Snorting Drugs Can Expose You To Hepatitis C

Recent clinical evidence for “intranasal transmission.”

Classify this item in the “not good news” file. Hepatitis C—it’s not just for syringe users anymore. Contrary to previous theory, dirty needles or direct blood exposure may not be necessary. While bodily fluids have always been suspect, researchers at the University of Rochester Medical Center and other institutions have discovered evidence of the hepatitis C virus (HCV) in nasal secretions left in straws used to sniff drugs.

It is no secret that the regular practice of snorting or sniffing drugs can lead to inflammation and bleeding in the tender mucous membranes in the nose. This complicates the risk of using “shared drug-sniffing implements,” as the study refers to them.

According to a report of the work in NIDA Addiction Research News, the method of disease transmission is unknown in an estimated 20 percent of Hepatitis C infections. NIDA said the researchers “asked participants to snort air through a straw in a way that would mimic their normal drug-sniffing behavior to determine whether sniffing implements became contaminated. The straws were then tested for blood and HCV.”

In the study of 38 intranasal drug users, all of whom had active Hepatitis C infections, “researchers found trace amounts of blood in 74 percent of mucus samples and on 8 percent of the straws used for sniffing. In addition, they detected HCV in 13 percent of mucus samples and on 5 percent of the straws.” The Hepatitis C virus is capable of surviving on surfaces for as long as 16 hours. The scientists conclude that the results, while preliminary, “lend important virological and clinical support to the intranasal HCV transmission hypothesis.”

In fact, the authors of the study suggest that the findings are quite likely conservative, given that the Hepatitis C virus is more likely to “occur in the nasal secretions with greater frequency during episodes of active drug sniffing, which may exacerbate the discharge of nasal fluids and blood.”

The findings were reported in the October 1, 2008 issue of Clinical Infectious Diseases.

PHOTO CREDIT: Hepatitis C Harm Reduction Project

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The Economics of Legalization

British study sees annual savings of $20 billion.

Legalizing heroin and cocaine would save Great Britain as much as $20 billion a year, a British drug reform group claims in a 50-page report issued this week. The Transform Drug Policy Foundation said the savings would come primarily in the form of reductions in the cost of government enforcement.

The report, “A Comparison of the Cost-effectiveness of Prohibition and Regulation,” purports to be the first cost-benefit analysis ever undertaken with respect to drug prohibition in Britain. According to an analysis in the Drug War Chronicle, “the British government has relied on mere assertion to justify maintaining prohibition and to argue that the harms of legalization would outweigh its benefits.” The drug reform foundation examined criminal justice, drug treatment, crime, and other social costs, and concluded that “a regime of regulated legalization would accrue large savings over the current prohibitionist policy.”

The Drug War Chronicle reported that the reform group “postulated four different legalization scenarios based on drug use levels declining by half, staying the same, increasing by half, and doubling. Even under the worst-case scenario, with drug use doubling under legalization, Britain would still see annual savings of $6.7 billion. Under the best case scenario, the savings would approach $20 billion annually.”

Specifically, the report says that “even in the highly unlikely event of heroin and cocaine use increasing 100%, the net benefit of a move to regulation and control remains substantial. The economic benefits of regulation identified are also of a magnitude to suggest that even with significant margins of error we can assume that legally regulated markets would deliver substantial net savings to the Treasury and wider society.”

In addition, the report notes that “The Government has also repeatedly failed to acknowledge that prohibition is a policy choice, not a fixed feature of the policy landscape that must be worked within, or around.”

“The most striking conclusion from the analysis of current costs,” the report concludes, “is that prohibition of drugs is the root cause of almost all drug-related acquisitive crime, and that this crime constitutes the majority of drug-related harms and costs to society.”

The full report from the Transform Drug Policy Foundation can be downloaded in PDF format here.

Photo Credit: http://thewhitedsepulchre.blogspot.com

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The Perils of Polydrug Abuse

Methadone and benzodiazepines.

For patients in opiate treatment programs, benzodiazepine use represents both a barrier to recovery and a potentially life threatening situation. The combination of benzodiazepines and methadone can lead to fatal overdose.

The five most commonly prescribed benzodiazepines fall into two major categories. High potency medications include Xanax (Alprazolam), with a short half-life of six to 12 hours, and Ativan (Lorazepam), with a slightly longer half-life. The low-potency benzodiazepines are represented by the short-lived Restoril (Temazepam), and the longer-lasting Valium (Diazepam), with a half-life of 20 to 100 hours. The fifth popular benzodiazepine, Klonopin (Clonazepam) is a high-potency drug with a half-life of 18 to 50, the highest in its class. Their primary clinical uses include the treatment of anxiety disorders, insomnia, convulsions, and muscle spasms. They also find use in the treatment of acute mania, catatonia, and detoxification from alcohol.

While some patients are able to use benzodiazepines safely at low dosage for years, patients with a history of opiate addiction are a high-risk category for these medications. Tolerance develops quickly in patients who use benzodiazepines to “boost” the effect of methadone, or as a sedative during opioid withdrawal. Since high doses of benzodiazepines cause respiratory depression, even among opioid users who have developed a high tolerance to such effects, the combination increases the risk of severe intoxication, injuries, or fatal overdose.

