Real-world study shows disturbing images get smokers to think about risks

Newswise, December 23, 2015– A new study is the first to provide real-world evidence of the effectiveness of smoking warning labels that include graphic photos of the damage caused by regular tobacco use.

Researchers found that smokers who saw graphic warning labels on every pack of cigarettes they smoked for four weeks had more negative feelings about smoking compared to those who saw just text warnings, which led them to look more closely at the warnings and put more credence into them.

This was associated with them thinking their habit was more dangerous and being more likely to consider quitting.

They also remembered more of the health risks of their habit.

“The graphic images motivated smokers to think more deeply about their habit and the risks associated with smoking,” said Ellen Peters, co-author of the study and professor of psychology at The Ohio State University.

The study, which was a joint project between Ohio State and the Annenberg Public Policy Center of the University of Pennsylvania, appears in the journal PLOS ONE.

The research is the first to look at the impact of graphic warning labels on smokers outside of a laboratory and over a relatively long period of time.

“Our study provides real-world evidence of how viewing these graphic images over time has an impact on smokers beyond what occurs with simple text warnings,” said Abigail Evans, lead author of the study and a postdoctoral researcher in psychology at Ohio State.

Other co-authors were Daniel Romer of the University of Pennsylvania’s Annenberg Public Policy Center; Andrew Strasser of the University of Pennsylvania; Lydia Emery of Northwestern University; and Kaitlin Sheerin of the University of Missouri.

For the study, the researchers used graphic warning labels created by the U.S. Food and Drug Administration. One of the labels included an image of a man smoking through a hole in his throat, called a tracheostomy. A tracheostomy may be necessary as a result of some smoking-related cancers.

The use of graphic warning labels was mandated by law to appear on cigarette packs in the United States in 2009. The warnings proposed by FDA were later invalidated by a federal appeals court.

The court concluded the labels were unconstitutional in part because the images were “unabashed attempts to evoke emotion … and browbeat consumers into quitting.”

This study suggests that the court was not correct in its assessment of how these images work to discourage smoking, Peters said.

“Smokers weren’t browbeaten by the images. The images definitely did stir their emotions, but those emotions led them to think more carefully about the risks of smoking and how those risks affected them,” Peters said.

“What the court is missing is that without emotions, we can’t make decisions. We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more.”

The study involved 244 adults who smoked between 5 and 40 cigarettes each day.

Participants were provided with their preferred brand of cigarettes for four weeks, in modified packages. All packages had the same text messages, such as “Cigarettes cause fatal lung disease.”

 Some participants received packs with only these messages. Some received packs with the text warnings plus one of nine graphic, somewhat disturbing images showing the dangers of smoking. A third group received the simple text and the image, plus additional text detailing how every cigarette entails risk.

Participants returned to the lab each week to receive additional cigarettes and respond to surveys about their experiences with the new packaging.

Results showed that smokers who had the warning labels with the graphic labels were more likely than those who received only text warnings to report that the packaging made them feel worse about smoking.

They were also more likely to read or look closely at the information on the warning labels and they better remembered what was on the labels.

Smokers who had the graphic labels also saw the warnings as more credible.

“The feelings produced by the graphic images acted as a spotlight. Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks,” Peters said.

Smokers who viewed the graphic labels were also slightly more likely to say they intended to quit smoking.

“For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population,” Peters said.

“The effect was small, but it was not unimportant.”

The results show warning labels with graphic images really do work, Evans said.

“Policies requiring such labels have the potential to reduce the number of Americans who smoke,” she said.

The study was supported by grants from the National Cancer Institute and the FDA Center for Tobacco Products.

Binge Drinking with Chronic Alcohol Use More Destructive than Previously Thought

Newswise, December 18, 2015― Excessive alcohol consumption is a global public health issue. In the United States, binge drinking is the most common form ― so common, in fact, that the Centers for Disease Control and Prevention reports approximately one in six adults binge drinks about four times each month.

Now, a study by University of Missouri School of Medicine researchers shows that chronic alcohol use, when combined with repeated binge drinking, causes more damage to the liver than previously thought.

“Heavy binge drinking by those who habitually consume alcohol is the most common cause of liver damage in chronic alcoholic liver disease,” said Shivendra Shukla, Ph.D., the Margaret Proctor Mulligan Professor of medical pharmacology and physiology at the MU School of Medicine and lead author of the study. 

