Survey Poststorm mental health worsens
Tue, 21 Aug 2007 21:02:29 GMTBy JANET McCONNAUGHEY, Associated Press Writer
NEW ORLEANS - More Gulf Coast residents are thinking seriously about suicide or showing symptoms of post-traumatic stress disorder as the recovery from Hurricane Katrina inches along, a new survey finds.
The survey is a follow-up to one done six months after the hurricane, which found that few people in Louisiana, Mississippi and Alabama — about 3 percent — had contemplated suicide in the storm's aftermath.
That figure has now doubled in the three-state area and is up to 8 percent in the New Orleans area, according to Ronald Kessler of Harvard Medical School, lead researcher for the Hurricane Katrina Community Advisory Group.
More people also showed signs of post-traumatic stress disorder, 21 percent of those interviewed this year compared to 16 percent in the earlier survey.
It's not surprising, said Karen Binder-Brynes, a New York psychologist who specializes in PTSD.
"It's a community that's in terrible distress. It's not like other things where, once everything's over, everything's getting rebuilt," she said.
Kessler team interviewed 1,000 people last year and was able to track down 800 of them for this year's survey. The latest survey is not yet ready for publication, but Kessler said the preliminary results for suicide and PTSD were striking.
Kessler said that in the months after the Aug. 29, 2005 hurricane, an underlying optimism protected many people from suicidal thoughts. Now, that optimism has worn thin — something the earlier report warned could happen if rebuilding didn't keep pace with expectations.
The recovery from Katrina has been slow in some areas, especially in New Orleans. In addition to losses due directly to the storm, violent crime, poor schools and other problems have piled trauma atop trauma.
Kessler, whose study is supported by the National Institutes of Health and the World Health Organization, said most disasters have relatively rapid recoveries, so rates for such ailments as depression and PTSD usually improve after a year.
The results of the New Orleans survey are more like those of people who lost their jobs in Detroit during the 1980s and couldn't find new work, he said.
Researchers test urine to track drug use
Tue, 21 Aug 2007 21:09:02 GMTBy SETH BORENSTEIN, AP Science Writer
WASHINGTON - Researchers have figured out how to give an entire community a drug test using just a teaspoon of wastewater from a city's sewer plant.
The test wouldn't be used to finger any single person as a drug user. But it would help federal law enforcement and other agencies track the spread of dangerous drugs, like methamphetamines, across the country.
Oregon State University scientists tested 10 unnamed American cities for remnants of drugs, both legal and illegal, from wastewater streams. They were able to show that they could get a good snapshot of what people are taking.
"It's a community urinalysis," said Caleb Banta-Green, a University of Washington drug abuse researcher who was part of the Oregon State team. The scientists presented their results Tuesday at a meeting of the American Chemical Society in Boston.
Two federal agencies have taken samples from U.S. waterways to see if drug testing a whole city is doable, but they haven't gotten as far as the Oregon researchers.
One of the early results of the new study showed big differences in methamphetamine use city to city. One urban area with a gambling industry had meth levels more than five times higher than other cities. Yet methamphetamine levels were virtually nonexistent in some smaller Midwestern locales, said Jennifer Field, the lead researcher and a professor of environmental toxicology at Oregon State.
The ingredient Americans consume and excrete the most was caffeine, Field said.
Cities in the experiment ranged from 17,000 to 600,000 in population, but Field declined to identify them, saying that could harm her relationship with the sewage plant operators.
She plans to start a survey for drugs in the wastewater of at least 40 Oregon communities.
The science behind the testing is simple. Nearly every drug — legal and illicit — that people take leaves the body. That waste goes into toilets and then into wastewater treatment plants.
"Wastewater facilities are wonderful places to understand what humans consume and excrete," Field said.
In the study presented Tuesday, one teaspoon of untreated sewage water from each of the cities was tested for 15 different drugs. Field said researchers can't calculate how many people in a town are using drugs.
