Thursday, December 23, 2010

Substance Use and Abuse During Holiday Periods

Research has shown that during the December-January holiday period, substance abuse problems can emerge and/or be exacerbated.  Brenda Iliff, Clinical Director of Hazelden in Naples, FL, discusses substance abuse problems and relapse during the holidays in an interview posted on Recovery Resource BLOG.

Holiday substance abuse problems not only affect individuals and families, but also have a major impact on public health and welfare.  Consider for example some statistics on holiday alcohol-related fatalities from Finland and from the United States.  A study by Makela and colleagues reported that in Finland over the 15-year period from 1987-2001, alcohol-related deaths spiked on Christmas Eve and New Years Day in men (58 and 48% increases, respectively) and in women (121 and 77% increases, respectively, see the figure).

Comparable statistics on alcohol-related traffic deaths in the US from 2001-2005 were reported by the US National Highway Traffic and Safety Administration (NHTSA), and showed that alcohol-related fatalities were 25 and 50% higher during the 3 to 4-day holiday periods surrounding Christmas and New Years Day, respectively.

The Office of National Drug Control Policy (ONDCP) in its Of Substance Blog suggested that party hosts plan to offer guests non-alcoholic beverage choices, and even provided several alcohol-free drink recipes to consider.

In addition, a number of anti-alcohol media campaigns targeting holiday drunken driving are underway, including one highlighted by the Addiction Inbox BLOG.

Alcohol seems to be the main holiday-related substance abuse problem.  However, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that in 2009, 10 million people drove while intoxicated with prescription or illicit drugs (compared to 30 million people drove while alcohol-intoxicated).  In fact, in some age groups, the prevalence of drugged-driving exceeds that of drunk driving.

Although statistics do not seem to be available yet clarifying whether drug-intoxication deaths (driving or otherwise) increase during the holidays, this week, President Obama issued a Proclamation naming December 2010 as National Impaired Driving Prevention Month, with a focus on preventing drunken and drugged driving.

CPDDBLOG welcomes CPDD member’s thoughts on this issue, thanks you for looking in over the past few months, and wishes you and yours a happy, healthy, prosperous, and especially a safe holiday season and new year.

Saturday, December 11, 2010

Naming of a new Addiction Institute: Injecting Politics into Science?

Originally posted on the CPDD Listserv, posted here on behalf of Jim Anthony 
Folks in CPDD:
Many of us within CPDD view alcohol/ethanol and tobacco/nicotine as 'drugs'.
We view the early-mid-1970s substitution of the term 'substance' as an inappropriate
politics maneuver, and possibly a supercilious denial that ethanol/alcohol and
tobacco/nicotine are drugs.
In consequence, the idea of a new NIH agency called "Institute for Substance Use,
Abuse, and Addiction" may be a bit of an injection of politics into the science.
There is a Facebook group that advocates a different name such as: "National
Institute on Drug Use and the Public's Health."
I invite you to join that Facebook group and to help us make sure that the politics
are not injected into the science of NIH research.
(I appreciate that there may be an intent for a reach toward 'internet addiction',
'gambling addiction', 'food addiction', 'exercise addiction',  'sugar addiction',
etc., and to bring these related conditions into the fold. This goal can be
accomplished by taking a page from the NESARC program - e.g., 'National Institute
on Drug Use and Related Conditions' although my personal preference is to bring
those conditions into the fold via the allusion to the Public's Health.)
The most important piece of this "pontification" is not to saddle future generations
of scientists with the politics that were involved when early-mid-1970s political
considerations got injected into the naming of SAMHSA.
Also, please note that, to date, the leaders of CPDD resisted any notion of changing
the name of the college to 'College on Problems of Substance Dependence' even though
the reach of CPDD includes all of the above-listed 'related conditions'. We can deal
with this issue in the 'fine print' of the new institute's description and in its
program announcements or funding opportunity statements, exactly where we also can
deal with the fact that the domain of 'drug' can extend to aspirin, chlorpromazine,
and other 'drugs' of less central prominence within the new institute's range.
Jim Anthony
CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Monday, December 6, 2010

NIMH, NIDA, and NIAAA Institute Directors Briefing at the 49th Annual Meeting of the American College of Neuropsychopharmacology (ACNP)

MIAMI, Fla. — Presentations were made yesterday afternoon to attendees of the ACNP 49th Annual Meeting by Tom Insel, Director, National Institute of Mental Health (NIMH), Kenneth Warren, Director, National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Nora Volkow, Director, National Institute on Drug Abuse (NIDA).  The Institute Directors briefed ACNP meeting attendees on Institute priorities and budget issues.

Dr. Insel spoke first and focused on strategic and budgetary themes.  He remarked that there is some frustration in Congress regarding the return on the financial investment that has been made to support research.  He suggested that NIH research needs to become more like the research program maintained by the Defense Advanced Research Project Agency (DARPA), that works off of directives and is focused on innovation.

He reported that NIMH Council recommended that it is important to stop conducting large studies that yield small effects, and that there should be a focus on methods standardization, data integration, and data sharing.  Insel also noted that NIMH is committed to preserving the New Investigator R01 pipeline, and this year is funding New Investigator R01s up to the 25th percentile.

In terms of budget issues, he said that the President’s FY11 budget proposed increased funding by 3.2%, but that actual budget increases have been below the level of inflation for the last 5 budget years.  Importantly, only a fraction of each year’s budget, ~25% for NIMH, goes into new awards, with ~75% already committed to existing programs.  If the President’s FY11 budget is approved, then the current funding line for new applications would be ~21% funding.  However, because Congress is working on a Continuing Budget Resolution, the current funding line is ~17.8%.  And, if the budget is funded at FY08 levels, the preference of some Congressional leaders, the new application funding level would reduce to a scary ~13.3%.  This could mean a ~30% cut in the number of newly funded projects.

