the association between alcohol intake and pancreatic cancer. The CPS-II is a long-term prospective study of U.S. adults 30 years and older. Initial data on alcohol consumption was gathered in 1982, and based on follow-up through 2006, there were 6,847 pancreatic cancer deaths among one million participants.

Of the million participants (453,770 men and 576,697 women), 45.7 percent of men and 62.5 percent of women were non-drinkers. The analyses of men only and of men and women combined showed statistically significant increased risk of pancreatic cancer death for consumption of three drinks per day and four or more drinks per day, whereas for women only the estimated risk of death from pancreatic cancer was statistically significant for consumption of four or more drinks per day.

Compared with non-drinkers, consuming three or more drinks of liquor per day was associated with an increased risk of pancreatic cancer death in the total study population, and consumption of two or more drinks of liquor per day was associated with an increased risk in both never smokers and in those who had ever smoked. This association was observed for liquor consumption but not for beer or wine.

Greater Risk for Smokers

In never smokers, there was a 36 percent higher risk of pancreatic cancer death associated with consuming three or more drinks a day compared with non-drinkers for men and women combined. In those who had ever smoked, there was a 16 percent higher risk of death from pancreatic cancer after adjustment for smoking history and other variables.

“Findings from the prospective study presented herein strongly support the hypothesis that alcohol consumption, in particular heavy intake, also is an independent risk factor for pancreatic cancer, the fourth most common cause of cancer mortality [death] in the United States,” the authors conclude.

March 16th, 2011  in Alcohol No Comments »

Doctors lax in monitoring potentially addicting drugs

Few primary care physicians pay adequate attention to patients taking prescription opioid drugs — despite the potential for abuse, addiction and overdose, according to a new study by researchers at Albert Einstein College of Medicine of Yeshiva University.

The study, published in the Journal of General Internal Medicine, found lax monitoring even of patients at high risk for opioid misuse, such as those with a history of drug abuse or dependence. The findings are especially concerning considering that prescription drug abuse now ranks second (after marijuana) among illicitly used drugs, with approximately 2.2 million Americans using pain relievers nonmedically for the first time in 2009, according to the National Institute on Drug Abuse (NIDA).

Missed Prevention Opportunity

“Our study highlights a missed opportunity for identifying and reducing misuse of prescribed opioids in primary care settings,” said lead author Joanna Starrels, M.D., M.S. , assistant professor of medicine at Einstein. “The finding that physicians did not increase precautions for patients at highest risk for opioid misuse should be a call for a standardized approach to monitoring.”

The researchers studied administrative and medical records of more than 1,600 primary care patients for an average of two years while they received regular prescription opioids for chronic, non-cancer pain. They looked at whether patients received urine drug testing, were seen regularly in the office, or received multiple early opioid refills.

Few Given Urine Tests

Only a small minority (8 percent) of patients were found to have undergone any urine drug testing. While such testing was more common in patients at higher risk for opioid misuse, the rate of testing among those high-risk patients was still low (24 percent). Only half of patients were seen regularly in the office, and patients at higher risk of opioid misuse were not seen more frequently than patients at lower risk. Although fewer than one-quarter (23 percent) of all patients received two or more early opioid refills, patients at greater risk for opioid misuse were more likely to receive multiple early refills.

“We were disturbed to find that patients with a drug use disorder were seen less frequently in the office and were prescribed more early refills than patients without these disorders,” said Dr. Starrels. “We hope that these findings will call attention to this important safety concern.”

Prescription Drug Misuse Problem

Prescription drug misuse is a major public health problem. In a 2004 NIDA report , it was estimated that 48 million people over the age of 12 have taken prescription drugs for nonmedical uses in their lifetime – which represents approximately 20 percent of the U.S. population. Opioids, central nervous system depressants and stimulants were the drugs most commonly abused.

“Most primary care physicians are attuned to these problems,” said Dr. Starrels, “but they haven’t put sufficient strategies in place to help reduce risks.” She and her co-authors recommend that physicians adopt the following risk-reduction strategies: standardize a plan of care for all patients on long-term opioids, which includes urine drug testing; schedule regular face-to-face office visits to evaluate patients’ response to opioids and evidence of misuse; and stick to a previously agreed-upon refill schedule.

