Prescription Opioids: Free Employee Education Video

blog-photo-lg04Has the line between legal “therapeutic prescription drugs” and illegal “street drugs” become so faint that either will do?

You could make a strong argument that the historic distinction now has minimal importance among American “consumers” looking for a high at the best price and from the closest source.

News accounts of actor Phillip Seymour Hoffman’s death from heroin overdose focused attention briefly on the rapid increase in heroin-related deaths in the last several years. The over-prescription of pain medicines like OxyContin, which began selling in the mid-‘90s, has led to increasing numbers of American prescription drug addicts who have switched to heroin either because prescription opioids became increasingly difficult to obtain from a doctor or simply because heroin often is less expensive and easier to access.

A study published by the New England Journal of Medicine found that heroin use more than doubled in the past decade, and research from the National Drug Intelligence Center shows heroin use up 79 percent from 2007-to-2012. Drug overdoses are now the leading cause of accidental death in the United States.

A huge increase in deaths from drug overdoses “has been driven,” according to the CDC http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6101a3.htm “by increased use of a class of prescription drugs called opioid analgesics” − drugs such as hydrocodone (Vicodin, Norco), hydromorhone (Dilaudid, Exalgo), oxycodone (Oxycontin, Percocet), and morphine (Astramorph, Avinza).

People who suffer from pain go to their doctor for help. Doctors, attempting to alleviate the pain, which may be mild or more severe, then prescribe opioid painkillers. Either people take all of the medicine, perhaps even getting refills (or getting multiple prescriptions) until they are addicted, or they do not finish the medicine and it lingers in medicine cabinets across the country where it can be found by family members, friends, and anyone else with access in the home.

In fact, a hundred Americans die of overdoses every day.

As experts try to explain the epidemic and look for methods of reducing the problem and helping the addicted, most of America seems unaware of the scope of the problem (http://www.washingtonpost.com/blogs/wonkblog/wp/2014/02/07/100-americans-die-of-drug-overdoses-each-day-how-do-we-stop-that/). In fact, more Americans die of overdoses every day (100) than are killed in car crashes (in the 90s and declining). More Americans die every year from prescription opiate overdoses (16,000 in 2010) than are killed in gun homicides (10,000 annually). If we lost 100 Americans a day to subway crashes or factory accidents there would be outrage and a search for a solution to the problem. But there is no such outrage.

Who is addicted? The addicts are not always the ones you would expect. Large numbers of women struggle with prescription drug addiction and many insured middle-class people get hooked after going to the doctor for muscle and/or back pain. Four-in-five of today’s heroin users began with prescription opioids according to a study at Drexel University’s School of Public Health.

Moreover, poly-substance abuse (with prescription drugs, illegal drugs, and alcohol all in the mix) has become common, making addictions more serious and treatment efforts more complicated.

It is a huge problem for business.

The number of employees testing positive for prescription opiates is increasing dramatically. Research by Quest Diagnostics, a provider of workplace drug tests, shows that the positive rate for prescription opiates among employees increased 40 percent from 2005-to-2009 and has continued to rise each year. Workers tested after accidents were four times more likely to have opiates in their system than those who were tested on a preemployment basis.

Working Partners/Cardinal Health offers a free video on employee prescription-drug abuse.

Institute member Working Partners of Columbus, Ohio has developed (with funding from the Cardinal Health Foundation and the Ohio State College of Pharmacy) the new video A Dose of Reality targeted at employees with the goal of enlisting American workers in recognizing and combatting the prescription-drug problem.

View the video at: http://www.generationrxworkplace.com/index.html and share it with your employees.

We are seeing some progress in the form of improved labeling of prescription opioids and awareness campaigns that target employees directly. The Working Partners video can be a very useful tool in this regard and an important component of your company’s employee education and awareness program. We have to drive home to employees the message that prescription-drug use can − and does − easily spiral out of control and can be a killer.

