Thursday, June 30, 2016
Newswise. June 30, 2016 — The immune system in the elderly is dysfunctional and infections are more prevalent, more severe, and harder to defeat.
Drinking alcohol has a variety of damaging effects on the immune system and organs – like the gut, liver and lung – which can be worsened by pre-existing conditions as well as consumption of prescription and over-the-counter medications that aged individuals often take.
This presentation addresses how alcohol affects the elderly more dramatically, and also suppresses their ability to battle infections, like pneumonia, much more severely than it does younger individuals.
“Our laboratory has been studying inflammatory and immune responses in the aged for well over a decade,” said Brenda J. Curtis, Ph.D., a research assistant professor at the University of Colorado Denver.
“We know that even healthy elderly individuals have an elevated basal inflammatory state, known as ‘inflamm-aging.’ Advanced age alone is a risk factor for a poor prognosis after injury or infection. Adding alcohol to the fragile immune milieu of the aged reduces their ability to fight infections.”
“Our research suggests that alcohol intoxication perturbs the immune system of the aged both throughout the body and in local regions, like the lung,” added Elizabeth J. Kovacs, Ph.D., director of Burn Research and professor in the department of surgery at the University of Colorado Denver / Anschutz Medical Campus.
“We have shown that alcohol exposure makes macrophages less effective at clearing pathogens and releasing molecules important for recruiting other immune cells to the site of infection, and that this is worsened in the elderly.”
Innate immune cells control the immediate response to an infection, including neutrophils and macrophages, Curtis explained. These cells work together to find and eradicate infectious organisms.
However, drinking alcohol can impair innate immune function, thereby rendering the individual more susceptible to infections.
“This is due in part to direct effects of ethanol on innate immune cells,” said Curtis. “Even short-term exposure of macrophages to alcohol reduces their ability to migrate to a site of infection as well as their ability to destroy the pathogen.”
“In addition, the effects of alcohol on the elderly are more potent than they are in younger individuals in part because of the pro-inflammatory state of the aged,” noted Kovacs. “Aged individuals also have decreased lung function and cough strength, which further escalates the risk for developing pneumonia.”
This view is completely at odds with research demonstrating that these disorders are indeed a brain disease. A documentary called “The Anonymous People” features personal narratives that call for a fundamental reframing of the national conversation about alcohol and substance-use disorders and recovery.
“It is important for scientists to have a good sense of what alcohol-use disorders look like in the real world,” said George F. Koob, Ph.D., NIAAA director.
“It is an ‘equal opportunity’ disease that cuts across economic, occupational, racial/ethnic, and gender lines. It is a disease that is profoundly devastating at the personal and societal level. It is a disease that, to this day, is shrouded in stigma and shame.”
Koob was part of the panel that discusses this documentary after its screening at the 39th Annual Research Society on Alcoholism in New Orleans June 25-29, 2016.
“The recovery community is undergoing a transformation,” added Robert Huebner, Ph.D., director of the NIAAA Division of Treatment and Recovery Research.
“In the past, it focused on anonymity and consisted primarily of small groups meeting in church basements. Now we see a very assertive recovery community that is not shy about talking about recovery in public, is organized on a national level, and is politically active at the state, regional, and national level.”
He added that NIAAA, and the addiction-research field, grew out of multiple historical currents, including the rise of Alcoholics Anonymous, organizations like the National Council on Alcoholism and the Society of Americans for Recovery, and the leadership and courage of Senator Harold Hughes (D-Iowa).
“This documentary represents a very different way of talking about people with alcohol-use disorders and their recovery,” said Lorenzo Leggio, M.D., Ph.D., M.Sc., CPN Section Chief, NIAAA and NIDA. “The people in this documentary make a strong case for rejecting common stereotypes and terminology when describing individuals with alcohol- and other drug-use disorders.
They argue for bringing their stories of recovery out of the shadows and talking about recovery in positive rather than negative terms. Individuals describe themselves as being ‘in long-term recovery, without using alcohol or drugs since a certain date.’ This sounds very different from traditional characterizations of personal recovery which declare first and foremost that one is an alcoholic or addict.”
This focus on deliberately reframing one’s recovery echoes the call by Senator Hughes for people in recovery to start saying that they have “gotten well” rather than referring to themselves as a “recovering alcoholic,” added Leggio.
“Moreover, this documentary significantly seeks to characterize an alcohol-use disorder as a health problem, rather than a moral issue. Furthermore, this film challenges the field of alcohol research to address the issue of long-term recovery, given that the focus of much of our clinical research has been on acute care. We need more research on the complex set of factors that support long-term recovery and effective interventions to support it. Patients who achieve long-term abstinence can, especially in stressful situations, relapse after years of abstinence. This documentary reminds physicians and other health-care providers to follow their patients with alcohol-use disorders beyond acute care. In this regard, the long-term relationships between physicians, patients, and their families can play a key role in helping a patient's recovery efforts.”
