200 Million People Use Illicit Drugs

By Katie Moisse | ABC News Blogs

Roughly 200 million people worldwide use illicit drugs such as marijuana, amphetamines, cocaine and opioids each year, according to a new study. The figure represents about one in 20 people between the ages of 15 and 64.

Using a review of published studies, Australian researchers estimated that as many as 203 million people use marijuana, 56 million people use amphetamines including meth, 21 million people use cocaine and 21 million people use opioids like heroin. The use of all four drug classes was highest in developed countries.

"Intelligent policy responses to drug problems need better data for the prevalence of different types of illicit drug use and the harms that their use causes globally," reads the report, published today in The Lancet. "This need is especially urgent in high-income countries with substantial rates of illicit drug use and in low-income and middle-income countries close to illicit drug production areas."

The 200 million number does not include people who use ecstasy, hallucinogenic drugs, inhalants, benzodiazepines or anabolic steroids - just one reason it's likely a vast underestimate of illicit drug use, according to lead author Louisa Degenhardt of the Sydney-based National Drug and Alcohol Research Center.

"Drug use is often hidden, particularly when people fear the consequences of being discovered for using drugs, such as being imprisoned," Degenhardt said in a press conference.

Up to 39 million people are considered "problematic" or dependent drug users and up to 21 million people inject drugs, according to the report.

"It's likely that injectable drug users have increased," said Degenhardt, adding that the practice "is a major direct cause of HIV, hepatitis C and to some extent hepatitis B transmission globally." Cocaine, amphetamine and heroin can be injected either alone or in combination.

Illicit drugs can have dangerous health effects, including overdosing, accidental injury caused by intoxication, dependence and long-term organ damage. While they may not cause immediate death, they're thought to shave 13 million years of the life spans of users worldwide, according to the report. A 2000 report by the World Health Organization attributed roughly 241,000 deaths to illicit drug use - double the number from 1990.

New powerful painkiller has abuse experts worried

By Chris Hawley, Associated Press

NEW YORK (AP) -- Drug companies are working to develop a pure, more powerful version of the nation's second most-abused medicine, which has addiction experts worried that it could spur a new wave of abuse.

The new pills contain the highly addictive painkiller hydrocodone, packing up to 10 times the amount of the drug as existing medications such as Vicodin. Four companies have begun patient testing, and one of them — Zogenix of San Diego — plans to apply early next year to begin marketing its product, Zohydro.

If approved, it would mark the first time patients could legally buy pure hydrocodone. Existing products combine the drug with nonaddictive painkillers such as acetaminophen.

Critics say they are especially worried about Zohydro, a timed-release drug meant for managing moderate to severe pain, because abusers could crush it to release an intense, immediate high.

"I have a big concern that this could be the next OxyContin," said April Rovero, president of the National Coalition Against Prescription Drug Abuse. "We just don't need this on the market."

OxyContin, introduced in 1995 by Purdue Pharma of Stamford, Conn., was designed to manage pain with a formula that dribbled one dose of oxycodone over many hours.

Abusers quickly discovered they could defeat the timed-release feature by crushing the pills. Purdue Pharma changed the formula to make OxyContin more tamper-resistant, but addicts have moved onto generic oxycodone and other drugs that do not have a timed-release feature.

Oxycodone is now the most-abused medicine in the United States, with hydrocodone second, according to the Drug Enforcement Administration's annual count of drug seizures sent to police drug labs for analysis.

The latest drug tests come as more pharmaceutical companies are getting into the $10 billion-a-year legal market for powerful — and addictive — opiate narcotics.

"It's like the wild west," said Peter Jackson, co-founder of Advocates for the Reform of Prescription Opioids. "The whole supply-side system is set up to perpetuate this massive unloading of opioid narcotics on the American public."

The pharmaceutical firms say the new hydrocodone drugs give doctors another tool to try on patients in legitimate pain, part of a constant search for better painkillers to treat the aging U.S. population.