“We know that this behavior causes large fatty deposits in the liver that ultimately impair the organ’s ability to function properly. However, we wanted to understand the mechanism that causes this damage and the extent of the harm. Our research focused on different forms of alcohol abuse and the results of those behaviors.”

Shukla’s team studied mice to examine the extent of liver injury caused by chronic alcohol use, repeat binge episodes and a combination of both. During a four-week period, the team found that mice exposed to chronic alcohol use and repeated binge consumption exhibited the highest levels of liver damage.

“Either chronic alcohol use or acute repeat binge episodes caused moderate liver damage when compared to the control group not exposed to alcohol,” Shukla said.

“This outcome came as no surprise. However, in the mice exposed to both chronic use and repeat binge episodes, liver damage increased tremendously. Even more shocking was the extent of fatty deposits in the livers of those exposed to chronic plus binge alcohol. It was approximately 13 times higher than the control group.”

The highly amplified fat accumulation was in part caused by metabolic changes within the liver. These changes not only significantly increased fatty liver deposits, but increased stress on the organ while decreasing the liver’s ability to fight the stress.

Shukla also pointed out that chronic and excessive alcohol use should not be associated only with liver damage.

“Drinking alcohol excessively can create an inflammatory response to the liver and other organ systems in the body,” Shukla said.

“If those organs work at a lower level of function, then a whole host of physiological processes can be affected. It is important for us to understand the extent of damage caused by alcohol abuse, which also can lead to other health issues such as diabetes, cardiovascular disease and some forms of cancer.”

The study, “In Vivo Acute on Chronic Ethanol Effects in Liver: A Mouse Model Exhibiting Exacerbated Injury, Altered Metabolic and Epigenetic Responses,” recently was published in Biomolecules, a peer-reviewed journal on biogenic substances published by the Multidisciplinary Digital Publishing Institute.

NYU Study Finds Adults Aged 50-59 Now Largest Age Group in Opioid Treatment Programs

Notable shifts found in demographic background including gender and ethnicity among older adults

Newswise, December 1, 2015 — Recent years have seen a change in drug use patterns, especially for older adults, with an increase in their admission to substance abuse treatment and increased injection drug use among those over the age of 50. 

Yet, there has been little research regarding the epidemiology, health status, and functional impairments in the aging population of adults accessing opioid treatment.

Of the few studies on this population to date, most have been based off of a limited dataset that only accounts for treatment admissions, and therefore may not fully capture the utilization of substance abuse treatment over time. 

Furthermore the treatment episode dataset (TEDS), defines an older adult as aged over 50 or 55, and may not fully demonstrate how the population is aging.

Given the gaps in existing data, researchers affiliated with New York University's Center for Drug Use and HIV Research (CDUHR), and NYU’s School of Medicine (NYUSoM) sought to elucidate age trends for opioid treatment programs, with an emphasis on older adults, in a new study published in the Journal of Substance Use & Misuse. 

The investigation focuses on such trends in New York City, as it has one of the largest methadone treatment systems in the U.S. and consistently provides access to treatment in the public system.

The study, “Demographic Trends of Adults in New York City Opioid Treatment Programs- An Aging Population,” used data collected by New York State's Office of Alcoholism and Substance Abuse Services (OASAS). OASAS provides more detailed information on the treatment population than what is available nationally through the TEDS dataset, allowing the NYU researchers to characterize basic demographic, self-reported other substance use, and self-reported physical impairments.

“Most notably,” says Benjamin Han, MD, MPH, an instructor at NYUSoM and the study’s principle investigator, “we found a pronounced age trend in those utilizing opioid treatment programs from 1996 to 2012, with adults aged 50 and older becoming the majority treatment population.”

Specifically, individuals aged 50-59 which made up 7.8% (N= 2,892) of the total patient population in 1996, accounted for 35.9% (N= 12,301) of the population in 2012. Patients aged 60-69, also saw a dramatic increase in numbers, originally constituting 1.5% of patients (N= 558) to 12.0% of patients (N= 4,099).