Mark A. de Bernardo

10 Facts About Marijuana

blog-photo-lg04Marijuana is having increasingly widespread and detrimental effects on American society. Those Americans who support enforcing existing laws on marijuana (a Schedule I drug under the federal Controlled Substances Act) are being attacked in the media and by those who favor liberalized marijuana laws and consider themselves to be open-minded on the issue.

To really have an open mind on marijuana is to evaluate all of the evidence, to understand the costs to society and to individuals of marijuana use, and to weigh those against the benefits of decriminalizing or legalizing marijuana.

Fact #1: Legalizing marijuana is bad for the workplace.

The impact of employee marijuana use is seen in the workplace in lower productivity, increased workplace accidents and injuries, increased absenteeism, and lower morale. This can and does seriously impact the bottom line.

According to the U.S. Department of Justice, 50 percent of all on-the-job accidents and up to 40 percent of employee theft is due to drug abuse. Drug-abusing employees are absent from work ten times more frequently than their non-using peers, and the turnover rate is 30 percent higher than for those employees who do not engage in illicit drug abuse. Workers who reported drug use are significantly more likely to have worked for three or more employers in the past year, and to have higher rates of unexcused absences and voluntary turnover in the past year.

Small businesses face the largest problem. They are disproportionately hurt by employee marijuana use because they are much more likely to rely on younger workers (who have higher usage rates), and are less likely to utilize and/or be able to afford the preemployment drug testing which would detect drug use.

Fact #2: Marijuana use is rising.

Marijuana is the most common illegal drug used in the U.S. In 2012, 18.9 million Americans were past-month users, according to the U.S. Government’s National Survey on Drug Use and Health (NSDUH). In fact, the rate of use is increasing rapidly and went from 5.8 percent to 7.3 percent of the population between 2007 to 2012, an additional 4.4 million more current marijuana users in our country.

More Americans add to these numbers daily. There were 2.4 million people over age 12 who used marijuana for the first time in 2012.

This means there were 6,600 first-time marijuana users each day in America in 2012, and that number is trending significantly upward.

Fact #3: Marijuana is much more potent – and addictive – today.

The levels of THC in marijuana (Tetrahydrocannabinol is the psychoactive ingredient in marijuana) have never been higher, and samples seized by law enforcement have reached a new average high of 10.1 percent, compared to less than 3 percent in the 1980s. High potency strains, such as sinsemilla, reportedly are now four times as strong containing a 16-22 percent THC content.

Fact #4: Marijuana use has long-term negative effects.

In study after study, adolescents who use marijuana have been found to have problems with attention, learning, and processing information. A teenage marijuana user is twice as likely to become a high school dropout as a non-user. In a recent study of college students, regular marijuana smokers were found to have impairment of critical skills connected to concentration and recall. Compared with infrequent users, regular marijuana users had difficulty in sustaining their concentration, and/or organizing and using information.

In 2012, an estimated 5.4 million past-year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This represents a 74-percent increase in “daily” marijuana users (300 days or more in the last year) in the six years from 2006 when “only” 3.1 million Americans were daily marijuana users. Frequent marijuana smokers like these face escalating problems in school and at work, and extreme difficulty in reaching their potential.

Fact #5: Marijuana is bad for your health.

Years of research indicate substantial concern for marijuana’s impact on health:

Lungs: Repeatedly smoking marijuana increases the risk of respiratory ailments ranging from chronic lung infections to bronchitis and cancers of the respiratory tract.

Liver: International studies show that people who have current liver complications and use marijuana every day are more likely to develop severe liver fibrosis.

Heart: The heart rate increases up to 100 percent for up to three hours after smoking marijuana. Cardiac problems in marijuana smokers are linked to the rise in blood pressure and reduction in blood oxygen carried to the heart which occurs after smoking. Harvard researchers reported that the risk of heart attack in the hour after smoking marijuana is five times higher than normal.