In addition, benzodiazepines and methadone interact pharmacologically through the actions of the CYP450 liver enzyme, which detoxifies both substances. If the work load for CYP450 becomes too great, the result can be an accumulation of high levels of methadone in the body.

It has been estimated that “80 percent of benzodiazepine abuse is part of polydrug abuse, most commonly with opioids.” In a two-year study by the National Institute of Drug Abuse (NIDA), 73 per cent of heroin users also used benzodiazepines more often than weekly.

According to a recent Canadian study of 172 subjects, the reported lifetime prevalence of benzodiazepine abuse in methadone maintenance patients ranged from 67 to 94 percent, with two-thirds of the patients reporting benzodiazepine use during the past 6 months. Patients who took benzodiazepines also reported more previous opioid overdoses, according to the study. And women are more likely than men to abuse benzodiazepines. In a study by Australia’s National Drug and Alcohol Research Centre (NDARC), researchers conducting a five-year study of heroin overdoses in New South Wales found that attempted suicide by benzodiazepine overdose was more common than attempted suicide by heroin overdose.

Methadone maintenance patients need to be questioned carefully about benzodiazepine use. By doing so, physicians and other caregivers can work toward actively decreasing the likelihood of treatment failure or fatal methadone overdose.

Photo Credit: www.drug.uz

House Tobacco Bill Moves to Senate

Bill would give FDA control over nicotine products.

It is one of the most popular drugs in America, used and abused by millions. Yet it is not regulated by any government agency. There is no federal testing, no quality control, no standards of any kind. As representative Jared Polis (D-Colorado) memorably told the U.S. House of Representatives: “Tobacco use is the single largest cause of preventable death in our country. Yet it continues to receive less regulation than a head of lettuce.”

That deplorable situation may soon change, as the U.S. Senate takes up a bill recently passed by the House. The legislation would give the Food and Drug Administration (FDA) broad new powers to regulate the tobacco industry for the first time in history.

The house bill is similar to one passed last session, which died in the Senate after it was opposed by the Bush administration. According to reports by Duff Wilson in the New York Times, the legislation would enable the FDA to “approve or reject current and proposed tobacco products and ingredients, based on scientific and health findings.” The FDA would be able to restrict harmful chemicals and reject new tobacco products, but in a major concession to Philip Morris, the nation’s largest cigarette maker, the bill “would not allow a complete ban of tobacco products, or permit the agency to order the complete removal of nicotine.” The Times article also said the bill would lead to larger and more graphic warning labels on cigarette packs.

Senator Edward Kennedy (D-Massachusetts) said he plans to introduce the bill later this month. The legislation is supported by President Obama. An official statement released by the administration said that tobacco use “is a major factor driving the increasing costs of health care in the U.S. and accounts for over a hundred billion dollars annually in financial costs to the economy.” Attempts to mandate FDA regulation of tobacco have been made repeatedly over the past decade.

Tobacco industry supporters have vowed to fight the bill on the Senate floor. Senator Richard Burr (R-North Carolina) said he was considering a filibuster. House Republican Virginia Foxx, also of North Carolina, derided the legislation as “an unnecessary and expensive regulatory scheme at the expense of our rural farming communities.” North Carolina is the country’s leading tobacco growing state.

A spokesperson for the American Heart Association said the Senate was expected to act quickly on the bill: “This has certainly been a passion of Senator Kennedy’s and a legacy he can leave to the public health of America.”

Photo Credit: Winston-Salem Journal

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Gimme a Drink--But Hold the Acetaldehyde

Another look at alcohol and cancer.

If beverage alcohol were a new drug, it would face an uphill battle to make it through the Food and Drug Administration (FDA) pipeline. Why? Because the amount of acetaldehyde in alcoholic drinks—combined with acetaldehyde from other sources—might be too carcinogenic to pass muster under existing regulations.

When drinkers drink, the first thing that happens is that enzymes convert the alcohol into acetaldehyde. Previous research has shown that this common organic chemical is implicated in certain cancers, particularly cancers of the digestive tract. Studies at the National Institutes of Health (NIH) showed that the concentration of acetaldehyde measured in human saliva during drinking episodes was sufficient to produce the kind of damage to DNA that can result in cancer.

In a study published recently in the journal Addiction, researchers from Canada and Germany showed that heavy drinkers ingest enough acetaldehyde to raise their lifetime cancer risk to as high as 1 in 1,000. The study concludes: “The life-time cancer risks from acetaldehyde from alcoholic beverages greatly exceed the usual limits for cancer risks from the environment.”

The real problem comes when alcohol is used in combination with acetaldehyde from other sources, such as tobacco, food flavorings, pesticides, and perfume. Heavy drinkers “face a magnitude of risk requiring intervention.” According to Dr. Jurgen Rehm at Canada’s Centre for Addiction and Mental Health (CAMH), quoted in Science Daily: “Most risk assessments to date were based on one source of exposure only. This has led to a negligence of the overall risk.”