"Sometimes you circulate a patient between various opioids, and some may have a better effect than others," said Karsten Lindhardt, chief executive of Denmark-based Egalet, which is testing its own pure hydrocodone product.

The companies say a pure hydrocodone pill would avoid liver problems linked to high doses of acetaminophen, an ingredient in products like Vicodin. They also say patients will be more closely supervised because, by law, they will have to return to their doctors each time they need more pills. Prescriptions for the weaker, hydrocodone-acetaminophen products now on the market can be refilled up to five times.

Zogenix has completed three rounds of patient testing, and last week it announced it had held a final meeting with Food and Drug Administration officials to talk about its upcoming drug application. It plans to file the application in early 2012 and have Zohydro on the market by early 2013.

Purdue Pharma and Cephalon, a Frazer, Pa.-based unit of Israel-based Teva Pharmaceuticals, are conducting late-stage trials of their own hydrocodone drugs, according to documents filed with federal regulators. In May, Purdue Pharma received a patent applying extended-release technology to hydrocodone. Neither company would comment on its plans.

Meanwhile, Egalet has finished the most preliminary stages of testing aimed at determining the basic safety of a drug. The firm could have a product on the market as early as 2015 but wants to see how the other companies fare with the FDA before deciding whether to move forward, Lindhardt said.

Critics say they are troubled because of the dark side that has accompanied the boom in sales of narcotic painkillers: Murders, pharmacy robberies and millions of dollars lost by hospitals that must treat overdose victims.

Thousands of legitimate pain patients are becoming addicted to powerful prescription painkillers, they say, in addition to the thousands more who abuse the drugs.

Prescription painkillers led to the deaths of almost 15,000 people in 2008, more than triple the 4,000 deaths in 1999, the Centers for Disease Control and Prevention reported last month.

Emergency room visits related to hydrocodone abuse have shot from 19,221 in 2000 to 86,258 in 2009, according to data compiled by the Drug Enforcement Administration. In Florida alone, hydrocodone caused 910 deaths and contributed to 1,803 others between 2003 and 2007.

Hydrocodone belongs to family of drugs known as opiates or opioids because they are chemically similar to opium. They include morphine, heroin, oxycodone, codeine, methadone and hydromorphone.

Opiates block pain but also unleash intense feelings of well-being and can create physical dependence. The withdrawal symptoms are also intense, with users complaining of cramps, diarrhea, muddled thinking, nausea and vomiting.

After a while, opiates stop working, forcing users to take stronger doses or to try slightly different chemicals.

"You've got a person on your product for life, and a doctor's got a patient who's never going to miss an appointment, because if they did and they didn't get their prescription, they would feel very sick," said Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing. "It's a terrific business model, and that's what these companies want to get in on."

Under pressure from the government, Purdue Pharma last year debuted a new OxyContin pill formula that "squishes" instead of crumbling when someone tries to crush it.

But Zogenix, whose drug is time-released but crushable, says there is not enough evidence to show that such tamper-resistant reformulations thwart abuse.

"Provided sufficient effort, all formulations currently available can be overcome," Zogenix said in a written response to questions by The Associated Press.

At a conference for investors New York on Nov. 29, Zogenix chief executive Roger Hawley said the FDA was not pressuring Zogenix to put an abuse deterrent in Zohydro.

"We would certainly consider later launching an abuse-deterrent form, but right now we believe the priority of safer hydrocodone — that is, without acetaminophen — is a key priority for the FDA," Hawley said.

FDA spokeswoman Erica Jefferson said the agency would not comment on its discussions with drug companies, citing the need to protect trade secrets.

Drug control advocates say they're worried the U.S. government is too lax about controlling addictive pain medications. The United States consumes 99 percent of the world's hydrocodone and 83 percent of its oxycodone, according to a 2008 study by the International Narcotics Control Board.

One 41-year-old loophole in particular has fed the current problem with hydrocodone abuse, critics say. The federal Controlled Substances Act, passed in 1970, puts fewer controls on combination pills containing hydrocodone and another painkiller than it does on the equivalent oxycodone products.