Reproductive Systems: Regularly ingesting marijuana has been shown to impact reproductive health in both men and women. In men, United Press International reports that erectile dysfunction and sperm motility have been linked to marijuana use. In women, international studies have shown children of marijuana smokers are born with low birth weights and small head size, both of which are associated with learning issues after age four.

Fact #6: Marijuana is not medicine.

There are strict standards for what constitutes a medicine in this country. It must be deliverable in exact dosages and must be made up of measurable amounts of compounds so that doctors can predict and control its impact. Marijuana potency and purity varies from plant to plant, often contains harmful contaminants, and when it is smoked or ingested in foods and beverages as is permitted in “medical-marijuana” states, the dosage can vary greatly. Marijuana does not fit the basic definition of a medicine and since it is self-delivered, the dosages frequently are random and inconsistent, as are the effects on the human body.

It is well-documented that marijuana impacts people in different ways and at different rates. While one user may feel mild effects from smoking marijuana, others who smoke the same dosages report disorientation, loss of motor control and coordination, and severe symptoms lasting for varying amounts of time.

Fact #7: The record on marijuana legalization in other countries provides a sound basis to reject legalization in the U.S.

Colombia legalized the personal use and possession of marijuana, cocaine, and heroin in 1994. Since the law’s implementation, research in a ten-year study indicated drug use increased by 40 percent. Nine percent of city-dwelling Colombians aged 12-25 were regularly using drugs by 2004, just ten years later. Drug treatment costs skyrocketed and the Colombian government is considering recriminalizing drugs to combat the problem of drug dealing.

Marijuana has been legal in the Netherlands for a long time and the statistics unfortunately reflect it. Drug use among persons aged 18-25 progressively increased more than 200 percent between 1986 and 1996. The number of cannabis addicts receiving treatment jumped 25 percent in 1997 alone.

We hear about the Netherland’s acceptance of drug use, but we are less familiar with the ways the Netherlands has slowly become more restrictive and retreated from its liberal drug policies. Over time, the number of marijuana “coffee houses” has been reduced by 37 percent, and approximately 70 percent of Dutch towns have zero-tolerance policies in effect. Clearly many – if not most – Dutch people oppose marijuana use and legalization.

An interesting experiment was conducted in Zurich, Switzerland’s Platzspitz Park in the late 1980s when they dispensed heretofore illegal drugs for free. The program began with the expectation that “legal” drugs would generate less crime, decrease AIDS, and help ensure that addicts received treatment. After five years, the experiment was abandoned because crime and AIDS cases increased dramatically, drug-related deaths doubled, and the healthcare system was overloaded and could not handle all of the new cases.

The international track record on drug legalization does not support legalization in the U.S. Their experiences show us that legalizing drugs does not have the effects advocates claim. We should be learning from these international failures, not repeating them.

Fact #8: Marijuana is a gateway drug.

Adults who begin using marijuana early are five times more likely to become dependent on a drug, eight times more likely to become cocaine users, and 15 times more likely to use heroin in their lifetimes. According to NSDUH data, in 2012 marijuana was the most commonly used illicit drug and it was used by 79 percent of current American drug users. Marijuana is most definitely a gateway drug.

Fact #9: Motor Vehicle crashes are rising as a result of marijuana use.

There has been a 49-percent increase in the rate of positives for marijuana among drivers stopped by State Troopers for suspicion of Driving Under the Influence in the first six months of 2013 in the State of Washington. In the brain, cannabinoid receptors are found in large concentration in areas that influence memory, thought, concentration, sensory and time perception, and coordination. Depth perception, coordination, and concentration are all required to safely drive a car or operate machinery.

A 2011 study entitled Marijuana Use and Motor Vehicle Use found that “crash risk appears to increase progressively with dose and frequency of marijuana use.” Key study findings included that “drivers who test positive for marijuana or self-report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes.”

Another study of more than 64,000 insured drivers from 1979-1985 found that 31 percent of drivers involved in motor vehicle crashes reported smoking marijuana prior to the accident.