“These increases are especially striking, considering there was about a 7.6% decrease in the total patient population over that period of time, and suggests that we are facing a never before seen epidemic of older adults with substance use disorders and increasing numbers of older adults in substance abuse treatment. 

Unfortunately there is a lack of knowledge about the burden of chronic diseases and geriatric conditions or the cognitive and physical function of this growing population” says Dr. Han.

During the same period, those age 40 and below, who in 1996 accounted for 56.2% of patients (N= 20,804), were a fraction of that in 2012, responsible for 20.5% of total patients (N= 7,035).

There were also notable shifts with regards to race and ethnicity. During this period older adults over the age of 60 were increasingly white, with a 10.3% increase in representation, while there was a 13.8% decrease in the percentage of black patients. 

There was a small increase in the Hispanic constituency from 35.0% in 1996 to 38.8% in 2012. These trends, however, were different for those aged 50-59. In this age group there were smaller decreases in both the white (3.5%) and black (5.9%) populations, and a larger increase in Hispanic patients (9.2%). 

However, when looking at all age groups during this period, the overall white population remained steady (-0.4%), with a slight decrease in black patients (3.5%) and a slight increase in Hispanic patients (3.4%).

Researchers believe the increase in older adults utilizing opioid treatment programs is likely to continue into the next decade. Further studies are required to better understand the specific and unique health needs of this growing population from a geriatric perspective. 

More research is also need to understand how other substance use can complicate care and how to address the changing ethnic and racial demographics of this population in New York City.

Researcher Affiliations: Benjamin H. Han, MD, MPH1*; Soteri Polydorou, MD2; Rosie Ferris, MPH1; Caroline Blaum, MD, MS1; Stephen Ross, MD2; Jennifer McNeely, MD, MS3.
1 NYU School of Medicine, Department of Medicine, Division of Geriatrics.
2 NYU School of Medicine, Division of Alcoholism and Substance Abuse
3 NYU School of Medicine, Department of Population Health and the Department of
Medicine.

Declaration of Interest: Gail Dorn, MS1 and Dawn Lambert-Wacey, MA1 provided the aggregated dataset used in this study, and assisted in the editing of the article.

1NYS Office of Alcoholism and Substance Abuse Services
Division of Outcome Management and System Information
1450 Western Ave, Albany, NY 12203-3526

About CDUHR
The mission of the Center for Drug Use and HIV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the New York University College of Nursing. For more information, visit www.cduhr.org

About NYU Langone Medical Center
NYU Langone Medical Center, a world-class, patient-centered, integrated academic medical center, is one of the nation’s premier centers for excellence in clinical care, biomedical research, and medical education. Located in the heart of Manhattan, NYU Langone is composed of four hospitals—Tisch Hospital, its flagship acute care facility; Rusk Rehabilitation; the Hospital for Joint Diseases, the Medical Center’s dedicated inpatient orthopaedic hospital; and Hassenfeld Children’s Hospital, a comprehensive pediatric hospital supporting a full array of children’s health services across the Medical Center—plus the NYU School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history. The Medical Center’s tri-fold mission to serve, teach, and discover is achieved 365 days a year through the seamless integration of a culture devoted to excellence in patient care, education, and research. For more information, go to www.NYULMC.org

About New York University College of Nursing
NYU College of Nursing is a global leader in nursing education, research, and practice. It offers a Bachelor of Science in Nursing, a Master of Science and Post-Master’s Certificate Programs, a Doctor of Philosophy in Research Theory and Development, and a Doctor of Nursing Practice degree. For more information, visit www.nursing.nyu.edu/ 

The Great American Smokeout: How to Diplomatically Help a Friend/Relative Stop Smoking

Newswise,November 18, 2015 — November 19, 2015 marks the date of the American Cancer Society’s Great American Smokeout, when cigarette smokers are asked to refrain from smoking for one day in hopes that the effort will lead to quitting forever.

Most people know a smoker they would like to see stop, but wonder if making that request is appropriate. Research from the University of Vermont (UVM) says “yes” – smokers who are exposed to cues to stop are twice as likely to try to quit.

What are these cues? According to John Hughes, M.D., a UVM professor of psychiatry who has been studying how smokers quit for the last 30 years, prompts can range from simply feeling embarrassed to direct requests from others – spouses, friends, children – to quit.