A Vicodin prescription can be refilled five times, for example, while a Percocet prescription can only be filled once.

The Drug Enforcement Administration and Food and Drug Administration have been studying whether to close this loophole since 1999 but have made no decision. Congress is now considering a bill that would force the agencies to tighten the controls.

"This is a problem that is fundamentally an oversupply problem," said Jackson, the drug-control advocate. "The FDA has kind of opened the floodgates, and they refuse to recognize the mistakes made in the past."

Pure hydrocodone falls into the stricter drug-control category than hydrocodone-acetaminophen medications, meaning patients would have to go to their doctors for a new prescription each time they needed more pills. But Jackson said that's no guarantee against abuse, noting that dozens of unscrupulous doctors have been caught churning out prescriptions in so-called "pill mills."

The Drug Enforcement Administration, which enforces controls on medicines along with the FDA, said it could not comment on drugs that have not yet been approved for sale.

However, Zogenix has acknowledged the abuse issue could become a liability.

"Illicit use and abuse of hydrocodone is well documented," it said in a filing with the Securities and Exchange Commission in September. "Thus, the regulatory approval process and the marketing of Zohydro may generate public controversy that may adversely affect regulatory approval and market acceptance of Zohydro."

Heavy Meth Use Linked to Schizophrenia

Thursday, Nov. 10 2011 (HealthDay News)

Heavy methamphetamine use may increase the risk of developing schizophrenia, according to a new study.

It also confirmed previous research showing a possible link between marijuana dependence and schizophrenia.

Methamphetamine and other amphetamine-type stimulants are the second most common type of illicit drug used worldwide.

In this study, researchers at the Centre for Addiction and Mental Health (CAMH) in Toronto analyzed the records of patients who were admitted to California hospitals between 1990 and 2000 with a diagnosis of dependence or abuse for methamphetamine, marijuana, alcohol, cocaine or opioids.

People who were hospitalized for meth dependence and who had never been diagnosed with schizophrenia or psychotic symptoms at the start of the study had a roughly 1.5- to three-fold higher risk of later being diagnosed with schizophrenia than patients who used cocaine, alcohol or opioid drugs, study leader Dr. Russ Callaghan said in a CAMH news release.

The researchers also found that the increased risk of schizophrenia in methamphetamine users was similar to that of heavy users of marijuana.

The study was published online Nov. 8 in the American Journal of Psychiatry.

It's not clear how methamphetamine and marijuana may increase the risk of developing schizophrenia.

"Perhaps repeated use of methamphetamine and cannabis in some susceptible individuals can trigger latent schizophrenia by sensitizing the brain to dopamine, a brain chemical thought to be associated with psychosis," Dr. Stephen Kish, senior scientist and head of CAMH's Human Brain Laboratory, said in the news release.

"We hope that understanding the nature of the drug addiction-schizophrenia relationship will help in developing better therapies for both conditions," Callaghan said.

Addiction a brain disorder, not just bad behavior

EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press.

Addiction isn't just about willpower. It's a chronic brain disease, says a new definition aimed at helping families and their doctors better understand the challenges of treating it.

"Addiction is about a lot more than people behaving badly," says Dr. Michael M. Miller of the American Society for Addiction Medicine.

That's true whether it involves drugs and alcohol or gambling and compulsive eating, the doctors group said Monday. And like other chronic conditions such as heart disease or diabetes, treating addiction and preventing relapse is a long-term endeavor, the specialists concluded.

Addiction generally is described by its behavioral symptoms - the highs, the cravings, and the things people will do to achieve one and avoid the other. The new definition doesn't disagree with the standard guide for diagnosis based on those symptoms.

But two decades of neuroscience have uncovered how addiction hijacks different parts of the brain, to explain what prompts those behaviors and why they can be so hard to overcome. The society's policy statement, published on its website, isn't a new direction as much as part of an effort to translate those findings to primary care doctors and the general public.

