March 26, 2018

Poverty, Stress a Factor in Overdose Deaths

Drug-related deaths have grown to be a major US public health problem over the past two decades. Between 2006 and 2015 there were more than 515,000 deaths from drug overdoses and other drug-related causes. The economic, social, and emotional tolls of these deaths are substantial, but some parts of the US are bearing heavier burdens than others. Evidence from the first national study of county-level differences suggests that addressing economic and social conditions will be key to reversing the rising tide of drug deaths, reports the American Journal of Preventive Medicine.


"The drug epidemic is a pressing concern among policymakers," noted Shannon M. Monnat, PhD, Associate Professor of Sociology and Lerner Chair for Public Health Promotion, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA, who conducted the study. "The media portrayal of the drug overdose epidemic has largely been that it is a national crisis. However, drug deaths are not randomly distributed across the US. My analyses show that some places in the US have much higher drug mortality rates than others."

Drug-Related Mortality Rates

Using data from the US Centers for Disease Control and Prevention (CDC) Multiple-Cause of Death Files (2006-2015), US Census Bureau, US Department of Agriculture Economic Research Service, Agency for Healthcare Research and Quality, and Northeast Regional Center for Rural Development, the study modeled associations between county-level drug-related mortality rates and economic, social, and healthcare environments.

Analysis showed the average county-level age-adjusted drug-related mortality rate was 16.6 deaths per 100,000 population, but there were substantial geographic differences with drug-related deaths reaching over 100 per 100,000 in some counties. There was significant spatial variation in rates.

  • High mortality rate clusters in Appalachia, Oklahoma, parts of the Southwest, and northern California
  • Low mortality rate clusters in parts of the Northeast, the Black Belt, Texas, and the Great Plains
  • Substantial within-state variation with West Virginia having the largest disparity between the highest and lowest rate counties

Family Distress a Factor

Average mortality rates were significantly higher in counties with greater economic and family distress and in counties economically dependent on mining. Counties at the highest level of family distress (divorce/separation and single parent families) had an average of more than eight more drug-related deaths per 100,000 population than counties at the lowest level.

Average mortality rates were significantly lower in counties with a larger presence of religious establishments, a greater percentage of recent immigrants, and counties with economies reliant on public (government) sector employment.

On average, there were no differences in mortality rates between rural and urban counties, but some rural counties, especially those in Appalachia, have the highest mortality rates in the country. Healthcare supply factors did not contribute to the differences between county mortality rates.

Opioids Are Just a Symptom

According to Dr. Monnat's findings, social and economic environments are important for prevention because they affect stress, healthcare investment, residents' knowledge about and access to services, self-efficacy, social support, and opportunities for social interaction.

"We need to get real with ourselves about the US drug problem," explained Dr Monnat. "We are not going to Narcan our way out of this. Opioids are a symptom of much larger social and economic problems. Just as other chronic diseases have underlying social determinants, addiction is also a social disease. 'Addiction does not discriminate' is a soundbite that ignores the reality that overdose rates are highest in economically distressed communities, particularly places that have experienced declines in job opportunities for people without a college degree. Addressing economic and social conditions will be key to reversing the rising tide of drug deaths."

Posted by Webmaster at 04:21 PM


March 21, 2018

Alcohol Biggest Risk for Dementia

Alcohol use disorders are the most important preventable risk factors for the onset of all types of dementia, especially early-onset dementia. This according to a nationwide observational study, published in The Lancet Public Health journal, of over one million adults diagnosed with dementia in France.

This study looked specifically at the effect of alcohol use disorders, and included people who had been diagnosed with mental and behavioural disorders or chronic diseases that were attributable to chronic harmful use of alcohol.

Of the 57,000 cases of early-onset dementia (before the age of 65), the majority (57%) were related to chronic heavy drinking.

Completely Preventable

The World Health Organization (WHO) defines chronic heavy drinking as consuming more than 60 grams pure alcohol on average per day for men (4-5 Canadian standard drinks) and 40 grams (about 3 standard drinks) per day for women.

As a result of the strong association found in this study, the authors suggest that screening, brief interventions for heavy drinking, and treatment for alcohol use disorders should be implemented to reduce the alcohol-attributable burden of dementia.

"The findings indicate that heavy drinking and alcohol use disorders are the most important risk factors for dementia, and especially important for those types of dementia which start before age 65, and which lead to premature deaths," says study co-author and Director of the CAMH Institute for Mental Health Policy Research Dr. Jürgen Rehm. "Alcohol-induced brain damage and dementia are preventable, and known-effective preventive and policy measures can make a dent into premature dementia deaths."

