Friday, January 22, 2010

Safe-Injection Program Survives Another Shutdown Attempt by Canadian Government

January 19, 2010

The British Columbia Court of Appeal has rejected a lawsuit from Canada's Conservative government that sought to shutter Vancouver's Insight safe-injection program for IV-drug users, the Canwest News Service reported Jan. 16.

Insite was established as a three-year program in 2003 under the previous Liberal administration, but the B.C. Supreme Court later granted the program an extension of its exemption from Canada's drug laws. This week, the appeals court rejected the current government's challenge to that decision.

Canada's federal government is expected to appeal the latest decision to the Supreme Court of Canada.

Wednesday, January 20, 2010

Join Harm Reduction Coalition for a FREE talk by Dr. David Marsh: "Supervised Injection and Prescribing Heroin in North America: Evidence and Politics

Dr. David C. Marsh, MD, CCSAM Physician Leader, Addiction Medicine with Vancouver Coastal Health and Providence Health Care will be at HRC in New York at 3:00 pm Friday January 22, 2010.

Learn what has been happening in Vancouver with these harm reduction interventions. All welcome!

22 West 27th Street, 5th floor
New York, NY 10001
About Dr David C. Marsh, MD, CCSAM:

Dr. Marsh graduated in Medicine from Memorial University of Newfoundland following prior training in neuroscience and pharmacology. In January 2004, Dr. Marsh began serving as the Physician Leader, Addiction Medicine with Vancouver Coastal Health and Providence Health Care. In this role he is also Medical Director for Addiction Services, HIV/AIDS Services and Aboriginal Health for Vancouver Community. Dr. Marsh is also Clinical Associate Professor in the Department of Health Care and Epidemiology, Faculty of Medicine at the University of British Columbia. Prior to relocating to Vancouver he was the Clinical Director, Addiction Medicine at the Centre for Addiction and Mental Health in Toronto.

Dr. Marsh's research interests include the integration of pharmacotherapy and psychotherapy in the treatment of substance use disorders and focus primarily on novel interventions for opioid dependence. He is presently involved in several research projects including the North American Opiate Medication Initiative (NAOMI) trial of prescription heroin, an Interdisciplinary Health Research Team on Illicit Opiate Dependence in Canada funded by the Canadian Institutes of Health Research and an evaluation of the Supervised Injection Site in Vancouver.

Harm Reduction Coalition
22 West 27th Street, 5th Floor
New York, NY 10001
Tel: 212-213-6376
Fax: 212-213-6582

Tuesday, January 19, 2010

Word Choices Affect Attitudes Toward Addiction Recovery

A survey of health professionals found that referring to people with addictions as "substance abusers" was more likely to evoke punitive responses to drug use than those who referred to individuals with "substance-use disorders," according to researchers at Massachusetts General Hospital (MGH).

John F. Kelly, Ph.D., associate director of MGH's Center for Addiction Medicine noted that the World Health Organization declared the term "abuser" as stigmatizing three decades ago, but the term is still commonly used to describe people with addictions to illicit drugs. Referring to recovery, Kelly said, "There's an old proverb that states, if you want something to survive and flourish, call it a flower; if you want to kill it, call it a weed."

Kelly and colleagues surveyed more than 700 mental-health professionals attending a conference on addiction and mental illness. Half received a survey that referred to a hypothetical patient as a "substance abuser," while the rest got a survey referring to the patient as having a "substance use disorder." The surveys were otherwise identical.

Respondents who received the "substance abuser" version were more likely to say that the patient should be punished for failing to follow a treatment plan and to agree that the patient shouldered blame for having trouble complying with court-ordered treatment requirements.

"Our results imply that these punitive attitudes may be evoked by use of the 'abuser' term, whether individuals are conscious of it or not, and suggest that this term perpetuates that kind of thinking," Kelly said. "From the perspective of the individual sufferers, who often feel intense self-loathing and self-blame, such terminology may add to the feelings that prevent them from seeking help."

The study was published in the International Journal of Drug Policy

Saturday, January 16, 2010

Nicotine Replacement Therapy Before Quitting May Help (NRT) -- nicotine-infused gums, patcheicotine Replacement Therapy Before Quitting May Help

(NRT) -- nicotine-infused gums, patches, etc. -- before quitting cigarettes may improve long-term cessation success, Reuters reported June 25.

A study of 1,100 New Zealanders -- half of whom began NRT two weeks before they quit cigarettes, and another half that started NRT after -- found only a 2 percent difference in abstinence success after six months. When combined with previous pre-quitting NRT studies, however, success increased by approximately 25 percent overall.

The findings suggest a "small-to-moderate" benefit to pre-quitting therapy, University of Auckland researchers wrote. Side effects from the pre-quitting and regular NRT groups were approximately the same.

