Friday, March 18, 2016

In-Car Breathalyzers for DUI Offenders Curb Drunk-Driving Deaths by 15 Percent

So-Called “Ignition Interlocks” Save Lives with Similar Success as Airbag Laws, Penn Study Says

In-Car Beathalyzers save lives from Drunken Driving Accidents
Newswise, March 18, 2016 —  State laws that require drivers who’ve been convicted of drunk driving to pass a breathalyzer-type test before starting their cars saved an estimated 915 lives between 2007 and 2013, according to a study published in the American Journal of Public Health by researchers at the Perelman School of Medicine at the University of Pennsylvania.

The findings represent a 15 percent reduction in drunk driving-related deaths compared to states without legislation requiring DUI offenders to use “mandatory ignition interlock.”

The research, led by Elinore J. Kaufman, MD, a student in Penn’s Health Policy master’s degree program and a resident at New York-Presbyterian Weill Cornell Medical College, used National Highway Traffic Safety Administration data to compare alcohol-related crash deaths in the 18 states that required ignition interlocks for all those convicted of DUI as of 2013 with the number of alcohol-related crash deaths in states without mandatory interlocks.

States with mandatory interlock laws saw a 0.8 decrease in deaths for every 100,000 people each year – which is comparable to lives shown to have been saved from mandatory airbag laws and the 21-year minimum legal drinking age combined (0.9 and 0.2 lives saved per 100,000 people, respectively).

Car crashes involving alcohol make up 30 percent of vehicular fatalities, resulting in 11,000 deaths each year. The National Highway Traffic and Safety Administration estimates that for each of the million drunk driving convictions each year, there are 88 previous instances of drunk driving.

“These laws are proven feasible and effective, and they are low hanging fruit for the remaining half of states, including Pennsylvania, that don’t have this protection in place yet,” Kaufman said.

Following increasing support for interlock laws in other states, Pennsylvania’s House of Representative’s Transportation Committee is considering legislation – SB 290 – that would require first-time DUI offenders with a blood-alcohol content of .10 or higher to install these devices.

“Our findings show that by preventing intoxicated drivers from starting their vehicles, these ignition interlock laws can directly prevent drunk driving and save lives,” Kaufman said. “We are encouraged by growing public and governmental support for expansion of interlock programs and innovative ways to use this technology to prevent more lives lost resulting from drunk driving.”

Previous research on mandatory interlock laws focused on recidivism rates, but the new Penn study serves as the first national analysis of the impact of a universal interlock requirement on alcohol-involved crash deaths.

“Although crashes and crash fatalities decline, we’re not seeing a significant reduction in those involving alcohol,” said the study’s senior author, Douglas J. Wiebe, PhD, an associate professor of epidemiology in the department of Biostatistics and Epidemiology and a senior scholar in the Center for Clinical Epidemiology and Biostatistics.

“We’re encouraged by the increasing number of states enacting mandatory interlock laws since 2013 and hope these findings advance public health conversations aimed at saving more lives.”

The researchers note that the variation in state ignition interlock laws and enforcement of those laws further illustrates the importance of taking a comprehensive approach to ensuring driving safety.

While mandatory minimum drinking age and interlock laws have shown progress in curbing drunk-driving incidence, the authors call for further steps, including new strategies to encourage alternative forms of transportation and changing “alcohol culture” and social behaviors to reduce binge drinking.

Wednesday, March 9, 2016

The Medical Minute: The Path From Prescription Pain Killers to Addiction

Newswise, March 9, 2016 — Abuse of prescription pain killers has become an epidemic in the United States, according to the Centers for Disease Control and Prevention (CDC). Even more concerning is that those going through withdrawal may turn to heroin as an inexpensive, easy-to-access substitute.
Dr. Vitaly Gordin, division chief of chronic pain management in the Department of Anesthesiology at Penn State Hershey Medical Center said it’s because heroin is an opiate analgesic, just like drugs such as oxycodone and tramadol, which are frequently prescribed for pain control.

The problem is not with patients who use the medicines to relieve short-term acute pain, like the kind after surgery. 

“The vast majority of them will very easily get off these medications as their condition improves and pain is decreasing,” he said.

Nor does it lie with those who have chronic conditions that require them to be on high doses of narcotic painkillers for long periods of time: “There are a lot of very legitimate patients who are receiving these medicines in a chronic setting who are not abusing them.”

The challenge comes when someone is taken off the medication after using a high dose for a length of time.

“Because of this declared epidemic, many primary care physicians, specialists and surgeons are taking these patients off the narcotics,” Gordin said. “But if they don’t have an exit strategy and get referred for alternate treatment, addictions counseling or rehabilitation, they can become desperate as they go through withdrawal.”

Without a renewing prescription for narcotics, the patients may turn to heroin.

Unlike with prescription painkillers, which are regulated by the Food and Drug Administration, it’s hard to verify exactly what is in the heroin you buy from a dealer.
“Several years ago there was a string of deaths of addicts who bought heroin laced with a potent painkiller called fentanyl,” Gordin said. “Because it’s all an underground, illegal business, you don’t know exactly what you’re getting.”

Many of the 20,000 deaths that occur each year from abuse of prescription pain killers happen when the narcotics are combined with another substance such as benzodiazepine or alcohol, which creates a dangerous – if not deadly – mix.

Gordin said patients with a history of drug abuse, untreated psychiatric conditions or pre-adolescent abuse of any kind are much more likely to develop addictions.

“In my 17 years working here, I have never seen as many inpatients on heroin as I have in the past six to 12 months,” he said. “Those who have abused heroin are getting into car accidents or involved in violent crimes because of being on the drug or trying to obtain it. I think it’s directly related.”

Gordin also said it is important that society begin to de-stigmatize addiction as a character flaw. “We need to understand it is a disease with psycho-social components and we need to have resources available to both prescribing physicians and patients who need drug rehabilitation.”

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.