“Inflamm-Aging:” Alcohol Makes It Even Worse

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.”

“The Anonymous People” Documentary: 25 Million Americans Will No Longer Be Quiet

Newswise, June 30, 2016 — Current public perceptions about alcohol- and other drug-use disorders are out of step with scientific knowledge. There remains a general belief that these disorders are essentially moral failings and/or bad choices.

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.”

Six in Ten Adults Prescribed Opioid Painkillers Have Leftover Pills

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.

National Organizations Band Together to Ensure that Congress Passes Comprehensive Policies to Combat the U.S. Opioid Epidemic

The Coalition to Stop Opioid Overdose Launches to Advance Legislation that Will Address this Public Health Crisis

WASHINGTON, May 25, 2016 -- More than 10 million Americans report misusing opioids. In response to this unprecedented and growing epidemic in the United States, the Coalition to Stop Opioid Overdose launched today, uniting diverse stakeholders around the common goal of achieving meaningful legislative solutions to address opioid misuse and overdose.

The Coalition is composed of leading state and national groups that are committed to advancing meaningful legislative and regulatory policies.

Congress, the Administration, public health agencies and a number of state legislatures have taken important initial steps to combat the opioid epidemic.

Last week the House passed 18 bills. In March, a wide-ranging bill was passed by the full Senate and the Senate Committee on Health, Education, Labor and Pensions (HELP) approved additional important legislation, which is pending before the full Senate.

Now is the critical time to build on this progress and ensure that comprehensive legislation aimed at addressing opioid misuse, overdose and addiction is passed and funded appropriately, according to R. Corey Waller, MD, DFASAM, Chair of the American Society of Addiction Medicine's Legislative Advocacy Committee.

"There remains an urgent need for simple and achievable prevention, treatment and recovery policies that can reduce opioid overdose," says Dr. Waller.

"Now is the time for us to come together as a unified group to ensure that Congress sends meaningful legislation to the President's desk this year."

The Coalition's efforts will focus around five key strategies to combat the opioid epidemic:

• Improving access to medication-assisted treatment for those with opioid addiction
• Expanding availability of naloxone in health care settings and beyond
• Implementing enhanced prescription drug monitoring programs that track the dispensing and prescribing of controlled substances
• Raising the level of opioid prescriber education
• Enacting the Comprehensive Addiction and Recovery Act
•  

Addiction is a chronic disease that too often goes untreated. More than half of Americans (56 percent) say that they or someone they know has misused, been addicted to, or died from prescription pain medications, according to a recent Kaiser Health Tracking Poll.

When patients can't access treatment and recovery support services, addiction can lead to disability or premature death.

According to the U.S. Centers for Disease Control and Prevention, the rate of death from opioid-related overdose has quadrupled since 2000.

Drug overdoses are the leading cause of accidental death in the United States, surpassing even traffic fatalities. And emergency room visits linked to misuse of prescription opioids are up by more than 50 percent since 2004.

"Emergency physicians see first-hand the devastating consequences of opioid misuse. We often pick up the pieces, from first-contact psychiatric care to acute resuscitation after overdose," says Jay Kaplan, MD, FACEP, President of the American College of Emergency Physicians.

"We need to do more to prevent these life-shattering, or even life-ending, events."

The epidemic is compounded by the vast gap in access to opioid addiction treatment. There are three FDA-approved medications approved to treat opioid use disorder.

Patients need access to all available options so they can find what works for them; however, current prescribing limits restrict access to one of these treatment options. Additionally, there is a lack of access to medication that can help prevent and reverse opioid overdose.

The Coalition held its inaugural meeting at the U.S. Capitol Visitor Center in Washington D.C. where speakers, including Dr. Kaplan, Justin Luke Riley, Advocate, Young People in Recovery and Yngvild Olsen, MD, MPH, Director at Large of the American Society of Addiction Medicine, discussed strategies for addressing the opioid epidemic.

The following organizations have joined the Coalition to date, including:

• American Academy of PAs
• American Association of Nurse Practitioners
• American College of Emergency Physicians
• American Congress of Obstetrics and Gynecology
• American Medical Student Association
• American Society of Addiction Medicine
• Association of Women's Health, Obstetric and Neonatal Nurses
• Facing Addiction
• National Association of Clinical Nurse Specialists
• National Association of Social Workers
• The Association of Recovery Schools
• The National Center on Addiction and Substance Abuse
• Young People in Recovery
•  

For more information about the Coalition to Stop Opioid Overdose, please visit http://www.stopopioidoverdose.org/ . 

About the Coalition to Stop Opioid Overdose
The Coalition to Stop Opioid Overdose is an organization of state and national groups that are committed to advancing meaningful legislative and regulatory policies in response to the opioid epidemic.

The Coalition seeks to address the U.S. opioid epidemic by engaging policy makers, public health leaders, chronic pain and addiction specialists, individuals in and seeking recovery and family members, so that legislation and policies get the support needed to pass Congress this year and become law.

Financial support for the Coalition is provided by the following: Adapt Pharma, The American Society of Addiction Medicine, CleanSlate Centers, Indivior, Merck and Proove.

Alcohol-Induced Blackouts: The Last Five Years of Research

Newswise, May 12, 2016— Alcohol-induced blackouts, defined as memory loss of all or a portion of events that occurred during a drinking episode, are reported by approximately 50 percent of drinkers, and are associated with a wide range of negative consequences, including injury and death.