According to the Science Daily article, “Alone, the risks associated with surpassing limits of acetaldehyde from the air may not yet be alarming, but for heavy drinkers and smokers, it adds to the acetaldehyde levels already received from these sources. This overall risk then surpasses established safety limits.” To make matters worse, acetaldehyde is a common substance in tobacco smoke—and alcoholics are often heavy cigarette smokers.

A Finnish drug company is currently conducting clinical trials of a time-release capsule of the amino acid cysteine, which can bind with acetaldehyde and render it inactive.

In a related development, a study in PLoS Medicine appeared to demonstrate that people who suffer from the so-called alcohol flush reaction—primarily Japanese, Chinese, and Koreans—are at increased risk for throat cancer. The culprit? An excess of acetaldehyde.

Photo Credit: National Institute of Standards and Technology

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Drug Addicts Punished in New York Prisons

Drug offenders get “the box” instead of treatment.

The common practice of placing drug addicts in “disciplinary segregation” for drug use violations in New York state prisons has drawn fire from Human Rights Watch. The international human rights group issued a report condemning the practice of placing addicts in “the box” and denying them treatment for their drug dependence, calling it “cruel, inhuman, and degrading treatment.”

In the report, entitled “Barred from Treatment: Punishment of Drug Users in New York State Prisons,” Human Rights Watch notes that even addicts who are allowed to seek treatment face major delays “because treatment programs are filled to capacity.” New York State Assemblyman Jeff Aubry, chair of the State Committee on Corrections, told the investigators: “Denying treatment to inmates who suffer from a drug dependency is illogical and counterproductive to the goal of rehabilitation.”

Some of the findings in the report are shocking: “Despite overwhelming evidence that medication-assisted therapy is the most effective treatment for opiate addiction, the majority of New York State prisoners dependent on heroin or other opiates have no access to methadone or buprenorphine.” Furthermore, the state’s Department of Correctional Services “has conducted few evaluations of its own treatment programs.” Prison officials have estimated that as many as eight out of ten inmates have substance abuse problems. A National Institute of Drug Abuse (NIDA) study earlier this year, covered in a previous post, estimated that only one-fifth of the nation’s inmates needing formal treatment are able to get it.

The report comes just as New York legislators have agreed to revamp the so-called Rockefeller drug laws, which are among the strictest in the nation. “Reforming the Rockefeller drug laws to prevent drug users from being sentenced to long prison sentences is critically important, said Megan McLemore, a researcher with Human Rights Watch. “But timely and effective programs must be available to serve the inmates still in prison.” McLemore said in a press release that “discipline should be proportionate to the offense, and should never prevent prisoners from getting the treatment they need.”

As a prisoner at Attica told Human Rights Watch, “Here is a notice telling me ‘it could be a long time’ until I get into treatment again. There’s plenty of room for me in the box, but not in a program.”

Photo Credit: ACS blog

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Economy Down, Addictions Up?

Do people drink more or less during a recession?

According to a report from Mintel, a consumer research firm, "sin stocks" historically have performed well during times of economic recession. "Chocolate, cigarettes and alcohol again seem relatively recession-proof," comments Marcia Mogelonsky, senior analyst at Mintel.

Lest anyone think that somehow the tobacco dragon has been tamed after 45 years of public health announcements (surely no one can afford cigarettes anymore?), Mintel documents that "cigarette and tobacco product sales increased 44% from 2003 to 2007 to $103 billion.” Moreover, “as price and tax increases continue to take hold, Mintel projects that the cigarette and tobacco market will grow 28% through 2011 (to $132 billion).”

There is also a bull market for chocolate: “Innovative, dark and premium chocolates are extremely popular, so Mintel expects Americans to continue indulging in this favorite treat. The market research firm predicts 4% annual sales increases each year for the next six years.”

As for alcohol, a mixed picture: “Motivated by high gas prices and expensive bar tabs, more Americans are opting to drink at home. But that doesn't mean they're drinking less. New research from Mintel reveals the market for at-home alcohol is expected to reach $77.8 billion in 2008, a 32% increase from 2003.” Mintel expects in-home alcohol sales to rise as much as 5% per year.

However, earlier studies of the matter have been inconclusive. Melissa Healy reported in the Los Angeles Times that the connection between “hard times and hard drinking isn't clear. In the U.S., a state's alcohol consumption declined by 3% for every one percentage point increase in that state's unemployment rate, according to one study. But another study found that rates of binge drinking went up 8% when unemployment rose 5%. The increase in binge drinking was concentrated most heavily among adults who were still employed.”

In the Los Angeles Times article, Andrew Barnes of the UCLA School of Health Services, estimates that “during this economic decline, those who drink alcohol will consume 12% less (10% less nationally), there will be a 13% reduction in alcohol-impaired driving, and a 1.2% decrease (1% nationally) in the number of people who drink at all. The probability of being a heavy drinker (consuming 60 or more drinks per month) is predicted to decline in California by 31%.”

Graphics Credit: www.bloggingstocks.com

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