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Saturday, January 29, 2011

Painkiller Misuse in the National Football League and its Future Consequences

Football enthusiasts are gearing up for the National Football League’s (NFL’s) Pro Bowl this weekend, an exhibition game that will tide fans over until next week’s big event, Super Bowl XLV.  In the meantime, many fans have been reading a report on ESPN.com about prescription painkiller abuse in the NFL entitled “Painkiller misuse numbs NFL pain”.

The report, which was sponsored by ESPN and supported by funding from the National Institute on Drug Abuse (NIDA), includes segments on painkiller misuse by current and former NFL players, painkiller use in today’s NFL, how concussions may impact drug use, and additional resources.

ESPN’s segment on painkiller misuse is based on a new study just published online in CPDD’s journal Drug and Alcohol Dependence, which was conducted by researchers at Washington University in St. Louis and ESPN in Connecticut.

The study reported that more than half of the 644 former NFL players who participated in a phone survey admitted using prescription opioid analgesics during their careers and more than 70% of those players had misused them.

The study also concluded that former NFL players currently use painkillers 3 times more frequently than men of the same age range in the general population, and that painkiller misuse during NFL careers was associated with future painkiller misuse during retirement.  Pain and undiagnosed concussions during playing careers and current alcohol use also predicted current painkiller misuse.

Linda Cottler, lead author on the report commented that “This study shows the need to monitor players both in the NFL and those who are retired.  It also highlights a need to monitor and assist elite athletes all over the world as well as collegiate players.”

The NFL study findings are consistent with a link that has been established in the general population between initial opioid analgesic misuse and later dependence: in a report presented at the 2010 CPDD Annual Meeting, Adelaja and colleagues at Michigan State University revealed that more than 3% of people who misused prescription opioids developed some features of dependence within 2 years after initial use (Click on hotlink to CPDD 2010 Abstract Book PDF, page 2, abstract #5 at http://www.cpdd.vcu.edu/).

In a separate study published this week, the NFL players association (NFLPA) reported that injuries actually increased during NFL 2010 season games versus in 2002-2009, averaging 3.7 per week per team (versus 3.2 per week per team in prior years), with 63% of players injured at least once (versus 59% of players injured at least once in prior years).

Thus, pain levels for NFL players appear to be on the rise, as may be problems they may experience during and after their careers with pain medications.

Sport injuries at the high school level also are common, particularly in contact sports, as is pain medication misuse, which is higher among those of high school age than in older adults.  This suggests that a convergence between sports participation and pain medication misuse also may exist in this age-group.

These reports will be of interest not only to football fans and other sports enthusiasts but also to those studying and treating prescription medication abuse, which according to the Office of National Drug Control Policy (ONDCP) is the fastest growing drug problem we face.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Sunday, January 23, 2011

More on NIH Institutes Restructuring

While a number of earlier postings on this site have focused on the proposed restructuring of NIDA and NIAAA into a single addiction Institute, NIH, upon recommendation in early December by the Scientific Management Review Board (SMRB), is planning other restructuring efforts that may result in contraction and/or elimination of existing Institutes, and the rapid birth of a new one.

The proposed new Institute is to be called the National Center for Advancing Translational Sciences (NCATS), and the rationale for its formation, its organization, and its goals are described on the NCATS FAQ site.

An FAQ site also exists describing the rationale for and organization of the proposed NIDA-NIAAA restructuring.

Nature News, reporting on the SMRB recommendation to form NCATS, included a Q & A with NIH Director Collins on why the new Institute is necessary.

An article in today’s New York Times (NYT) reports that the new Institute was designed to address a growing problem: despite spending more and more to develop and especially to market drugs, the pharmaceutical industry actually is producing fewer new drugs.  This is especially true for therapeutic areas relevant to NIDA and NIAAA researchers.

According to the NYT article, an aim of the new Institute will be to catalyze development of new drugs to the point that they will be embraced and developed by pharmaceutical companies.  Budgets and projects currently based at other NIH Institutes will be shifted to the new Institute and additional funding from Congress will be sought, possibly by “cannibaliz[ing] other parts of the health institutes to bring more resources to the new center.”

By law (National Institutes of Health Reform Act of 2006, H.R.6164), only 27 NIH Institutes may exist at any given time, so to create a new Institute by October 2011 which is the stated goal, NIH must eliminate one Institute.  The proposed NIDA-NIAAA structural merger into a single Institute may fulfill the requirement but other Institute changes are being considered, including downgrading the status of the National Center for Research Resources (NCRR).

