About That Methedemic

Jack Shafer gives Newsweek a big TOLD YA SO!

Last Friday, Jan. 26, the federal National Survey on Drug Use and Health released results from a survey that showed meth use had "declined overall between 2002 and 2005" and that the number of "initiates"— people using the drug for the first time in the 12 months before the survey—had "remained relatively stable between 2002 and 2004, but decreased between 2004 and 2005."

Mid-lifers most likely to have injected drugs

More evidence that the most serious drug problems are among middle-aged people:

Injection drug use is becoming less common among young people in the U.S., especially blacks, a new analysis of national data shows.

In fact, middle-aged men and women are more likely to have ever injected drugs than younger people -- or older people, for that matter...

Narcotic Meds for Back Pain Questioned

This caught my attention and has some practical application, for physicians treating back pain--they should engage in pretty tight follow-up of they are prescribing opiates on long term basis for back pain. What I found more interesting is that this figure of 24% matches previous "capture rate" data pretty closely.

While the pain may be relieved to some extent over the short-term (3 months), the risk of addiction and long-term effectiveness may override any temporary benefits.

Researchers from the Yale School of Medicine found use of opiods for short-term relief of chronic back pain lead to behaviors of opiod abuse in 24 percent of the cases reviewed.

Public support for parity

Mental Health American (formerly the National Mental Health Association) released a poll on mental health and substance abuse parity this week. They are an advocacy group, so they have a clear bias, but the results they report are overwhelming:

Americans Think Health Coverage Should Include Mental Health and Substance Abuse... A large majority (74%) believe that insurance plans should cover substance abuse treatments at the same levels as treatments for general health issues. 23% feel that they should not be covered equitably. * The public demand for mental health equity is bipartisan -- 83% of Republicans and 92% of Democrats want equitable health insurance.

Benefit-Cost in the California Treatment Outcome Project: Does Substance Abuse "Pay for Itself?"

I think I posted a news article summarizing these findings, but this link includes a PDF of the journal article:

Results from a cost-benefit analysis of substance abuse treatment programs are presented. Sections of this article include: abstract; methods; results according to per diem substance abuse treatment costs, average cost and benefits associated with substance abuse treatment, pre-post changes in the individual sources of monetary benefit, sensitivity analyses; "inflating" the arrest data, multiple regression models, cohort, and varying treatment intensity across providers; and discussion. A ratio of 7:1 benefits to costs exists; a benefit of $11,487 to a cost of $1,583.

US prison release a health risk: study

A new study reinforces the risks associated with overdose and release from prison:

Getting released from US prisons could be even more dangerous than being in them.

Death and prison records from Washington state show that 30,237 convicts released from 1999 to 2003 were 12 times more likely to die from a drug overdose and 10 times more likely to be murdered in a two-year period than the general population.

...

During the two-week period immediately after their release, compared to years later, the ex-cons were:

* 29 times more likely to die from cocaine;

* 34 times more likely to die from a heroin overdose;

* 15 times more likely to be killed by alcohol;

* more than twice as likely to be gunned down; and

* nearly 8 times more likely to commit suicide.

The authors of the study characterized these results as surprising. I'm not sure why it should be surprising. It's well known that substance use problems occur in around 80% of inmates and that addicts are at greatest risk for overdose after a period of abstinence, especially involuntary abstinence. Additionally, people who end up in prison are probably among those with the greatest number of co-occurring problems. They get placed in a toxic environment, get little or no treatment and (locally) are often released into conditions that make relapse and recidivism nearly inevitable.

This Is Your Brain on Drugs, Dad

In an Op-Ed in the New York Times, Mike Males calls for an end to "the obsession with hyping teenage drug use." I have the same reaction every time I read something from him. He always does a good job arguing that we while our attention is on drugs, sex and violence among youth, the biggest problems in these area are adults.

Among Americans in their 40s and 50s, deaths from illicit-drug overdoses have risen by 800 percent since 1980, including 300 percent in the last decade. In 2004, American hospital emergency rooms treated 400,000 patients between the ages 35 and 64 for abusing heroin, cocaine, methamphetamine, marijuana, hallucinogens and “club drugs” like ecstasy.

Equally surprising, graying baby boomers have become America’s fastest-growing crime scourge. The F.B.I. reports that last year the number of Americans over the age of 40 arrested for violent and property felonies rose to 420,000, up from 170,000 in 1980. Arrests for drug offenses among those over 40 rose to 360,000 last year, up from 22,000 in 1980. The Bureau of Justice Statistics found that 440,000 Americans ages 40 and older were incarcerated in 2005, triple the number in 1990.

...