A recent study he conducted featured 134 smokers from across the U.S. who tracked their thoughts about quitting, cues to stop smoking, and actual smoking nightly for three months. The study appears in the journal Drug and Alcohol Dependence.

“Our study found that the large majority of quit attempts were spontaneous,” says Hughes, “so there must have been a ‘straw that broke the camel’s back’ and induced a quit attempt.”

The research suggests that cues to quit often lead to quit attempts. The more cues, the greater the chance of a quit attempt.

So how best can nonsmokers provide a cue that helps prompt quitting? Hughes has four recommendations, based on his research:

• Diplomacy is important. Refrain from using terms like “ought to,” “should” or “need to” and instead use statements that express concern, like “I am worried about your smoking,” or less threatening statements, such as “Have you thought about quitting?”
• Mention new treatments as an icebreaker. For example, say “I heard about this new app that you can use to stop smoking – have you seen it?” and be prepared to mention the local telephone help line (802Quits in Vermont) and provide contact information for free phone counseling and medication sources.
• Remember that more is not necessarily better. A single comment is probably as effective as a 30-minute discussion.
• Repetition is usually necessary. It’s o.k. to say “I know I asked about your stopping smoking several months ago – has anything come of that?” Most of the time, it will take several diplomatic comments from friends and/or loved ones to have an effect.

Public Health Leaders Urge Far-Reaching Reforms to Curb Prescription Opioid Epidemic

Comprehensive report calls for mandatory prescription monitoring programs, expanded naloxone access, tamper-resistant drug packaging, among other measures

Newswise, November 16, 2015 — A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, today issued recommendations aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S.

The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated.

The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation.

The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations.

The call to action comes at a time of heightened awareness about the prescription opioid epidemic. More than 16,000 people died in the U.S. from overdoses related to opioid pain relievers in 2013, four times the number who died in 1999, according to the U.S. Centers for Disease Control and Prevention (CDC). Prescription opioid sales have increased 300 per cent since 1999. The CDC estimates that two million Americans were dependent on opioid medications in 2013.

“What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids,” says Andrea Gielen, ScD, ScM director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report’s signatories.

“Not only are the recommendations comprehensive, they were developed with input from a wide range of stakeholders, and wherever possible draw from evidence-based research.”

Carefully used, opioids provide important pain relief for many patients with acute or post-surgical pain. Up until the late 1990s, prescription opioids were prescribed primarily to cancer patients.

They became more widely used as new products were developed and aggressively promoted for wider use. In addition, their addictive potential was substantially underestimated.

Another complicating factor is so-called diversion–use by friends and family rather than those actually prescribed the painkillers. According to the CDC, in 2012, health care providers wrote 259 million prescriptions for opioid pain relievers, enough to supply every adult in the U.S. a four-week, round-the-clock supply.

The report, titled “The Prescription Opioid Epidemic: An Evidence-Based Approach,” breaks its recommendations into seven categories:

• Prescribing Guidelines
• Prescription Drug Monitoring Programs (PDMPs)
• Pharmacy Benefit Managers (PBMs) and Pharmacies
• Engineering Strategies (i.e., packaging)
• Overdose Education and Naloxone Distribution Programs
• Addiction Treatment
• Community-Based Prevention Strategies

“This is a complex epidemic with no simple solutions,” says G. Caleb Alexander, MD, MS, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School and another of the report’s signatories.

“We tried to identify as many windows as possible, and to tie together as much research as available, to inform these recommendations which together we believe provide the best chance of turning this steamship around.”

The report calls for stricter oversight of clinical prescribing and more comprehensive training of medical students, who presently receive very little instruction on the subject.

The signatories also recommend expanding the role of pharmacies and Pharmacy Benefits Managers, both of which stand between the prescribers and the patients who receive the medication.

For example, increased use of electronic prescribing to identify high-risk patients and prescribers, along with expanded availability of drug take-back programs, would give pharmacies a greater role in reducing opioid misuse and abuse.

The authors also call for mandatory use of Prescription Drug Monitoring Programs (PDMPs), state databases that include controlled substance prescriptions from in-state pharmacies.

Every state but Missouri has a version of a PDMP, as do Washington, D.C., and Guam. At present, PDMPs are voluntary in many states and actual use varies – many prescribing providers are not aware of them – and their design varies from state to state. In addition to making PDMPs mandatory, the report recommends making them more accessible to law enforcement when warranted.