The study is published in the July 2010 issue of the journal Addiction.

Friday, January 15, 2010

Information, Not Scare Tactics, Helps Smokers Quit: Study

A new study finds that smokers who called a tobacco quitline were twice as likely to experience short-term success in quitting if they heard positive messages rather than negative ones, MedPage Today reported Jan. 8.

Researcher Benjamin A. Toll, Pd.D., of the Yale University School of Medicine and colleagues found that the positive messages were more effective in the short run, although the effects were not sustained, with abstinence rates evening out among the two groups after three months. "Multiple messages may be necessary for longer-term impact," the study noted.

The findings were published online in the Journal of the National Cancer Institute.

Thursday, January 14, 2010

Fast morphine treatment may prevent PTSD

Speedy care slashes wounded troops’ chance of developing the disorder

Associated Press
Wed., Jan. 13, 2010

Quickly giving morphine to wounded troops cuts in half the chance they will develop post-traumatic stress disorder, according to a provocative study that suggests a new strategy for preventing the psychological fallout of war.

Researchers at the U.S. Naval Health Research Center led the study of about 700 troops injured in Iraq from 2004 through 2006.

“It was surprising how strong the effect of the morphine was,” said study leader Troy Lisa Holbrook, an epidemiologist at the naval center. The findings were published in Thursday’s New England Journal of Medicine.

Whether the Pentagon will adopt the practice on the battlefield remains to be seen. Dr. Jack Smith, acting deputy assistant secretary of defense for clinical and program policy, said in an e-mail that the “very interesting findings” are “likely to stimulate further research.”

About 53,000 troops returning from Iraq and Afghanistan have been treated for PTSD, a disorder in which someone who has endured a traumatic event keeps re-experiencing it and the fear it caused. Patients often have trouble with work, relationships, substance abuse and physical ailments.

Researchers have been testing ways to treat it, and the new study looked at whether fast and strong pain relief can help prevent it.

It was unclear whether it was the fast pain treatment or something specific to morphine that made the difference.

But researchers theorize that simply easing pain might reduce the severity of the psychological trauma, or that prompt relief might alter the way the brain remembers the attack or injury — in essence, causing the mind to file away the episode as less traumatic.

Troops in the study initially were treated at military medical facilities in Iraq, mainly for wounds caused by roadside bombs, bullets, grenades or mortar fire. A few dozen had burns or were hurt in crashes or falls. The decision on whether to give morphine was up to the individual doctor, based on the patient’s condition.

Of the 696 troops in the study, 493 — about 70 percent — were given morphine, most within an hour of injury. Two years later, 147 of them had developed PTSD. Of the 203 not given morphine early on, 96 developed PTSD.

That worked out to a 53 percent lower risk of developing PTSD for those treated early with morphine. No other factor, such as the nature or severity of injuries, had much effect on the chances of developing PTSD, Holbrook said.

“These are provocative and thought-provoking findings that should lead scientists to investigate the underlying mechanisms” in future studies, said JoAnn Difede, a PTSD researcher at New York-Presbyterian/Weill Cornell Medical Center.

Difede and Barbara Rothbaum, who heads the Trauma and Anxiety Recovery Program at Emory University School of Medicine, said that until more research backs up the findings, the study probably won’t lead to many more patients in civilian emergency rooms getting morphine.

“At this point, I don’t see it having a huge impact” for civilians, Rothbaum said.

A second study in the journal found that Army wives were more likely to develop depression or sleep problems the longer, or the more times, their spouses were sent to Iraq or Afghanistan.

That study, by researchers at the University of North Carolina and elsewhere, examined medical records for outpatient care of about 250,000 wives of active-duty soldiers from 2003 through 2006.

Compared with wives whose husbands stayed home, those whose husbands were deployed for up to 11 months were 18 percent more likely to be diagnosed with depression and at least 20 percent more likely to be diagnosed with sleep disorders, anxiety and acute stress.

For wives whose husbands were deployed for more than 11 months, problems were even more common: They were at least 24 percent more likely to be diagnosed with depression or anxiety, and about 40 percent more likely to be diagnosed with acute stress or sleep problems.

The researchers didn’t have data showing whether husbands were deployed or at home when the wives were being treated for mental health problems.

That meant the scientists couldn’t conclude whether those problems were caused by worries about the spouse’s safety and the difficulties of being a single parent, or by stress caused by the returning spouse’s psychological problems or other behavior changes.

“I suspect that if you look at the Reserve and National Guard wives, the toll might be even worse,” because they have less social support than families living in a military community, Rothbaum said.

She said the effects of deployment on children also need to be studied so the military can figure out how to provide more help to families.