Identifying the factors that contribute to and result from alcohol-induced blackouts is critical for developing effective prevention programs.

This manuscript is an updated review of clinical research that has focused on alcohol-induced blackouts. It outlines practical and clinical implications of these findings and provides recommendations for future research.

The authors conducted a comprehensive, systematic literature review of all articles published from January 2010 through August 2015 that examined vulnerabilities, consequences, and possible mechanisms for alcohol-induced blackouts.

The review yielded 26 studies on alcohol-induced blackouts: 15 studies examined prevalence and/or predictors of alcohol-induced blackouts, six publications described the consequences of alcohol-induced blackouts, and five studies explored potential cognitive and neurobiological mechanisms underlying alcohol-induced blackouts.

The research suggests that individual differences, not just alcohol consumption, increase the likelihood of experiencing an alcohol-induced blackout, and the consequences of the blackouts extend beyond those related to the drinking episode to include psychiatric symptoms and neurobiological abnormalities.

The authors suggest that prospective studies and a standardized assessment of alcohol-induced blackouts are needed to fully characterize factors associated with them and to improve prevention strategies.

Using “Heavy Drinking Days” to Measure Treatment Effectiveness

Newswise, May 12, 2016 — One of the challenges in evaluating the effectiveness of alcohol treatment is determining what constitutes a “good” outcome or meaningful improvement. While abstinence at the end of treatment is clearly a good outcome, a focus on abstinence ignores the benefits of patients reducing their drinking to less problematic levels so that they can function better and incur fewer social costs.

This study estimates the relationship between drinking practices at the end of a treatment program and subsequent health-care costs, with an emphasis on heavy and non-heavy drinking levels.

Researchers used data from the COMBINE trial, which randomized 1,383 adult participants with alcohol dependence to nine different combinations of medications and psychosocial interventions.

For this study, the authors examined heavy drinking days (HDDs) – defined as five or more drinks for men, four or more for women – and non-heavy drinking days (non-HDDs) during the last 30 days of COMBINE treatment for 748 patients (524 men, 224 women) enrolled in the COMBINE Economic Study. Total costs were treated as a function of drinking indicators.

Results indicate that having HDDs at the end of treatment is associated with higher costs.

For example, patients with HDDs had 66.3 percent higher health-care costs than those who were abstinent, and having more than two HDDs was associated with the highest costs (76.1%). Furthermore, patients who had only HDDs at the end of treatment had worse subsequent outcomes than those who had both non-HDDs and HDDs.

These findings offer a new context for evaluating treatment outcomes and provide new information on the association of drinking with adverse consequences.

Patients Abusing Drugs and Alcohol Are Self-Medicating Chronic Pain

 Newswise, May 12, 2016--With opioid addiction and prescription drug abuse considered one of the biggest public health threats of our time in the U.S., many are asking why so many Americans are struggling with addiction to illegal drugs and prescription medications. New research suggests that chronic pain may be part of the answer.

In a study that appears in the May issue of the Journal of General Internal Medicine, researchers at Boston University School of Medicine and Boston Medical Center have found that the majority of patients misusing drugs and alcohol have chronic pain and many are using these substances to "self-medicate" their pain.

According to the researchers, many illegal drugs such as marijuana and heroin have pain-relieving properties.

The researchers screened approximately 25,000 patients in primary care for illegal drug use and misuse of prescription medications.

Among these patients, 589 who screened positive for substance use were asked questions about chronic pain and their substance use. Substance use was defined as use of illegal drugs (heroin, marijuana, cocaine, etc.), use of prescription drugs in ways other than prescribed or high risk alcohol use.

They found that 87 percent of those who screened positive for illegal drug use, misuse of prescription drugs or heavy alcohol use suffered from chronic pain.

Half of these patients graded the pain as severe. In the subgroup that was using illegal drugs, 51 percent reported using one or more drug specifically to alleviate physical pain.

In those using prescription drugs without a prescription or using more than prescribed, 81 percent identified self-medication of pain as the reason for misuse. With regard to high risk alcohol use, the majority (79 percent) did so to manage pain.

"While the association between chronic pain and drug addiction has been observed in prior studies, this study goes one step further to quantify how many of these patients are using these substances specifically to treat chronic pain.

“It also measures the prevalence of chronic pain in patients who screen positive for illegal drug use and prescription drug abuse," explained corresponding author Daniel Alford, MD, MPH, associate professor of medicine and assistant dean of Continuing Medical Education and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program at BUSM. He is also the director of BMC's Clinical Addiction Research and Education Unit.

The results of this study suggest that counseling focused only on informing patients about the negative consequences of drug and alcohol use may miss a key aspect of why people are using these substances.

"Pain should be treated as part of the long-term strategy for recovery. If drugs are being used to self-medicate pain, patients may be reluctant to decrease, stop, or remain abstinent if their pain symptoms are not adequately managed with other treatments including non-medication-based treatments," added Alford.

###

This research was part of the ASPIRE study, which was funded by the National Institute on Drug Abuse (RO1 DA025068) and the Massachusetts Department of Public Health both of which received funding from the Center for Substance Abuse Treatment (TI018311). Other support included the National Center for Research Resources (UL1RR025771).