Fact #10: Most Americans do not want marijuana use to become commonplace.

Polls can be misleading. It’s not that half of all Americans support legalizing marijuana, it’s that majorities of some groups do, primarily in certain regions of the country. In a 2013 Pew Research study, the clear majority of Americans said they would feel uncomfortable if someone around them smoked marijuana. Younger Americans support legalizing marijuana far more (64 percent) than older Americans do, skewing the overall numbers. Most women oppose legalizing marijuana, while men are slightly more likely to support it. Regionally, support is strongest in the West, while most other areas of the country do not support it.

The next time you read that Americans support legalizing marijuana, consider the source of the message. Ask yourself who really benefits and who will be paying the costs in terms of lost productivity, increased healthcare costs, compromised education, and decreased safety.

We have been successful in getting out the message about cigarettes and alcohol use being harmful, and their use is declining. Ironically, the message on marijuana seems to be the opposite – the patently erroneous assertions that marijuana is not harmful and is a legitimate medicine are taking hold in the public consciousness. We need to push back against those who want to legalize marijuana and put the preferences of marijuana smokers above the overall interests of American society.

Marijuana is an increasingly dangerous and addictive drug, and its health risks for the individual and detrimental impacts for American society are very frequently misstated, misunderstood, and/or underestimated.

A credibly open-minded person needs to be an informed person. Informed Americans oppose marijuana use and oppose marijuana legalization.
Mark A de Bernardo

5.4 Million Americans Are Daily Marijuana Users

The number of Americans using marijuana daily is on the rise – and sharply so.

According to the most recent Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (“Survey”), 5.4 million people aged 12 or older used marijuana on a daily or almost daily basis in the previous 12 months.

This number reflects a 74-percent increase from the 3.1 million daily or almost daily marijuana users in 2006, and includes only those users who reported marijuana use on 300 or more days in the previous year. This frequency of use translates to using, and presumably being “high,” four out of every five days for an entire year.

The Survey further found a 50-percent increase, between 2007 and 2012, in the number of individuals who used marijuana on 20 or more days in the past month – meaning 7.6 million Americans used, and were “high,” two out of every three days in the previous month at the time of the study.

The results may not be surprising, however, considering the perception of harm from smoking marijuana once a month has fallen almost 30 percent since 2007.

Ultimately, the Survey found that marijuana boasted the highest number of first-time users, with nearly 6,600 new users per day in 2012, and that an increase in marijuana use continues to drive the overall rising rate of current illicit drug use among young adults.

With more-and-more Americans finding less-and-less “harm” in using marijuana on a regular basis, one can only imagine – and lament – the effect that legalization of “recreational” marijuana, and the broadening availability of “medical” marijuana, will have on these statistics in the years to come.
Mark A. de Bernardo

Alcohol Testing at .04

Recently we were asked by a U.S. company revising it’s policy whether there is any precedent for setting workplace blood-alcohol levels at 0.04 for purposes of determining impairment in the U.S. or internationally.

The answer? Sure there is. Setting the level at 0.04 is the most common action level for law-enforcement purposes of determining intoxication but impairment can and does occur in most people below that level. In fact, 0.01 is permissible for terminations if the company’s policy says no alcohol use during work time and/or company premises. A little draconian, perhaps, but permissible. The basis of employee termination is then violation of company policy – not a perceived alcohol problem.

The Federal Motor Carrier Safety Administration regulation “prohibits you from allowing a driver with an alcohol concentration of 0.04 or greater to perform any safety-sensitive functions until he/she has been evaluated by and SAP (Substance Abuse Professional) and has passed a return-to-duty test. A driver with an alcohol concentration of 0.02 or greater, but less than 0.04 must be removed from duty for 24 hours.”

More information from the Federal Motor Carrier Safety Administration is available at http://www.fmcsa.dot.gov/safety-security/safety-initiatives/drugs/chap07.htm.