The report calls for expanding the availability of naloxone, which can reverse the effects of an overdose if administered promptly.

Among the recommendations to address addiction, working group members call for providing funding for treatment programs to communities with high rates of addiction and educating prescribers and pharmacists on ways to prevent addiction.

Among the report’s other recommendations: develop more secure and tamper-resistant packaging through design contests and other approaches and, as noted above, expand “take back” programs that allow patients to return unused medication to pharmacies to reduce chances that the pills might be taken by potential abusers.

The report will be among topics discussed at a forum hosted by the Bloomberg School of Public Health and the Clinton Health Matters Initiative on Nov. 17, 2015 at the Bloomberg School.

Participants include Michael Botticelli, MEd, Director of the White House Office of National Drug Control Policy; Christopher Jones, PharmD, MPH, director of Science Policy, U.S. Department of Health and Human Services; and Bloomberg School faculty Joshua Sharfstein, MD, and Shannon Frattaroli, PhD, MPH. (Sharfstein and Frattaroli are signatories to the report.)

Kicking an Addiction? Replace It with Joy, UCLA Expert Advises in New Book

Bringing pleasure into recovery is the key to turning over a new leaf

Newswise, November 16, 2015 — People in the midst of alcohol or drug addiction tend to imagine life without those substances as one of deprivation, which can make kicking the habit seem like a joyless and dreary prospect.

But recovery from addiction has at least as much to do with rewarding oneself as it does with depriving oneself, according to a new book by a UCLA expert in addiction treatment.

“People with the most success in staying sober tend to get involved in a range of pleasurable activities and do them frequently,” said Suzette Glasner-Edwards, author of “The Addiction Recovery Skills Workbook,” which is to be published Dec. 1 by New Harbinger Publications.

“These activities can replace the time and energy that they had been spending on addictive behaviors, enabling them to experience pleasure without the devastating consequences of alcohol or drug use.”

Glasner-Edwards is an adjunct associate professor at UCLA’s Semel Institute for Neuroscience and Human Behavior and a licensed clinical psychologist. Her research focuses on advancing treatments for addictions and mental health problems at the UCLA Integrated Substance Abuse Programs.

Subtitled “Changing Addictive Behaviors using CBT, Mindfulness and Motivational Interviewing Techniques,” the workbook details the science of a wide range of treatment options for addicts and their loved ones, and it is filled with worksheets, lists and questionnaires that allow readers to try them out.

Among the newest approaches it describes is behavioral activation therapy, which advocates rediscovering life’s healthy rewards. Glasner-Edwards said the strategy is effective because it combats the allure of drugs and alcohol at their source.

Both drugs and alcohol release dopamine, a chemical that the brain associates with the pleasure of receiving rewards, but both cause the brain to release dopamine at a far greater rate than life’s normal pleasures. As a result, the book explains, activities that once brought pleasure pale by comparison.

“While the feeling of disappointment at routine pleasure does get better over time, it is one of the things that prevents people from really getting a head start in recovery,” Glasner-Edwards writes.

“They keep relapsing in that early phase when nothing feels enjoyable. Their brain is still really healing from all that depletion and depression that the depletion can lead to.”

To combat these disappointments and blues, Glasner-Edwards encourages people in sobriety to resume activities that they once enjoyed or discover new ones: Cook something new. Plan a party. Exercise. Go to a museum. Take up a sport. And, to increase the likelihood that readers will carry out the activities, the book advocates scheduling them for specific times.

“Ideally you should have one pleasant activity worked into each day,” Glasner-Edwards writes. What if embarking on the activity feels more like a chore than a diversion?

“The workbook urges readers to rate how good — or miserable — they expect the experience will be on a 10-point scale, and then, after the activity, to rate how fun (or not) it actually proved to be.

“More often than not, an activity is more fun than you thought it was going to be,” she said, adding that seeing the pattern play out repeatedly can break down people’s resistance to enjoying future fun pursuits.

Readers are also urged to reward themselves again after the activity: Get a massage or eat a piece of chocolate cake, for example. The intent is to make them more inclined to pursue the activity again.