"The behavioral problem is a result of brain dysfunction," agrees Dr. Nora Volkow, director of the National Institute on Drug Abuse.

She welcomed the statement as a way to help her own agency's work to spur more primary care physicians to screen their patients for signs of addiction. NIDA estimates that 23 million Americans need treatment for substance abuse but only about 2 million get that help. Trying to add compassion to the brain findings, NIDA even has made readings from Eugene O'Neill's "Long Day's Journey into Night" a part of meetings where primary care doctors learn about addiction.

Then there's the frustration of relapses, which doctors and families alike need to know are common for a chronic disease, Volkow says.

"You have family members that say, 'OK, you've been to a detox program, how come you're taking drugs?'" she says. "The pathology in the brain persists for years after you've stopped taking the drug."

Just what does happen in the brain? It's a complex interplay of emotional, cognitive and behavioral networks.

Genetics plays a role, meaning some people are more vulnerable to an addiction if they, say, experiment with drugs as a teenager or wind up on potent prescription painkillers after an injury.

Age does, too. The frontal cortex helps put the brakes on unhealthy behaviors, Volkow explains. It's where the brain's reasoning side connects to emotion-related areas. It's among the last neural regions to mature, one reason that it's harder for a teenager to withstand peer pressure to experiment with drugs.

Even if you're not biologically vulnerable to begin with, perhaps you try alcohol or drugs to cope with a stressful or painful environment, Volkow says. Whatever the reason, the brain's reward system can change as a chemical named dopamine conditions it to rituals and routines that are linked to getting something you've found pleasurable, whether it's a pack of cigarettes or a few drinks or even overeating. When someone's truly addicted, that warped system keeps them going back even after the brain gets so used to the high that it's no longer pleasurable.

Make no mistake: Patients still must choose to fight back and treat an addiction, stresses Miller, medical director of the Herrington Recovery Center at Rogers Memorial Hospital in Oconomowoc, Wis.

But understanding some of the brain reactions at the root of the problem will "hopefully reduce some of the shame about some of these issues, hopefully reduce stigma," he says.

And while most of the neuroscience centers on drug and alcohol addiction, the society notes that it's possible to become addicted to gambling, sex or food although there's no good data on how often that happens. It's time for better study to find out, Miller says.

Meanwhile, Volkow says intriguing research is under way to use those brain findings to develop better treatments - not just to temporarily block an addict's high but to strengthen the underlying brain circuitry to fend off relapse.

Topping Miller's wish list: Learning why some people find recovery easier and faster than others, and "what does brain healing look like."

Cut Cocaine Addiction With A Drug That Erases Your Memory

Derrick Mead July 15, 2011

The constant bloody noses, bloodshot eyes and complete lack of meaningful sleep earned in attempts to be cool may soon be a thing of the past.

Devin Mueller and James Otis at the University of Wisconsin-Milwaukee have discovered what may be a potential drug therapy to break cocaine addiction. Propranolol, a beta-blocker currently prescribed for hypertension and anxiety, was successful in blocking animals' brains from dialing up cocaine-related memories, which are a key to addiction. So while right now thinking about how much more personable and exciting you were at the bar last night brings the urge to rack more lines, in the future popping a pill may help you forget just how great getting high felt.

Most treatments for other highly addictive drugs, like heroin and nicotine, have relied on patients easing off use. Rather than go cold turkey, withdrawals from which are joyless and shitty enough to make you want to light or shoot up again, using methadone or nicotine patches and the like help you slowly drop your use to nothing. Ideally, that is. Methadone itself has plenty of addicts, and there are legions of former smokers who have been chewing Nicorette for years. Nicotine-blockers and new drugs are always in development, but results are mixed. Most people just try to quit by substitution.

Unfortunately, cigarettes aside, there isn't any sort of cocaine light out there, and some sort of patch will surely never be made. So cocaine addicts have always been stuck trying to kick the habit by just plain stopping. The physical withdrawals aren't as bad as heroin, but that's only half the equation. There are also psychological cravings, and memories, being a lot less-understood and more ethereal, are hard to beat.