March 12th, 2011  in Prescription Drugs No Comments »

Many children get their alcohol at home

A new study by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 5.9 percent of adolescents aged 12 to 14 drank alcohol in the past month and that the vast majority of them (93.4 percent) received their alcohol for free the last time they drank.

About 317,000 (44.8 percent) 12 to 14 year olds who drank in the past month received their alcohol for free from their family or at home. This includes 15.7 percent (or an estimated 111,000) who were provided alcohol for free by their parents or guardians.

Increased Risk for Alcoholism

“People who begin drinking alcohol before the age of 15 are six times more likely than those who start at age 21 and older to develop alcohol problems. Parents and other adults need to be aware that providing alcohol to children can expose them to an increased risk for alcohol abuse and set them on a path with increased potential for addiction,” said SAMHSA Administrator Pamela S. Hyde, J.D.

SAMHSA Data Spotlight: Young Alcohol Users Often Get Alcohol from Family or Home is based on the combined data from SAMHSA’s 2006 to 2009 National Surveys on Drug Use and Health (NSDUH) and involves responses from more than 44,000 respondents ages 12 to 14.

NSDUH is a primary source of information on national use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States. The survey is part of the agency’s strategic initiative on behavioral health data, quality and outcomes.

March 7th, 2011  in Alcohol No Comments »

Alcohol intake may increase risk of atrial fibrillation

Atrial Fibrillation (AF) is the most common cardiac arrhythmia (abnormal heart rhythm). Its name comes from the fibrillating (i.e., quivering) of the heart muscles of the atria, instead of a coordinated contraction. The result is an irregular heartbeat, which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. Atrial fibrillation alone is not in itself generally life-threatening, but it may result in palpitations, fainting, chest pain, or congestive heart failure.

There is no doubt that heavy alcohol intake and binge drinking can lead to cardiac arrhythmias, with the “Holiday Heart Syndrome” being known for more than three decades. This syndrome often includes atrial fibrillation; the syndrome is usually not associated with long-standing heart disease and the arrhythmia tends to resolve when drinking stops.

Heavy Drinking and Atrial Fibrillation

Members of The international Scientific Forum on Alcohol Research comment ‘This paper, Alcohol consumption and risk of atrial fibrillation. A meta-analysis. J Am Coll Cardiol 2011;57:427-436. analyzing the results of 14 papers suggests that even moderate drinking can lead to this syndrome, but others find no effect for moderate alcohol intake, only for heavy drinking.

One of the best studies on alcohol consumption and risk of atrial fibrillation is a Danish cohort study (the Danish Diet, Cancer and Health Study) examining the issue among 22,528 men and 25,421 women followed over 6 years. The study included a large number of cases with atrial fibrillation, detailed information on potential confounding factors, and complete follow up through nationwide population-based registries.

The results included a modest increase in risk of atrial fibrillation in men drinking more that 2 drinks/day and no association between alcohol consumption and risk of atrial fibrillation in women.

Binge Drinking Dangers

There is much evidence that heavy alcohol consumption is associated with an increased incidence of atrial fibrillation, among other health risks. The pattern of consumption (speed, time frame and without food), not often addressed, affects risk too – we know that binge drinking is associated with a greater incidence of arrhythmias, especially atrial fibrillation.

A weakness of this paper, and of essentially all meta-analyses, is that there were varying definitions for categories of alcohol consumption, and the highest category of alcohol intake included alcoholics and 6 or more drinks/day for some studies, while the highest category of alcohol intake was = 1-2 drinks/day in other studies.

Inherent Health Risk

The consistent message is that there is a difference between heavy and moderate use of alcohol, between binge drinking and a healthy pattern of drinking, and inherent health risk. The most important question would be: Does light to moderate drinking increase the risk of AF? The conclusion of the authors of this paper seems to be yes, while many other studies find little effect of such drinking’.

Overall, the scientific evidence from many studies suggests that heavy drinking may increase the risk of atrial fibrillation, although whether light-to-moderate intake increases the risk seems unlikely. Previous basic scientific data of mechanisms of atrial fibrillation have suggested that alcohol has little effect on this arrhythmia.

March 6th, 2011  in Alcohol No Comments »