Author: Arahant Admin
Nora D. Volkow, MD, director of the National Institute on Drug Abuse, and her associates reported in a letter on April 17, 2017 in the Annals of Internal Medicine that past-month prevalence of marijuana use among pregnant teens aged 12-17 years was 14% compared with 6.5% for their non-pregnant peers. This study involved 410,000 females aged 12-44 years between 2002 and 2015.
According to a report by the Centers for Disease Control and Prevention (CDC), opioid prescribing decreased in parts of the country between 2010 and 2015, but remains high compared with 1999 data. Opioid prescribing peaked at 782 morphine milligram equivalents (MME) per capita in 2010. In 2015, this number decreased to 640 MME per capita.
Several hit hardest by the opioid epidemic include, Florida, Kentucky, and Ohio. The implementation of pain clinic regulation and mandating that clinicians review Prescription Drug Monitoring Program (PDMP) data has helped many of these states reduce prescribing.
Street and Club Drugs
A designer drug is a structural or functional analog of a controlled substance that has been designed to mimic the pharmacological effects of the original drug but avoids being classified as illegal, avoids detection in standard drug test, and are available online for a lower cost than illegal substances. The use of these drugs can result in chronic psychiatric and medical conditions as well as complicated withdrawal symptoms.
Stimulants
Drugs of this class produce amphetamine-like euphoria in addition to anxiety, agitation, insomnia, hallucinations, and decreased appetite. They include:
Piperazines – Sold in pill form as “herbal ecstasy.”
Cathinones – Also known as bath salts and appears as white or brown crystalline powder sold in small plastic or foil packages. They can be bought online or in drug paraphernalia stores under a variety of brand names, such as Ivory Wave, Bloom, Cloud Nine, and Scarface.
Hallucinogens
Tryptamines (eg, LSD, psilocybin)
Phenethylamines (eg, mescaline, the 2C family, the NBOMe series, the DO series, FLYs)
MDMA Dissociatives – Long term use can cause cognitive impairment, memory loss, attention problems, and manic, psychotic and depressive symptoms.
Ketamine – Recreationally used to achieve the state of derealization, described as a near-birth experience.
Dextromethorphan – A cough medication. Effects are dose dependent.
Synthetic cannabinoids (“fake weed”) – Sold as Spice, K2, and Crazy Monkey. Compared to marijuana, synthetic cannabinoids produce more significant agitation/irritability and is associated with seizures.
Salvia – The leaf form can be chewed or brewed in drinks or smoked from pipes or water bongs. It has hallucinogenic effects, in addition to disrupting space and time and causing and agitated delirium.
Sedatives
γ-Hydroxybutyric acid (GHB) – Used recreationally and as an aphrodisiac at raves to induce symptoms of euphoria, relaxation, and disinhibition. In large amounts, it can cause confusion, respiratory depression, and coma, and if combined with other respiratory depressants it can cause death.
Kratom (Mitragyna speciosa) – The leaves are chewed or it can be consumed as processed capsules. Results in stimulant effects at lower dosages and opioid-like effects at higher dosages.
Highlights from the 2014 National Survey on Drug Use and Health (NSDUH)
Background:
The NSDUH is an annual nationwide survey involving interviews with approximately 70,000 randomly selected individuals aged 12 and older. The Substance Abuse and Mental Health Services Administration (SAMHSA), which funds NSDUH, is an agency in the U.S. Department of Health and Human Services (DHHS).
Data from the NSDUH provide national and state-level estimates on the use of tobacco products, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health in the United States. In keeping with past studies, these data continue to provide the drug prevention, treatment, and research communities with current, relevant information on the status of the nation’s drug usage.
Highlights:
27.0 million people aged 12 or older used an illicit drug in the past 30 days, which corresponds to about 1 in 10 Americans This percentage in 2014 was higher than those in every year from 2002 through 2013.
Approximately 21.5 million people aged 12 or older had a substance use disorder in the past year, including 17 million people with an alcohol use disorder, 7.1 million with an illicit drug use disorder, and 2.6 million who had both an alcohol use and an illicit drug use disorder.
An estimated 22.2 million Americans aged 12 or older were
current users of marijuana.
About 3.3% of all adults had both any mental illness and a substance abuse disorder in the past year, and 1% had both serious mental illness and a substance use disorder.
For more information visit: http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
I completed my addiction fellowship in 2006, here at the University of Colorado School of Medicine, and then went to Hawaii to pursue an additional fellowship in addiction medicine research and then became the assistant addiction fellowship director under William Haning, MD at the University of Hawaii John A Burns School of Medicine. While there I was given the opportunity to participate in a National Institute of Drug and Alcohol national clinical trial. Interestingly, while serving in these academic roles, I was given the opportunity to serve as a psychiatric consult for a private, for-profit, abstinence-based residential program.
When my wife and I moved back to Denver, I had the opportunity to work in various public health agencies (Denver VA, Arapahoe Douglas Mental Health) as well as an academic and private for-profit inpatient program (CeDAR on the CU Anshutz Medical Center) as an addiction psychiatrist. I have served as a psychiatric consult to several private abstinence-based programs as well as served as medical director for several methadone/harm reduction clinics.
These various clinical experiences and academic/research roles, began to shape my professional and treatment philosophy. I felt compelled to give “voice” to this philosophy in the form of a clinic that specializes in substance use disorders and co-occurring psychiatric illnesses.
We picked the name Arahant for our clinic because it means “one who is worthy” in Sanskrit. We felt that our patients needed to be reminded that they are worthy human beings because the label of “addict” caused them to forget this.
In medical school we are taught to think of our patients in their entirety, not as “cases.” The current understanding of addictions is that it is a chronic medical illness with strong biological, genetic, and psychological underpinnings, much like hypertension and diabetes; just as hypertension and diabetes have an approximate 40-60% genetic/biological underpinnings and 60-40% behavioral aspect to these illnesses, alcohol and drug addictions are thought to have this same 40-60% split in biology/genetics versus behavior.
In medicine, we are taught to avoid calling our patients “diabetics” or “hypertensives.” In the field of addiction treatment, however, we continue this tradition of defining a person based on their one disease. It is estimated that 70% or more of patients with addictive disorder have a co-occurring psychiatric disorder, usually a depressive or anxiety disorder. Furthermore, a significant percentage of patients with substance use disorders have experienced traumatic events, either preceding the phenotypic manifestation of their genetic vulnerabilities to addictions or during the expression of their genotypes. This suggests that we need to treat all of our patients’ psychiatric and psychological illnesses simultaneously.
Just as other physicians don’t tell patients “we will be happy to treat your hypertension as soon as your diabetes is under control” we don’t tell patients in our clinic to come back as soon as their substance use disorder or psychiatric illnesses are under control. Our treatment program is designed to address all of our patients’ psychiatric and psychological illnesses simultaneously. Our treatment philosophy and the name of our program is set up to remind our patients that there is more to them than just their illness; they are people in our eyes not “addicts” or “alcoholics.”