ScienceInsider reports that this proposal is creating a lot of “anxiety” in the biomedical research community.

Interestingly enough, as of today, the proposed NCRR program restructuring has generated many more comments on the NIH feedback website (>1200) than the number of comments posted regarding the proposed NIDA-NIAAA structural merger (<40) over the same time frame, although that may be due to the fact that the NIDA-NIAAA merger was recommended several months before the NIH feedback site was available.

Times seem to be a-changing at NIH.  We can only hope that what materializes at NIH will improve researchers’ abilities to discover and develop new treatments for addiction and other health disorders.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Saturday, January 15, 2011

So, how are you doing with that New Year’s Resolution?

It's two weeks into the new year and many of those who made “New Year’s Resolutions” are breaking them about now.  Surveys indicate that the most popular resolutions include appetitive disorders CPDD members study such as smoking, drinking, and eating disorders.

Little research has been published on outcomes for those making New Year’s Resolutions, but one study that is almost 10 years old suggests that while making resolutions can be effective, people tend to break their resolutions quickly.

Another study reported that within 1 month, more than 65% of people who made a quit smoking resolution in conjunction with either New Year’s Day or the Great American Smokeout had resumed smoking, although some people can relapse more quickly.

Recently, NIDA Director Nora Volkow was interviewed on this topic and commented that reward systems in our brain involving dopamine signaling get in the way of our intentions to break certain habits.  She even revealed that she personally has a problem resisting popcorn when she goes to the movies.

The good news is that effective treatments exist for smoking, drinking, and other appetitive disorders (options are described on the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) websites) that are more effective than personal resolutions. However, existing treatments for smoking and alcohol use disorders are associated with high relapse rates.  This underscores the need for more research into improving treatment options for these and other appetitive disorders.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.

Saturday, January 1, 2011

Underage Drinking-Related Emergency Room Visits on New Year’s Day, 2009, and Measures to Address This Societal Problem.

CPDDBLOG wishes you a happy New Year 2011!

In follow up to last week’s CPDDBLOG post discussing historical data documenting increases in alcohol-related deaths during the Christmas and New Year’s holiday periods, new data were just reported by the Substance Abuse and Mental Health Services Administration (SAMHSA) on emergency room (ER) visits associated with underage drinking on New Year’s day 2009.

The Drug Abuse Warning Network (DAWN) data reveal a nearly 4-fold increase in underage drinking-related ER visits on New Year’s day 2009 (N=1980, 363% higher than the 546 visits nationally on an average day in 2009).  The New Year’s day visit tally also eclipsed totals on the July 4th (N=942, 73% higher than average) and Memorial Day (N=676, 24% higher than average) holidays (Figure).

These statistics are quite sobering, no pun intended, since they likely only reflect the tip of the iceberg in terms of the underage drinking problem we face.  For example, there is substantial evidence that underage drinking is associated with the development of adult drinking problems due to genetic or environmental factors including age at first drink and age at developing alcohol dependence.  Further, recent data suggest that the structure of brain areas involved in memory and cognition is persistently altered in nonhuman primates after adolescent binge drinking, suggesting the possibility of enduring cognitive deficits in humans after early binge drinking.

Together, these findings indicate that it is especially important to identify and treat underage problem drinkers to avoid lifelong alcohol problems and the personal and societal problems they bring.

Recent research suggests that the alcohol screening, brief intervention, and referral to treatment (SBIRT) process may be useful for reducing underage drinking and its consequences.  For example, screening and brief intervention of underage drinkers presenting to pediatric emergency rooms was shown to modify some drinking behaviors while web-based screening and intervention modified binge drinking patterns.  Other encouraging data support the idea that interventions involving electronic resources can reduce problem drinking behaviors and smoking over the long-term.  Since underage alcohol problems appear to cluster geographically and socioeconomically, locating SBIRT resources in and heavily publicizing online resources to problem clusters may be especially effective strategies.

Alcohol pricing (including taxation) offers another means to reduce alcohol’s deleterious consequences and increased taxation appears to have a disproportionately large effect on reducing deaths due to underage drinking.

This is significant in the State of Massachusetts which today (in response to a November 2010 voter referendum) eliminated the 6.25% state tax on alcoholic beverages, after a campaign that according to the Boston Globe, was swayed by alcohol industry money.

While eliminating the alcohol tax should result in more alcohol purchases in Massachusetts (versus in bordering states with lower alcohol taxes), it also seems likely that Massachusetts can expect increased underage drinking and its negative consequences.

CPDDBLOG welcomes CPDD member’s thoughts on this issue.