She said that one fairly affluent community scored low for illicit drugs except for cocaine. Cocaine and ecstasy tended to peak on weekends and drop on weekdays, she said, while methamphetamine and prescription drugs were steady throughout the week.
Field said her study suggests that a key tool currently used by drug abuse researchers — self-reported drug questionnaires — underestimates drug use.
"We have so few indicators of current use," said Jane Maxwell of the Addiction Research Institute at the University of Texas, who wasn't part of the study. "This could be a very interesting new indicator."
David Murray, chief scientist for U.S. Office of National Drug Control Policy, said the idea interests his agency.
Murray said the U.S. Environmental Protection Agency is testing federal wastewater samples just to see if that's a good method for monitoring drug use. But he didn't know how many tests were conducted or where.
The EPA will "flush out the details" on testing, Benjamin Grumbles joked. The EPA assistant administrator said the agency is already looking at the problem of potential harm to rivers and lakes from legal pharmaceuticals.
The idea of testing on a citywide basis for drugs makes sense, as long as it doesn't violate people's privacy, said Tom Angell of the Students for Sensible Drug Policy, a Washington-based group that wants looser drug laws.
"This seems to be less offensive than individualized testing," he said.
Crackdown sought on energy drink claims
Tue, 21 Aug 2007 19:41:34 GMTBy STEPHEN SINGER, AP Business Writer
HARTFORD, Conn. - Attorneys general are asking federal regulators to crack down on the makers of energy drinks containing alcohol and caffeine, accusing them of misleading advertising for a product that can pose serious health and safety risks.
In a recent letter to John Manfreda, the administrator of the federal Alcohol and Tobacco Tax and Trade Bureau, attorneys general from 28 states, Guam and the District of Columbia warn that aggressive marketing of alcoholic energy drinks targets young people who are buying energy drinks without alcohol.
Connecticut Attorney General Richard Blumenthal said Tuesday that beverage companies are making outlandish and outrageous health-related claims about the drinks.
"Combining alcohol with caffeine hardly seems healthy — and that false claim is what we seek to halt," Blumenthal said.
"Nonalcoholic energy drinks are very popular with today's youth," Oregon Attorney General Hardy Myers said. "Beverage companies are unconscionably appealing to young drinkers with claims about the stimulating properties of alcoholic energy drinks."
The attorneys general singled out three manufacturers: SABMiller PLC's Miller Brewing Co. for Sparks and Sparks Plus; Anheuser-Busch Cos. for Bud Extra; and Charge Beverages for its Liquid Charge and Liquid Core drinks.
Blumenthal said some ads contain misleading health-related claims regarding the products' effects.
For example, he said Sparks and Sparks Plus advertises canned drinks and the cases in which they are packaged to look like batteries to imply they are energy drinks. The slogan is "Powered by Sparks," he said.
Julian Green, a spokesman for Miller Brewing, said Sparks was created only for customers who are of legal drinking age.
"There is no non-alcoholic version of Sparks. We work closely with the Trade and Tax Bureau to ensure that all of our products meet federal regulatory requirements," he said.
Liquid Charge's Web site displays a video of a nuclear power plant's cooling tower collapsing and being replaced by a can of Liquid Charge. The ad calls the drink a "new power source for the 21st century" the ad says.
Calls were placed to Charge Beverages, based in Portland, Ore., for comment.
Anheuser-Busch vice president Francine Katz said the federal government approved the Bud Extra labeling.
"This product is simply a malt beverage that contains caffeine, and is clearly marked as containing alcohol," she said.
The attorneys general also requested a federal investigation into the makeup of alcoholic energy drinks and other flavored malt beverages to determine whether, based on the percentage of distilled spirits contained in the drinks, they are properly classified as malt beverages under federal law. The malt beverage classification, in many states, enables cheaper and broader sale of these drinks, making them more readily available to young people than distilled spirits.
Besides Oregon and Connecticut, states involved in the action are Alaska, Arizona, California, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, Oklahoma, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Washington, West Virginia and Wyoming.