"Right now, there are no FDA-approved medications that are known to successfully treat cocaine abuse, only those that are used to treat the symptoms of cocaine withdrawal, which are largely ineffective at preventing relapse," Mueller said in a release.

Giving up the sweet reflections of events where, for example, you thought more of yourself thanks to cocaine use is an incredibly hard aspect of addiction to conquer because those memories become so associated with your psyche. Currently, the best way to try to help cocaine addicts is exposure therapy. A patient is repeatedly exposed to stimuli that induce cravings, and by not fulfilling those cravings the patient's mind starts to slowly disassociate cocaine with Depeche Mode concerts or whatever it was that caused them to enjoy blow in the first place.

But exposure therapy doesn't have a high rate of success. It takes a long time to break memories from urges, and all that time patients are quite literally triggering cravings. About 80 percent of people trying to quit cocaine relapse within six months.

Propranolol may help. Scientists first began looking at the drug because it helped patients going through exposure therapy continue therapy for longer. However, Mueller said that propranolol has never been used to block or eliminate craving-based memories before. But with animal trials showing positive signs, fans of cocaine may be able to start scrambling their memory to kick the habit in the near future.

Whether it's food or drugs, addiction is the same, new study finds

July 14, 2011 Rita Rubin MSNBC

You may think you're addicted to chocolate, but it's unlikely you cut yourself off from your friends because you're too embarrassed to scarf down Hershey bar after Hershey bar in front of them.

And it's doubtful you bar the door to your home because you don't want anyone to see the overflow of candy wrappers in your wastebaskets or the gallons of chocolate milk in your fridge.

Your kids probably aren't going barefoot because you're blowing your paycheck on Cadbury and Godiva.

Only a true food addict would go to such extreme behavior. And psychologist Caroline Davis appears to have identified some.

Davis and her colleagues at Toronto's York University recruited 72 obese men and women, ages 25 to 45, and gave them a questionnaire designed to identify people addicted to drugs or alcohol.

The addiction scale, developed by Yale University researchers, focuses on seven symptoms, such as repeatedly trying to quit without success and stopping social and recreational activities.

The researchers made one teensy change on the questionnaire: They replaced the word "drugs" with "food."

Of the 72 obese people in Davis's study, 18 fit the criteria for addiction -- only their substance of abuse was food, not drugs or alcohol.

"Their relationship with food and how it rules their behavior is dramatic," says Davis, a psychologist who works in the field of neuroscience.

One apparent food addict in her study had stopped going out with friends or inviting them over. Her fridge was stocked with gallons of Coke, her home littered with boxes from the large pizzas she ordered, two at a time, several nights a week.

"She didn't have a romantic partner because she didn't want anybody to see this side of her," Davis says.

About two-thirds of the study volunteers were women, as were about two-thirds of the "food addicts." The food addicts and the non-addicts were also similar in age and BMI.

But, like drug addicts and alcoholics, the food addicts were more likely to have other psychological issues. They were three times more likely than other study participants to meet the criteria for binge-eating. Depression also was more common among the food addicts, and they exhibited more symptoms of attention deficit/hyperactivity disorder.

Animal studies have suggested that foods high in sugar and fat have a similar effect on the brain as alcohol and other drugs of abuse, Davis says. "Alcohol is just fermented sugar. They work on our brain reward pathways in the same way."

Davis, who presented her findings June 15 at the annual meeting of the Society for the Study of Ingestive Behavior, says she has more work to do. Many addicts abuse more than one substance, so she wonders if she would have seen a greater proportion of food addicts if alcoholics and drug addicts had been allowed in her study. She also wants to see whether genes that may be linked to drug abuse are also more common in her food addicts.

Before she got into this line of research, Davis studied excessive exercising. "I absolutely believe there is such a thing as exercise addiction," she says.

Unfortunately, food addiction and exercise addiction seem to be mutually exclusive, Davis says.

In her experience, gym rats who work out four or five hours a day all have serious food and body image issues. But they're addicted to starving, not eating.

