Archive for April, 2012

Opioids associated with highest risk of death

People with an opioid addiction had the highest risk of death when compared with rates for alcohol and other drugs, according to a new study by the Centre for Addiction and Mental Health (CAMH).

For those dependent on opioids, the risk of death was 5.71 times higher than healthy individuals in the population of the same age, gender and race. Those with methamphetamine use disorders were next highest with a 4.67-fold risk, followed by those with addictions to cannabis (3.85), alcohol (3.83) and cocaine (2.96). Alcohol dependence was related to the highest number of deaths overall.

Mortality Rates Among Drug Users

The study, available online in the journal Drug and Alcohol Dependence, is the largest North American study to compare mortality rates among different drug users with the longest follow-up. It tracked records of more than 800,000 individuals hospitalized with drug dependence between 1990 and 2005. Of this group, more than 188,000 died during this period.

The findings mean that if 10 individuals in the general population died, then over the same period there would be 57 deaths among people dependent on opioids, which includes prescription opioids as well as heroin.

“One reason for undertaking this study was to examine whether methamphetamine posed a particular threat to drug users, as it has been called ‘America’s most dangerous drug,'” says CAMH Scientist Dr. Russell Callaghan, who led the study. Globally, methamphetamine and similar stimulants are the second most commonly used class of illicit drugs.

High Risk of Death

“The risk is high, but opioids are associated with a higher risk. We also wanted to compare mortality risks among several major drugs of abuse, as this comparison hasn’t been done on this scale before.”

Alcohol dependence affected the highest number of individuals, with 166,482 deaths and 582,771 hospitalizations over the study period. In the methamphetamine group, there were 4,122 deaths out of 74,139 hospitalizations, and for opioids, 12,196 deaths out of 67,104 hospitalizations.

Specific causes of mortality were not examined in this study, so the deaths may not be directly caused by drugs but due to related injuries, infectious disease or unrelated reasons. The researchers are now exploring mortality causes for each drug group, which may also point to reasons why women had a higher risk of death for alcohol, cocaine and opioids than males.

“These are not occasional, recreational drug users, but people who have been hospitalized for drug dependence,” notes co-author Dr. Stephen Kish, Senior Scientist at CAMH.

To calculate mortality rates, Dr. Callaghan and colleagues examined hospital records of all California inpatients with a diagnosis of methamphetamine, alcohol, opioid, cannabis or cocaine-related disorders from 1990-2005. They excluded records with evidence of multiple drug use disorders. The inpatient records were then matched to death records from the California Vital Statistics Database. Rates were adjusted by age, sex and race to the California population in 2000.

Risk Greater for Marijuana Users

“One surprising finding was the high rate of death among cannabis users,” says Dr. Callaghan. “There could be many potential reasons, including the fact that they may have other chronic illnesses such as psychiatric illnesses or AIDS, which can also increase the risk of death.”

The findings point to the importance of brief interventions for people receiving medical care for drug dependence on other related risks such as infectious diseases or injuries, says Dr. Callaghan.

April 26th, 2012  in Prescription Drugs No Comments »

Chronic cocaine use may speed up aging of brain

New research by scientists at the University of Cambridge suggests that chronic cocaine abuse accelerates the process of brain ageing. The study, published today 25 April in Molecular Psychiatry, found that age-related loss of grey matter in the brain is greater in people who are dependent on cocaine than in the healthy population.

For the study, the researchers scanned the brains of 120 people with similar age, gender and verbal IQ. Half of the individuals had a dependence on cocaine while the other 60 had no history of substance abuse disorders.

Loss of Brain Volume

The researchers found that the rate of age-related grey matter volume loss in cocaine-dependent individuals was significantly greater than in healthy volunteers. The cocaine users lost about 3.08 ml brain volume per year, which is almost twice the rate of healthy volunteers (who only lost about 1.69 ml per year). The accelerated age-related decline in brain volume was most prominent in the prefrontal and temporal cortex, important regions of the brain which are associated with attention, decision-making, and self-regulation as well as memory.

Previous studies have shown that psychological and physiological changes typically associated with old age such as cognitive decline, brain atrophy and immunodeficiency are also seen in middle-aged cocaine-dependent individuals. However, this is the first time that premature ageing of the brain has been associated with chronic cocaine abuse.