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Associated Press writers William McCall in Portland, Ore., and Jim Salter in St. Louis contributed to this report.
Hydrocodone abuse on rise in Appalachia
Tue, 21 Aug 2007 19:56:58 GMTBy TOM BREEN, Associated Press Writer
GILBERT, W.Va. - When his craving for painkillers got to be too much, Steve Dotson lay down and let his wife drive a car over his leg. It hurt, but he could dismiss the pain with thoughts of the medicated bliss that would follow. Soon, he lost his house, the state took his children away and he was spending nights under a bridge, where he hoped to die.
"You get to where you don't even want them anymore, you just do them so you can get through the day," said the 43-year-old southern West Virginia resident.
Dotson is one of millions of Americans who have experienced the harm that can come from addiction to the prescription narcotic hydrocodone. Less regulated than similar prescription painkillers, drugs containing hydrocodone have quietly become the most widely prescribed — and, perhaps, widely abused — opiate painkillers on the market.
With 124 million prescriptions in 2005, drugs containing hydrocodone are the most popular of their type in the country, according to the U.S. Drug Enforcement Administration's Office of Diversion Control. They are sold under hundreds of brand names and generic titles, and hydrocodone can be found in medication ranging from cough syrup to painkillers.
The most commonly prescribed product combines hydrocodone and acetaminophen, which is marketed under brand names like Vicodin and Lortab.
The DEA reported in 2006 that legal retail distribution of drugs with hydrocodone had grown by roughly 66 percent nationwide since 2001.
Its illicit use had grown as well, and by 2005, hydrocodone was the most frequently encountered pharmaceutical of its kind in drug evidence submitted to the National Forensic Laboratory Information System. The Drug Abuse Warning Network has said hydrocodone products are linked to more emergency room visits than any other prescription painkiller.
As abuse has grown, treatment for addiction and dependence has become more common — and more controversial.
While abstinence-based programs that encourage addicts to quit painkillers like hydrocodone are common, there is also a widespread drug-based way of treating the addiction with methadone, another opioid.
In many parts of the country, methadone clinics have drawn fire from residents and politicians who contend they attract crime. West Virginia's legislature earlier this year passed a moratorium on any new clinics that use methadone until a study can be completed.
"A lot of these people are soccer moms buying Vicodin off the Internet," said Timothy Lepak, a Connecticut-based advocate for alternative addiction treatments. "They wouldn't even think of going to a methadone clinic."
Some physicians now prescribe Buprenorphine, another drug, to help patients cope with addictions. But only about 11,000 physicians nationally are certified to prescribe it, experts said.
The extent of prescription painkiller abuse in central Appalachia drew national attention about five years ago, when oxycodone was the drug of choice for many people. The drug, most commonly known under the brand name OxyContin, was so widely abused it earned the nickname "hillbilly heroin."
As OxyContin came under scrutiny, doctors were more careful about how they prescribed it. Many switched to hydrocodone products, which were already popular but didn't have the same stigma.
All 50 states saw increases in the distribution of hydrocodone between 2001 and 2005. But the trend was particularly significant in the South, where all of the top 10 states in terms of increased distribution are located, the DEA says. Four of the top five — Tennessee, West Virginia, Kentucky and Alabama — include parts of Appalachia.
Authorities say hydrocodone is so popular in this region partly because it's easy to acquire. Street drugs like heroin are harder to come by in sparsely populated rural areas. Prescription painkillers can be found at every pharmacy and pain clinic, as well as ordered over the Internet.
"When I started in this field, the primary client was involved with alcohol," says David Bailey, a community resource specialist with the West Virginia Prevention Resource Center.
"I wish it were still alcohol. Not that that's not a very dangerous drug, but the addiction seems to be much more intense, much more severe within a shorter period of time."
It is a mistake to focus on a single drug, said Dr. Peter Cohen, medical director of the Maryland Alcohol and Drug Abuse Administration. He pointed out that while hydrocodone abuse has grown slightly in Maryland since 2002, it is still far less commonly abused than street drugs like heroin.