Drug Implant for Opioid Addiction Looks Effective

HealthDay - Mon, Jul 11, 2011

Implanting the addiction-treatment drug buprenorphine in people who are opioid-dependent seems to reduce cravings in the short term, researchers say.

By delivering a low but continuous dose of the medication, the implant is designed to reduce the risk that patients addicted to heroin or prescription painkillers (such as Oxycontin) will relapse after missing doses of buprenorphine or simply stop the daily, under-the-tongue treatment altogether.

Dr. Walter Ling, from the University of California, Los Angeles, and his colleagues report their findings in the Oct. 13 issue of the Journal of the American Medical Association.

"In summary, this study found that the use of buprenorphine implants compared with placebo resulted in less opioid use over 16 weeks and also across the full 24 weeks," the research team said in a news release from the journal.

According to the U.S. National Institute on Drug Abuse, the best way to address opioid addiction is through a combined intervention involving both behavioral (to help patients learn how to cope without drugs) and pharmacological treatments.

Medicinal treatment includes drugs such as naltrexone, methadone and buprenorphine.

The current study involved 163 adults between the ages of 18 and 65 diagnosed as opioid-dependent between 2007 and 2008.

Four buprenorphine delivery devices were implanted under the skin of one arm in 108 patients. Each device was set to slowly release 80 milligrams of medication. The remaining 55 patients received implants without any drug delivery. None of the patients received buprenorphine by the standard oral delivery route.

All the patients received drug counseling for the six months that the devices were in place.

Urine samples taken throughout 16 weeks of treatment revealed that patients given buprenorphine via implants were far less likely to test positive for illicit opioid use than the others.

About 40 percent of the urine samples taken from the implant group tested negative for illegal drug use, compared with about 28 percent of the placebo group.

Also, about two-thirds of those on an implantable buprenorphine regimen stuck to their treatment program for the full six months, while only about 31 percent of those getting no medication did so. None of the buprenorphine patients were deemed to have "failed" their treatment, as opposed to about 31 percent of those not getting the medication.

Despite these findings, Dr. John Mariani, director of the substance treatment and research service at New York State Psychiatric Institute/Columbia University in New York City, expressed some reservations about the innovation.

"First of all, oral treatment is a fantastic therapy," he said. "It's a very effective way to deliver treatment, and I would put it up against any other treatment for both substance abuse issues and psychiatric problems."

"Of course, there will be some patients that have adherence problems with the oral option, for which this would be something to consider," Mariani said. "But that's rare. Maybe one in 25 don't stick to it, whereas the vast majority of patients I treat like the effect of oral buprenorphine and they don't tend to stop taking it, because then they start to experience withdrawal."

Mariani noted some drawbacks to the implantable option. "Although it's not the most invasive procedure to have, it is a surgical approach and there's always the risk of infection, and then scarring if and when it has to be removed," he said. "And you can't individualize the dose, which is very easy to do with the oral drug."

The introduction of buprenorphine itself changed the landscape of treating opioid dependence, but this delivery system won't revolutionize treatment, he said. "It adds something to our options, but I don't think it will be an approach most people will choose."

Pharmacy Robberies Sweeping US

Associated Press writer Frank Eltman contributed to this report from Medford, N.Y.

A wave of pharmacy robberies is sweeping the United States as desperate addicts and ruthless dealers turn to violence to feed the nation's growing hunger for narcotic painkillers.

From Redmond, Wash., to St. Augustine, Fla., criminals are holding pharmacists at gunpoint and escaping with thousands of powerfully addictive pills that can sell for as much as $80 apiece on the street.

In one of the most shocking crimes yet, a robber walked into a neighborhood drugstore Sunday on New York's Long Island and gunned down the pharmacist, a teenage store clerk and two customers before leaving with a backpack full of pills containing hydrocodone.

"It's an epidemic," said Michael Fox, a pharmacist on New York's Staten Island who has been stuck up twice in the last year. "These people are depraved. They'll kill you."