In 1972, the University of Michigan researchers who carry out Monitoring the Future found that just 22 percent of high school seniors had ever used illegal drugs, compared to 48 percent of the class of 2005. Yet as that generation has aged, it has been afflicted by drug abuse and its related ills — overdoses, hospitalizations, drug-related crime — at far higher rates than those experienced by later generations at the same ages.

However, I get the sense that his intention is for the reader to be more alarmed about adult behavior and less alarmed about youth behaviors. I tend to be more alarmed about both young people and adults. He also (unintentionally?) makes the case that the problem is worse than we realize:

When releasing last week’s Monitoring the Future survey on drug use, John P. Walters, the director of the Office of National Drug Control Policy, boasted that “broad” declines in teenage drug use promise “enormous beneficial consequences not only for our children now, but for the rest of their lives.” Actually, anybody who has looked carefully at the report and other recent federal studies would see a dramatically different picture: skyrocketing illicit drug abuse and related deaths among teenagers and adults alike.

While Monitoring the Future, an annual study that depends on teenagers to self-report on their behavior, showed that drug use dropped sharply in the last decade, the National Center for Health Statistics has reported that teenage deaths from illicit drug abuse have tripled over the same period [emphasis added]. This reverses 25 years of declining overdose fatalities among youths, suggesting that teenagers are now joining older generations in increased drug use.

Everything I've read by Males is thought provoking and worth reading. I just always feel that he's successful in making his case about adults but fails to persuade me that we're overly concerned about young people.

Overall Youth Drug Use Down in 2006, But Survey Sees Trouble Brewing with Inhalants, Prescription Drugs, Smoking

The latest Monitoring the Future drug use survey numbers are out and much of the news is good:

The survey of 50,000 8th-, 10th- and 12th-graders found that the overall percentage of U.S. youths using alcohol or other drugs declined modestly in 2006, continuing a decade-long trend. Since the mid-1990s, past-year use of marijuana has fallen 36 percent among 8th-graders, 28 percent among 10th-graders, and 18 percent among 12th-graders. That led Bush administration drug czar John Walters to cite a "substance-abuse sea change among American teens."

"They are getting the message that dangerous drugs damage their lives and limit their futures," said Walters, director of the Office of National Drug Control Policy (ONDCP).

...

Use of marijuana, the nation's most commonly used illicit drug, has been the main focus of the ONDCP's antidrug media campaign. Not surprisingly, federal officials this week celebrated the fact that past-month use of marijuana reported by MTF survey participants has fallen 26 percent since 2001, from 16.6 percent of teens in 2001 to 12.5 percent in 2006. NIDA Director Nora Volkow called this finding "great news."

Some of the researchers are expressing concern about some of the findings:

The University of Michigan, which produced the report, took a more nuanced view, noting that while there was little evidence of increased drug use, reported overall declines in adolescent drug use were relatively small, and that use of many drugs -- including inhalants, LSD, powder cocaine, crystal methamphetamine, heroin, and club drugs like Ketamine, Rohypnol, and GHB -- did not decline at all.

Lloyd Johnson, Ph.D., principal investigator of the study, expressed particular concern about a decline in perceived risk of using inhalants. Use of inhalants did not increase in 2006, according to the study, but inhalant use has been rising among American youth in recent years. "Perceived risk is often a leading indicator of changes in actual use," said Johnston. "So when we see a change like this, we take it as an early warning of trouble ahead."

Misuse of prescription drugs, which also has risen sharply in recent years, did not increase in 2006, but remained at "unacceptably high levels,"... About 9 percent of 2006 survey respondents said they had used prescription narcotic drugs like OxyContin and Vicodin within the past year, and between 4 and 7 percent of 8th- to 12th-graders said they had used over-the-counter cold medicines -- typically containing dextromethorphan -- to get high.
...

University of Michigan researchers also sounded an alarm about youth smoking, saying the MTF findings indicate that the trend toward lower smoking rates among children in their early and middle teens has ended. While current daily smoking has fallen by half among 12th-graders and more than half among 8th- and 10th-graders since the mid-1990s, no further declines were reported in the 2006 survey among 8th- and 10th-graders (daily smoking declined slightly among 12th-graders, from 13.6 percent in 2005 to 12.2 percent in 2006).

Perceived risk of smoking also has leveled off, which researchers said could be due to slackening public attention and publicity about the dangers of smoking. On the other hand, lifetime use of cigarettes has declined by about half among 8th-graders, by 40 percent among 10th-graders, and by 30 percent among 12th-graders since the mid-1990s. Overall smoking rates among all three grades are at an all-time low, and disapproval of smoking among teens is still rising among teens.