Shortens Life Expectancy

Dr. Rehm points out that on average, alcohol use disorders shorten life expectancy by more than 20 years, and dementia is one of the leading causes of death for these people.

For early-onset dementia, there was a significant gender split. While the overall majority of dementia patients were women, almost two-thirds of all early-onset dementia patients (64.9%) were men.

Alcohol use disorders were also associated with all other independent risk factors for dementia onset, such as tobacco smoking, high blood pressure, diabetes, lower education, depression, and hearing loss, among modifiable risk factors. It suggests that alcohol use disorders may contribute in many ways to the risk of dementia.

Early Alcohol Screening Needed

"As a geriatric psychiatrist, I frequently see the effects of alcohol use disorder on dementia, when unfortunately alcohol treatment interventions may be too late to improve cognition," says CAMH Vice-President of Research Dr. Bruce Pollock. "Screening for and reduction of problem drinking, and treatment for alcohol use disorders need to start much earlier in primary care."

The authors also noted that only the most severe cases of alcohol use disorder - ones involving hospitalization - were included in the study. This could mean that, because of ongoing stigma regarding the reporting of alcohol-use disorders, the association between chronic heavy drinking and dementia may be even stronger.

Posted by Webmaster at 06:27 AM


March 06, 2018

Alcoholism 'Wonder Drug' Is a Dud

Baclofen, used to treat spasticity, was touted as a 'wonder drug' for alcohol use disorders, but researchers found it is no more effective than a placebo for reducing alcohol consumption and alcohol cravings.

Baclofen is a medication which has been used since the 1970s as an anti-spasticity treatment. More recently it has been used as a treatment for alcohol use disorders.

Baclofen has a key advantage compared with currently licensed medications: it is excreted largely through the kidneys. It is therefore possible to give baclofen to people suffering alcohol-related liver disease, a patient population with very high needs, and who often can't tolerate licensed drug treatments.

'Wonder Drug' It's Not

Many studies have found baclofen to be successful in treating alcohol use disorders, some have claimed it a wonder drug capable of curing alcoholism.

Following a number of successful clinical trials the use of use of baclofen increased massively and sales of the drug have soared in some countries.

In more recent years, there have been a growing number of studies which directly compare baclofen against placebo on a number of outcome measures. Often these outcome measures are drink-related, e.g. rate of abstinence at the end of the medication trial, or number of heavy drinking or abstinent days during the trial.

However, there are other measures, potentially related to why baclofen might work (i.e. its mechanism of action). Several possibilities have been identified; firstly baclofen may reduce craving for alcohol, secondly there are reports that baclofen reduces negative mood states, such as anxiety and depression, which are known risk factors for harmful drinking.

Abstinent Rates Actually Increased

Researchers, Dr Abi Rose and Dr Andy Jones, from the University's Addiction Research Team conducted a meta-analysis on all 12 clinical trials comparing baclofen with placebo on at least one of the described drinking outcomes, craving, anxiety, or depression.

Meta-analysis is an advanced statistical procedure that allows the researcher to merge the results of all the studies regarding a specific topic into a quantitative measure representing the size of the overall effect of one variable on another variable. Thus, meta-analysis provides more accurate and reliable outcomes compared to the single experiment.

The researchers found that baclofen led to higher abstinent rates compared with placebo, and that eight individuals would need to be treated with baclofen for one to remain abstinent due to the medication.

However, all other outcomes failed to show an effect of baclofen: baclofen did not increase abstinent days or decrease number of heavy drinking days during treatment, neither did it reduce rates of alcohol craving, anxiety or depression.

Effectiveness Questioned

Dr Rose, said: "Our research highlights several issues with the existing body of trials. Many of the studies only recruited a limited number of patients, so maybe too small to find an effect.

"The existing trials also differ on a number of factors, such as the dose of baclofen given and the length of treatment. Importantly, the pharmacokinetics of baclofen (how it moves in the body) are not well-understood, so there may be individual factors influencing the effectiveness of baclofen that we do not yet understand."

Dr Jones, said: "This new meta-analysis shows that baclofen is no more effective than placebo on a range of key outcome measures, suggesting that the current increasing use of baclofen as a treatment for alcohol use disorders is premature."

Source: Rose AK, et al. "Baclofen: its effectiveness in reducing harmful drinking, craving, and negative mood. A meta-analysis." Addiction 26 Feb. 2018

Posted by Webmaster at 08:44 AM