Premature Aging

Dr Karen Ersche, of the Behavioural and Clinical Neuroscience Institute (BCNI) at the University of Cambridge, said: “As we age, we all lose grey matter. However, what we have seen is that chronic cocaine users lose grey matter at a significantly faster rate, which could be a sign of premature ageing. Our findings therefore provide new insight into why the cognitive deficits typically seen in old age have frequently been observed in middle aged chronic users of cocaine.”

The scientists also highlight concerns that premature ageing in chronic cocaine users is an emerging public health concern. The United Nations Office on Drugs and Crime estimates that cocaine is used by up to 21 million individuals worldwide, with approximately 1 per cent of these individuals becoming dependent.

Dr Ersche said: “Our findings clearly highlight the need for preventative strategies to address the risk of premature ageing associated with cocaine abuse. Young people taking cocaine today need to be educated about the long-term risk of ageing prematurely.”

An Issue for Older Adults Too

The concern of accelerated ageing is not limited to young people but also affects older adults who have been abusing drugs such as cocaine since early adulthood.

Dr Ersche added: “Our findings shed light on the largely neglected problem of the growing number of older drug users, whose needs are not so well catered for in drug treatment services. It is timely for heath care providers to understand and recognise the needs of older drug users in order to design and administer age-appropriate treatments.”

April 26th, 2012  in Illegal Drugs No Comments »

Adolescents can benefit from 12-step involvement

Adolescents who misuse alcohol and other drugs to the point where they need treatment must contend with costly and limited options for youth-specific care, as well as high relapse rates following treatment. Mutual-help groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are widely available but little research has addressed their benefits for adolescents. An assessment of 12-step meetings and recommended activities has found that attendance, participation, and finding a sponsor promote greater abstinence among adolescents.

Results will be published in the July 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Long-Term Recovery Support

“Most substance use disorder (SUD) treatment is short-term and relapse rates post-discharge are typically high without continued support,” explained John F. Kelly, associate director of the Center for Addiction Medicine at Massachusetts General Hospital, and associate professor in psychiatry at Harvard Medical School. “Mutual-help organizations such as AA and NA can help fill this gap, providing free and flexible long-term recovery support in the communities in which people live.”

Kelly and his co-author assessed 127 adolescent outpatients (95 males, 32 females) aged 14-19 years old – who were enrolled in a naturalistic study of treatment effectiveness – at intake as well as at three, six, and 12 months later. Effects of the youths’ attendance and active involvement in activities, such as contact with their sponsor, on their subsequent abstinence were tracked over time.

“We found that about one quarter to one third of the youth attended AA/NA throughout the year-long study period following treatment, and that more meeting attendance was associated with significantly better substance use outcomes – particularly attending meetings at least once per week or more,” said Kelly. “Importantly, youth who also were in contact with an AA or NA sponsor or who participated verbally during AA/NA meetings had an even better outcome over and above the positive effects from merely attending. These findings support the common clinical recommendation that individuals should ‘go to meetings, get a sponsor, and get active.’ This is the first evidence to support this common clinical recommendation among young people.”

Encouraging A.A. Attendance

Kelly suggested that medical practitioners, counselors, and other clinicians can enhance the likelihood that youth will attend and participate in AA/NA by encouraging or facilitating their attendance early in treatment.

“Starting an on-site NA or AA young person’s meeting is another good idea,” he added. “Not all youth will be motivated to attend, but the more severely substance-involved ones will be more likely to give meetings a try and these are the ones most likely to benefit. It is also a good idea to facilitate a good match between the patient’s primary substance, cannabis/other drugs or alcohol, and the mutual-help organization to which they are being referred, Marijuana Anonymous, NA, or AA. Not doing this can lead to a poor initial match, which can be difficult to overcome.”

Kelly said that one of the key elements to success in 12-step involvement is the creation of a personal connection between the patient and an existing community AA or NA member.

A.A. for Young People

“This community member can then make introductions, answer questions, and generally act as an initial guide and onsite facilitator,” he said. “This is probably the most significant part of ensuring that young people get to their first meeting and have a positive experience – it’s hard for anyone to walk in ‘cold’ to a large AA or NA meeting. Another possibility is for parents or counselors to take adolescents to meetings or to arrange to meet them at meetings to help facilitate attendance and engagement. Once there, young people report that they like the camaraderie and social affiliation offered at meetings; they appreciate knowing that they are not the only ones suffering from addiction problems, and they report liking the attention, care, and support they get at meetings.”

April 20th, 2012  in Alcoholism No Comments »