Happy Anniversary, Drug-Free Workplace Act

blog-lg-photo01The Drug-Free Workplace Act of 1988, signed into law by President Ronald Reagan, had its 25th anniversary of enactment on November 18, 2013.

The law was enacted by Congress in the context of two highly publicized events at the time – (1) the January 4, 1987 headlong fatal crash of a Conrail train (operated by a drug-abusing conductor who tested positive for four of the five drugs he was tested for and was “toking up” at the moment of impact) into an Amtrak passenger train in Chase, Maryland; and (2) the June 19, 1986 accidental overdose death of University of Maryland basketball star Len Bias the day after he signed a huge contract with the Boston Celtics as the #2 player taken in the NBA draft.

The DFWA was watered down, and had only minimal requirements for most federal government contractors and grantees, but it did create a useful and important focus on drug abuse as a workplace issue, a focus which helped later usher in the law requiring U.S. Department of Transportation regulations which, among other things, require random drug and alcohol testing for more than 10 million employees in private-sector, transportation-related, safety-sensitive jobs.

Hydrocodone is the #1 Prescribed Drug in the U.S.

Abuse of prescription drugs, especially painkillers, continues to increase and be an alarming trend in American society – and American workplaces.

The Quest Diagnostics Drug-Testing Index reports that Hydrocodone, the #1 prescribed drug in the U.S. over the last seven years (and increasing in each of those years) increased 172 percent from 2002-to-2012.

During the same ten-year period Hydromorphone increased 423 percent, and Morphine increased 34 percent. More and more Americans are addicted to painkillers, and prescription drug abuse is an underestimated societal and workplace problem.

Marijuana-Related Fatal Vehicle Accidents Increase 112 Percent in Six Years in Colorado

In 2012, the Colorado Department of Transportation (“Colorado DOT”) reported that 12.2 percent of those drivers who were tested for illicit drug use after fatal traffic accidents, tested positive for “marijuana only.”

Overall, even without testing, at least 7.4 percent of all traffic fatalities are known to involve drivers who had detectible levels of THC in their blood following the accident.

The Colorado DOT’s Drugged Driving Statistics for 2006-2011 showed a 16-percent decrease in the overall number of traffic fatalities in the state. Conversely, the same six-year period showed a 112-percent increase in the number of fatalities that involved drivers testing positive for “marijuana only.”

Of course, many more drivers tested positive for poly-drug abuse, including marijuana and other illicit drug use.

The study also showed that in 2006, 28 percent of drug-related crash fatalities involved drivers testing positive for marijuana. That number increased to 56 percent in 2011, and remained high at 45.5 percent in 2012.

Notably, a 2011 meta-analysis looked at nine studies conducted over the past two decades on marijuana and car-crash risk, and concluded that drivers who test positive for marijuana or self-report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes.

Similarly, a 2010 study showed that 28 percent of fatally injured drivers and more than 11 percent of the general driver population tested positive for non-alcoholic drugs, with marijuana being the most commonly detected substance.

The available statistics obviously reflect the impact of marijuana use on the number of over-the-road fatalities prior to the legalization of “recreational” marijuana in Colorado.

Unfortunately, it can only follow that the recent legalization of “recreational” marijuana, and the opening of dispensaries on January 1, 2014, will only increase marijuana use and increase the number of drivers who can and will drive under the influence of marijuana.

Sources:
http://www.coloradodot.info/programs/alcohol-and-impaired-driving/druggeddriving/assets/DrugFatal_DataasofJanuary2012.pdf
http://www.coloradodot.info/programs/alcohol-and-impaired-driving/druggeddriving/assets/fatal-data-drug.pdf

Crippa, J.A.S., et al., “Pharmacological interventions in the treatment of the acute effects of cannabis: a systematic review of literature,” Harm Reduction Journal, 9:7 (2012).