To offset this grim possibility, Insel mentioned that NIMH is considering a number of options including shifting some resources from intramural to extramural programs.  He remarked that we are in the best of times scientifically and the worst of times financially.

Dr. Kenneth Warren of NIAAA spoke next and noted that he was glad to be speaking after Dr. Insel, who provided a perspective on a budget environment that affects all NIH Institutes.  Dr. Warren outlined the NIAAA mission and reported that the President’s FY11 budget request for NIAAA called for a 2.7% budget increase but the Senate markup called for only a 2.5% increase, both below inflation levels.  He then noted that the final budget could be flat or worse than flat.

Dr. Warren then spoke about the Scientific Management Review Board’s recommendation to form a new addiction research institute, and noted that the NIH Director appointed a task force to be led by NIH Principal Deputy Director Lawrence A. Tabak, D.D.S., Ph.D. and National Institute of Arthritis and Musculoskeletal and Skin Diseases Director Stephen I. Katz, M.D., Ph.D., to develop a new institute model by summer 2011.  Warren remarked that he had been told that those appointed to be task force members would “have no skin in the game”, presumably to eliminate conflicts of interest, but he expressed concern that the task force may not have all the expertise needed to formulate an optimal structuring plan.  Dr. Warren urged the audience to volunteer their time and advice, if requested by the task force, to consult on the structuring plan.  He then outlined a the timeline for the process, indicating that the structuring plan would have to be completed by summer 2011 in order to be able to start in FY 2013.

Dr. Warren spent the balance of his time discussing NIAAA accomplishments and priorities.

NIDA Director Dr. Volkow spoke last, agreeing with Dr. Insel in that these are extraordinary times scientifically.  She remarked that science is advancing at speeds not seen before because of open access to research data via the internet.  She termed the budget picture “challenging” and “competitive”.  She noted that the proposed NIDA budget is about $1 billion, but could be rolled back to FY2008 levels.  NIDA is considering a pre-emptive measures to respond to this possibility, and among other actions is not going to commit to new large program projects that run for long time periods.

She then focused on the SMRB recommendation to form a unified addiction institute, and indicated that she was “delighted” with the recommendation.  Dr. Volkow said that in her opinion, dividing research on alcohol from that on other drugs is bad, because of the high comorbidity between alcohol abuse and abuse of nicotine and illicit drugs.

Dr. Volkow noted that most animal models of alcohol abuse don’t include nicotine, which is relevant clinically and scientifically because of the high comorbidity of alcohol abuse and smoking, and because nicotine is neuroprotective and also can trigger alcohol relapse.  She noted that more alcoholics die from smoking-related diseases than from alcohol-related diseases.

She observed that supporters of NIAAA and NIDA research programs all are afraid that funding for these research areas will be reduced in an integrated institute, and that it will be critical to include mechanisms in a new institute structure that minimize inappropriate allocations.

Dr. Volkow lamented that the restructuring process has resulted in a polarization between NIDA and NIAAA, but that it is important to start working together to figure out how to best integrate resources and manage the change.  She also appealed to the audience to serve as consultants if asked to help provide guidance on integration.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Thursday, December 2, 2010

The Drug Enforcement Administration bans synthetic marijuana products including “Spice”, “K2”, “Blaze”, and “Red X Dawn”

So, the Food and Drug Administration (FDA) has been regulating tobacco products for a number of months now and recently banned the sale of caffeinated alcoholic beverages.  This past week, the Drug Enforcement Administration (DEA) placed temporary controls, effectively, a 1-year ban, on possession or distribution of synthetic marijuana, also known as “fake pot”.  The ban will allow a period of study to determine whether these fake pot products should be permanently controlled as Schedule I drugs.

These and other synthetic marijuana products already are banned in a number of European countries.

Synthetic marijuana is produced by spraying herb blends to be smoked with one or more of the following chemical substances, JWH-018 or analogs JWH-073 or JWH-200, or CP-47,497 or analog cannabicyclohexanol.

The JWH series of compounds were initially synthesized for research purposes by medicinal chemist John W. Huffman.

Together with Billy Martin and colleagues, Dr. Huffman published a pharmacology study in Drug and Alcohol Dependence showing that JWH-018 and JWH-073 have high affinity at cannabinoid CB1 and CB2 receptors, and are several times more potent at binding to these receptors than the primary active ingredient in marijuana, delta-9-tetrahydrocannabinol (THC).

Compound CP-47,497 is another synthetic cannabinoid synthesized originally by Pfizer.

National Public Radio recently interviewed Dr. Huffman who characterized the products containing these compounds as being “…pretty toxic.”

The American Association of Poison Control Centers issued 3 press releases this year in July, October, and November, reporting alarmingly high numbers of calls to Poison Control Centers related to these products (see Figure), particularly when compared to the small numbers of calls received in prior years.

In his NPR interview, Dr. Huffman pointed out that there are many other synthetic THC analogs with similar effects, some of which are many times more potent than THC.  Thus, more products like the banned substances likely will emerge pretty quickly and may need to be studied and possibly regulated.

At the CPDD Annual meeting held in June, Boos and colleagues from the DEA reported finding synthetic cannabinoids more frequently of late in seized products (Abstract 59, 2010 Abstract Book PDF page 15, downloadable at  Their abstract indicated that since 2000, 5 designer drugs have been added to the controlled substances act.  That number could be quickly doubled if the 5 synthetic cannabinoids under discussion also are added, and could grow even further and very quickly if other synthetic cannabinoids are added.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.