Wednesday, January 13, 2010

New Jersey Vote Backs Marijuana for Severely Ill

The New York Times
Published: January 11, 2010

TRENTON — The New Jersey Legislature approved a measure on Monday that would make the state the 14th in the nation, but one of the few on the East Coast, to legalize the use of marijuana to help patients with chronic illnesses.

The measure — which would allow patients diagnosed with severe illnesses like cancer, AIDS, Lou Gehrig’s disease, muscular dystrophy andmultiple sclerosis to have access to marijuana grown and distributed through state-monitored dispensaries — was passed by the General Assembly and State Senate on the final day of the legislative session.

Gov. Jon S. Corzine has said he would sign it into law before leaving office next Tuesday. Supporters said that within nine months, patients with a prescription for marijuana from their doctors should be able to obtain it at one of six locations.

“It’s nice to finally see a day when democracy helps heal people,” said Charles Kwiatkowski, 38, one of dozens of patients who rallied at the State House before the vote and broke into applause when the lawmakers approved the measure.

Mr. Kwiatkowski, of Hazlet, N.J., who has multiple sclerosis, said his doctors have recommended marijuana to treat neuralgia, which causes him to lose the feeling and the use of his right arm and shoulders. “The M.S. Society has shown that this drug will help slow the progression of my disease. Why would I want to use anything else?”

The bill’s approval, which comes after years of lobbying by patients’ rights groups and advocates of less restrictive drug laws, was nearly derailed at the 11th hour as some Democratic lawmakers wavered and Governor-elect Christopher J. Christie, a Republican, went to the State House and expressed reservations about it.

In the end, however, it passed by comfortable margins in both houses: 48-14 in the General Assembly and 25-13 in the State Senate.

Assemblyman Reed Gusciora, a Democrat from Princeton who sponsored the legislation, said New Jersey’s would be the most restrictive medical marijuana law in the nation because it would permit doctors to prescribe it for only a set list of serious, chronic illnesses. The law would also forbid patients from growing their own marijuana and from using it in public, and it would regulate the drug under the strict conditions used to track the distribution of medically prescribed opiates like Oxycontin and morphine. Patients would be limited to two ounces of marijuana per month.

“I truly believe this will become a model for other states because it balances the compassionate use of medical marijuana while limiting the number of ailments that a physician can prescribe it for,” Mr. Gusciora said.

Under the bill, the state would help set the cost of the marijuana. The measure does not require insurance companies to pay for it.

Some educators and law enforcement advocates worked doggedly against the proposal, saying the law would make marijuana more readily available and more likely to be abused, and that it would lead to increased drug use by teenagers.

Opponents often pointed to California’s experience as a cautionary tale, saying that medical marijuana is so loosely regulated there that its use has essentially been decriminalized. Under California law, residents can obtain legal marijuana for a list of maladies as common, and as vaguely defined, as anxiety or chronic pain.

David G. Evans, executive director of the Drug-Free Schools Coalition, warned that the establishment of for-profit dispensaries would lead to abuses of the law. “There are going to be pot centers coming to neighborhoods where people live and are trying to raise their families,” Mr. Evans said.

Keiko Warner, a school counselor in Millville, N. J., cautioned that students already faced intense peer pressure to experiment with marijuana, and that the use of medical marijuana would only increase the likelihood that teenagers would experiment with the drug.

“There are children at age 15, 14 who are using drugs or thinking about using drugs,” she said. “And this is not going to help.”

Legislators attempted to ease those fears in the past year by working with the Department of Health and Senior Services to add restrictions to the bill.

But with Democrats in retreat after Mr. Corzine’s defeat by Mr. Christie, some supporters feared that the Democratic-controlled Legislature — which last week failed to muster the votes to pass a gay marriage bill — would balk at approving medical marijuana.

Mr. Christie added to the suspense Monday, just hours before lawmakers were scheduled to vote, when he was asked about the bill during a press conference within shouting distance of the legislative chambers. He said he was concerned that the bill contained loopholes that might encourage recreational drug use.

“I think we all see what’s happened in California,” Mr. Christie said. “It’s gotten completely out of control.”

But the loophole Mr. Christie cited — a list of ailments so unrestricted that it might have allowed patients to seek marijuana to treat minor or nonexistent ailments — had already been closed by legislators. In the end, the bill received Republican as well as Democratic support.

“This bill will help relieve people’s pain,” said Senator William Baroni, a Republican.

Supporters celebrated with hugs and tears.

Scott Ward, 26, who said he suffered from multiple sclerosis, said he had been prescribed marijuana to alleviate leg cramps so severe that they often felt “like my muscles are tearing apart.” “Now,” he said, “I can do normal things like take a walk and walk the dog.”