Mu-Chen Li, Joanne E. Brady, Charles J. DiMaggio, Arielle R. Lusardi, Keane Y. Tzong, and Guohua Li, “Marijuana Use and Motor Vehicle Crashes.” Epidemiologic Reviews (2010), at 3, 6.

More Pot Equals More DUIs in Washington

blog-photo-lg031The liberalization of marijuana laws is producing more impaired drivers according to the Washington State Patrol.

There has been a 49-percent increase in the rate of positives for marijuana among drivers stopped by State Troopers for suspicion of Driving Under the Influence in the first six months of 2013 in the state of Washington — the first year after “recreational” marijuana use was legalized in Washington. This 49-percent increase is vis-à-vis positive test rates for Tetrahydrocannabinol (“THC”) — the psychoactive ingredient in marijuana — for drivers stopped in 2012 and 2011 (years in which there was no increase in positive rates for THC among stopped drivers).

This increase is despite the fact that commercial marijuana dispensaries will not even open in Washington until next year.

The bottom line is that significantly more drivers pulled over by police in Washington state are above the state’s THC legal limit (five nanograms of THC per milliliter of blood) since “recreational” marijuana was legalized in a state ballot initiative.

Is this what Washington voters had in mind? More impaired drivers on our highways and in our neighborhoods? Nearly 50 percent more? And this is the beginning.

Substance abuse is the #1 killer on our highways according to the U.S. Department of Transportation (a clear majority of fatal over-the-road vehicular accidents involved substance-abuse-impaired motorists). And now — in Washington — we have more substance-abuse-impaired motorists.
Mark A. de Bernardo

Wax: The 24-Hour High from a Potent Marijuana Product

blog-lg-photo11Wax. Honey. Dabs. The many names of marijuana extracts and concentrates do not sound so harmful, but U.S. Drug Enforcement Administration (“DEA”) agents in California are not convinced.

Despite “wax” increasingly, alarmingly, and legally being embraced by users in Colorado, according to ABC News, the DEA in California is cracking down on the popular new marijuana drug for a number of reasons, including its unparalleled THC potency and the dangerous methods used to produce it.

Wax is the new “ultimate distillation of marijuana” and so potent that one “hit” can keep users high for more than 24 hours. Wax and other distillations of marijuana are reported to contain 70-to-90-percent THC, and one undercover DEA agent told ABC News’ “Nightline” that one hit of wax is “like smoking 20 joints of the best grade of weed” you can get.

The drug is made by stripping THC out of marijuana using butane, the highly flammable chemical known to cause explosions. Production techniques, therefore, are similar to those used to make such “hard” drugs as methamphetamine, cocaine, and crack.

Aside from the dangers of production, the Assistant Special-Agent-in-Charge at the DEA’s San Diego office, Gary Hill, explained that there are fears that the high levels of THC in wax can cause psychosis and brain damage in users.

Nonetheless, in Colorado, where “recreational” marijuana is legal, persons over 21 can simply walk into a marijuana dispensary and buy it off the shelf. Many are.

Sources: http://abcnews.go.com/US/colo-marijuana-businesses-embrace-drug-center-dea-crackdown/story?id=22686105

http://www.hightimes.com/read/dab-or-not-dab

Prescription Drugs and Pain Management

What needs to change in pain management? Despite broad consensus that we have a problem, prescription painkillers are being abused in this country. The rate of deaths and hospitalizations due to painkiller abuse is high and climbing steadily in the U.S. It has become far too easy to walk into a doctor’s office with a chronic condition and receive a prescription for long-acting opiates. If a patient has cancer and is in the end stages of the disease, then the benefits of opiates are clear cut. Not so, if a patient suffers from back pain and will be potentially addicted to the prescription drugs he or she receives for life. Then the benefit of pain management must be weighed against the risk of addiction.

This problem is caused primarily by the health-care system and it is a solvable problem. The first step is to change the approach of the system to managing pain and encourage physicians to find alternatives to prescribing long-acting opiates.

Fortunately, there is bipartisan support on this issue.