“Just like the rewarding feelings that follow the use of drugs or alcohol in the early stages lead to forming a damaging habit, rewarding healthy behaviors can establish positive habits,” Glasner-Edwards said.

In choosing which activities to pursue, the book notes, one important consideration is whether the activity is likely to trigger a relapse. Glasner-Edwards counsels against activities that a recovering addict would associate with their substance abuse.

Someone trying to stop using marijuana, for instance, might avoid attending concerts by musicians they used to listen to while high.

Another consideration is people the recovering addict spends time with during their new activities. One person who Glasner-Edwards treated for alcoholism began grilling dinners for his friends.

Although he relished his guests’ compliments about his cooking, there was one problem: They often arrived with bottles of wine or six-packs of beer.

“I finally had to say, ‘OK, you have this love of grilling, but you have to be careful who you grill with,’” she said. “Because if they bring booze, all of a sudden you’re feeling like, ‘Why not just one?’”

Although behavioral activation therapy has not yet been extensively studied as a treatment for substance abuse, the new approach builds on some of the oldest and most often validated findings in addiction therapy, Glasner Edwards said.

Since the 1970s, repeated studies have shown that individuals with all kinds of addictions are more likely to stay sober if researchers routinely test them for substance abuse and then reward clean results, especially when the value of the rewards climb with each negative test.

“It could even be a gift card — a whole range of prizes will do,” Glasner-Edwards said. “It doesn’t even matter what the income level of the addict is, so long as the value of the rewards escalates with consecutive good outcomes. There’s something about the process of being rewarded that’s very motivating.”

Prescription Painkillers Source of Addiction for Most Women

Women need different treatment from men with addiction

Newswise, November 10, 2015 --Painkillers prescribed by doctors are the starting point for an opioid addiction for more than half of female methadone clinic patients, and they need different treatment from men with addiction, says a study led by McMaster University researchers.

The results, published in the open access journal Biology of Sex Differences today, show that more than half (52%) of women and a third (38%) of men reported doctor-prescribed painkillers as their first contact with opioid drugs, a family of drugs which include prescription medicines such OxyContin and codeine, as well as illicit drugs such as heroin.

The study of 503 patients attending Ontario methadone clinics identified significant gender differences between the men and women attending the clinics. Compared to men, women were found to have more physical and psychological health problems, more childcare responsibilities, and were more likely to have a family history of psychiatric illness.

Men were more likely than women to be working and more likely to smoke cigarettes. Rates of cannabis use were relatively high (47%) among both men and women.

“Most methadone treatment is based on studies with few or no women at all. We found men and women who are addicted to opioids have very different demographics and health needs, and we need to better reflect this in the treatment options that are available,” said Monica Bawor, first author of the paper and a recent PhD neuroscience graduate of McMaster.

“A rising number of women are seeking treatment for opioid addiction in Canada and other countries yet, in many cases, treatment is still geared towards a patient profile that is decades out of date – predominantly young men injecting heroin, and with few family or employment responsibilities.”

The study highlights the changing profile of people addicted to opioids. Compared to results from studies in the 1990s, the average age of patients being treated for opioid addiction is older (38 compared to 25 years), with opioid use starting at a later age (25 rather than 21 years).

Injecting drug use has reduced by 60%, and there has been a 50% reduction in rates of HIV in opioid users as a result.

At the same time, there has been a 30% increase in the number of patients becoming addicted to opioids through doctor-prescribed painkillers, usually for chronic pain management.

In Canada, the number of opioid painkiller prescriptions has doubled in the last two decades, and according to the World Health Organization (WHO), Canada consumes more opioid painkillers than any other country.

Senior author Dr. Zena Samaan added that the reasons are not clear why women are disproportionately affected by opioid dependence originating from prescription painkillers.

“It may be that they are prescribed painkillers more often because of a lower pain threshold or because they are more likely to seek medical care than men,” said Samaan, an associate professor of psychiatry and behavioural neurosciences at the Michael G. DeGroote School of Medicine.

“For whatever reason, this is a growing problem in Canada and in other countries, such as the U.S., and addiction treatment programs need to adapt to the changing profile of opioid addiction.”

Major funding for the study was from the Canadian Institutes for Health Research.

“Even more important, is its potential for greatly reducing the incidence of cardiovascular disease.”