From 2005 to 2006, the number of people admitted to Maryland drug rehabilitation programs with hydrocodone addictions grew from 284 to 596, according to figures from the drug abuse administration. But the number of heroin addicts admitted to treatment in the same period stayed at nearly 16,000.
The problem is not hydrocodone or even opiates per se, Cohen said, but addiction itself.
"If you're an opiate addict, you're going to find something, based on what's available and what you prefer," he said.
The DEA is considering moving drugs containing hydrocodone from being classified as so-called Schedule III drugs to being Schedule II drugs. The reclassification would mean it would be harder to obtain refills. Doctors and pharmacies would also have to keep more stringent records about how many prescriptions are written and filled.
Dotson has been off drugs since a religious experience in 2001. He got a job and is a board member of Strong Through Our Plan, a local anti-drug group.
He is determined to stay off drugs, and recently chose to pull out his own tooth with pliers to avoid the temptation of receiving a prescription for a hydrocodone-based painkiller after the extraction.
On a recent day, Dotson pointed out the spot under the bridge where he lived and pointed to the spot in the Guyandotte River where he was baptized after getting clean. Not all of his friends were so lucky, he said.
"You've got three choices," he said. "You either die, go to prison or get saved. Mostly, people around here are dying."
IUDs can be safe effective in highrisk patients
Tue, 21 Aug 2007 17:13:39 GMTNEW YORK - Intrauterine devices appear to be safe and effective for women who ordinarily might not be considered good candidates for this form of contraceptive because of factors such as a history of sexually transmitted infections, multiple partners or prior pelvic inflammatory disease, according to a new report.
IUDs are T-shaped devices made of flexible plastic that are placed in the uterus to prevent the sperm from joining with the egg. By altering the lining of the uterus, they are also thought to prevent pregnancy by keeping a fertilized egg from implanting on the wall of the uterus.
Although it protects against pregnancy, it is important to remember that IUDs don't protect against sexually transmitted infections, including HIV. A latex condom should be used along with the IUD to reduce the risk of infection.
IUDs have a high level of effectiveness, do not have any systemic metabolic effects, and require placement just once to provide long-term protection, Dr. Samuel J. Campbell and colleagues from Virginia Commonwealth University, Richmond, note in the American Journal of Obstetrics and Gynecology.
&;Despite these advantages,&; the researchers continue, &;IUD use is significantly less common in the United States than in other parts of the world, which possibly reflects the widespread concern regarding health risks that are associated with this method.&;
The authors point out that product labeling continues to say that women with a history of pelvic inflammatory disease, STDs, and high-risk sexual behavior should avoid using the IUD.
The researchers examined the effectiveness and complication rates of the IUD, along with how willing women were to use the device. The study involved 194 women attending an urban university-based obstetrics and gynecology clinic.
Overall, 45 percent of the women were married and 42 percent were never married; 33 percent had a history of an STD and 32 percent had a history of other gynecologic infections prior to IUD use.
Most of the women,155 , were given the Mirena intrauterine system and 39 were given the ParaGard intrauterine device (Duramed Pharmaceuticals Inc.) The ParaGard IUD was in place for an average of 19.44 months. The Mirena intrauterine system was in place for an average of 12.78 months.
After the IUD was inserted, 5.4 percent of women had a clinically diagnosed STD and 19.4 percent had clinically diagnosed gynecologic infection. Three pregnancies were reported after insertion.
No significant increased risk of pelvic inflammatory disease was seen after IUD insertion compared with before insertion, the researchers report. Neither type of IUD &;appeared to confer an increased risk of upper genital tract infection, despite a high prevalence of STDs in the population that was studied,&; they note.
Campbell's team believes the &;data suggest a significantly higher benefit-to-risk ratio for the use of IUDs in a population that typically was classified as poor candidates for this method of contraception.&;
SOURCE: American Journal of Obstetrics and Gynecology, August 2007.