Language is fundamentally important, agreed Koob and Huebner. “We need to get away from using terms like ‘alcoholic’ and ‘addict’ and frame this disorder as we would any other health problem,” said Koob.
“People who suffer from alcohol-use disorders or whose loved ones suffer from this disease need to feel comfortable about seeking help from their doctors.”
“Practitioners need to see people who suffer from alcohol-use disorders as patients for whom appropriate clinical care and treatment can and should be provided – no different from patients suffering from other health problems such as cancer or infectious diseases,” added Huebner.
“The community at large needs to see alcohol-use disorders as a serious medical problem that can be treated via shared efforts. Indeed, this documentary shows that recovery from alcohol- and other drug-use disorders is possible. The personal narratives demonstrate this very well and complement the findings of NIAAA-supported research on the prevention and treatment of alcohol-use disorders.”
Friday, June 17, 2016
Despite abuse epidemic, physicians prescribing more pills than patients are using; patients say they will save extra pills for future use
Newswise, June 17, 2016 — In the midst of an epidemic of prescription painkiller addiction and overdose deaths, a new Johns Hopkins Bloomberg School of Public Health survey suggests that more than half of patients prescribed opioids have leftover pills – and many save them to use later.
The researchers, reporting June 13 in JAMA Internal Medicine, also found that nearly half of those surveyed reported receiving no information on how to safely store their medications, either to keep them from young children who could accidentally ingest them or from adolescents or other adults looking to get high.
Nor were they given information on how to safely dispose of their medications. Fewer than seven percent of people with extra pills reported taking advantage of “take back” programs that enable patients to turn in unused pain medication either to pharmacies, police departments or the Drug Enforcement Administration for disposal.
“These painkillers are much riskier than has been understood and the volume of prescribing and use has contributed to an opioid epidemic in this country,” says study leader Alene Kennedy-Hendricks, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School.
“It’s not clear why so many of our survey respondents reported having leftover medication, but it could be that they were prescribed more medication than they needed.”
Says the study’s senior author Colleen L. Barry, PhD, MPP, a professor who directs Bloomberg’s Center for Mental Health and Addiction Policy Research: “The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern. It’s fine to give a friend a Tylenol if they’re having pain but it’s not fine to give your OxyContin to someone without a prescription.”
Over the past decade, there has been a sharp increase in the rates of prescription painkiller addiction and overdose deaths. Drug overdose – the majority of which involve opioid pain relievers – was the leading cause of injury death in 2014 among people between the ages of 25 and 64, and drug overdose has surpassed car crashes as the leading cause of injury death among this group.
In March, the U.S. Centers for Disease Control and Prevention urged doctors to avoid prescribing powerful opioid painkillers for patients with chronic pain, saying the risks from such drugs outweigh the benefits for most people.
Prolonged use of these medications can lead to addiction, putting people at much higher risk for overdose and raising the risk of heroin use since it is cheaper, worsening the heroin epidemic.
For the study, a collaboration between the Johns Hopkins Center for Mental Health and Addiction Policy Research and the Johns Hopkins Center for Injury Research and Policy, the researchers used GfK’s KnowledgePanel to construct a national sample of 1,032 U.S. adults who had used prescription painkillers in the previous year.
The survey was fielded in February and March 2015. Among those who were no longer using prescription pain relievers at the time of survey (592 respondents), 60.6 percent reported having leftover pills and 61.3 percent of those with leftover pills said they had kept them for future use rather than disposing of them.
Among all respondents, one in five reported they’d shared their medication with another person, with a large number saying they gave them to someone who needed them for pain.
Nearly 14 percent said they were likely to share their prescription painkillers with a family member in the future and nearly eight percent said they would share with a close friend.
Fewer than 10 percent said they kept their opioid pain medication in a locked location. Nearly half said they weren’t given information on safe storage or proper disposal of leftover medication.
More than 69 percent of those who got instructions said they had received information about turning over the remaining medication to a pharmacist or a “take back” program, but few actually did.
Fewer than 10 percent reported throwing leftover medication out in the trash after mixing it with something inedible like used coffee grounds, a safe method for disposing of medication.
Kennedy-Hendricks says that physicians should, when prescribing these medications, discuss the inappropriateness of sharing and how to safely store and dispose of them.
“We don’t make it easy for people to get rid of these medications,” she says. “We need to do a better job so that we can reduce the risks not only to patients but to their family members.”
Says Barry: “We’re at a watershed moment. Until recently, we have treated these medications like they’re not dangerous. But the public, the medical community and policymakers are now beginning to understand that these are dangerous medications and need to be treated as such. If we don’t change our approach, we are going to continue to see the epidemic grow.”
“Medication sharing, storage, and disposal practice among U.S. adults with recent opioid medication use” was written by Alene Kennedy-Hendricks, PhD; Andrea Gielen, ScD; Eileen McDonald, MS; Emma E. McGinty, PhD, MS; Wendy Shields, MPH; and Colleen L. Barry, PhD, MPP. This study was supported by an unrestricted research grant from AIG.