The death rate from suicide increased from 13.2 (per 100,000) to 17.6 (per 100,000) from 1999 — 2008 in the United States.
The death rate of black Americans by suicide was pretty stable. The increase is driven by increased suicide rates of white Americans.
In 2008, the suicide rates were as follows:
Also from the CDC, this survey authored by the Harm Reduction Coalition looks at the status of nation — wide programs that have distributed naloxone (Narcan) to try and prevent opioid overdose.
The states in dark blue (hello to my friends in Tennessee and Kentucky…) have the highest rates of drug — overdose death. The black dots are the locales that offer naloxone (Narcan) to try and prevent opioid overdose.
Accidental overdosage from drugs like heroin is a public health emergency. Of heroin users, 2/3 have witnessed an overdose, while 1/3 of heroin users have had their own accidental overdose. This post points you more information about the scale of the problem.
The Harm Reduction Coalition estimates that 53,000 dosages of naloxone were passed out, with an estimated 10,000 overdosages prevented. This is not a scientific study but rather a survey of programs and their reported results. Don’t consider it hard science and then be disappointed when you look at the methodology, think of it more as field — level intelligence about what may prevent a certain type of predictable death.
(Naloxone is a powerful anti — opioid medication that can quickly reverse an opioid poisoning; the typical cause of death for heroin overdosage is respiratory arrest. It causes almost immediate opioid withdrawal so there is no risk of the drug being abused by a heroin user. Naloxone is compounded with buprenorphine to make Suboxone.)
The CDC QuickStats for the week is about drug poisoning deaths. The trends noticed over the last several years remain: accidental drug overdosage outpaces intentional suicides by poisoning by a large amount.
Look here and here for more information from this site about drug patterns both leading to ED visits and overdosage death.
Here’s an article from the Denver Post about Urban Peak.
Urban Peak is a youth shelther that offers an array of emergency and restorative services. Over the years I’ve found Urban Peak a good resource for young adults and late — teens who are in desperate shape facing homelessness, whether from addiction, mental health disturbance, or a dire family situation. The late teens may appear street — tough when you’re walking by the guys and girls downtown, but they are a scared lot and don’t know how to get by as homeless in the city.
From the FDA, here’s an updated release about the safety of SSRIs in pregnancy. SSRI stands for Serotonin Selective Reuptake Inhibitor, a diverse group of chemicals that affect the serotonin neurotransmitter in a similar way.
These medications can be helpful in treating major depression and a variety of anxiety disorders.
The release affirms the current uncertainty about what is and what is safe in pregnancy. Some studies have shown that SSRIs can lead to a problem called primary pulmonary hypertension in newborn babies. Other studies suggest there is no relationship.
The FDA recommends that it remains appropriate to treat major depression with medications during pregnancy, and use appropriate clinical judgment in selecting the best choice. My practice is to consult a drug — safety database about medications safe in pregnancy or in women who are hoping to become pregnant. It’s too important to try and rely only on memory.
The Monitoring the Future Survey has a press release about drug/alcohol trends among 8th, 10th, and 12th graders in the United States.
Good news — alcohol and tobacco use continues to decline
Mixed news — small reductions in Vicodin misuse, stable rates of OxyContin misuse
Bad news — marijuana exposure, and exposure to designer drugs (like K2, spice), continues to increase. The rate of spice exposure was a surprise at more than 10% of 12th graders
From the Denver Post, this article reviews the dismissal of Arapahoe County’s attempt at prosecuting a physician for violations of Colorado Amendment 20.
(Disclaimer — I was an expert witness for Arapahoe County in a prosecution earlier this year)
In both cases, the presiding judge dismissed the action as there was not sufficient reason to believe that the physicians operated outside of the boundary of Amendment 20.
The article references what I think is the more compelling point — as currently construed, as a physician you can practice within the confines of Amendment 20 but with simultaneously outside of the confines of the community standard of care.
I’d agree that in almost any field of medicine, you can treatment patients lawfully but inadequately. I would like data that shows the percentage of medical marijuana examinations that pass the patient with a recommendation for cannabis. It would be especially interesting when compared to the “pass” rate of patients requesting other medications/procedures.
From the NY Times, the Governors of Washington (Christine Gregoire) and Rhode Island (Lincoln Chafee) have petitioned the federal government to change the classification status of marijuana from Schedule I to Schedule 2.
As discussed here, marijuana’s current status as Schedule I adds a further burden of complexity to the inconsistency between state and federal law about the status of “medical” marijuana.
Schedule I drugs have no accepted medical use. Schedule II drugs have limited medical use but are considered high — risk medications and require special procedures around prescription and storage. (For a list of DEA Schedule I — V, click here).
Some states have decided that marijuana has an accepted medical use. The federal government has stated that marijuana does not have an accepted medical use.
My opinion? I think medical vs not-medical is the wrong question. Medicalization of marijuana is a Trojan horse to decriminalize marijuana. The right steps would be to allow marijuana to be schedule II, and then have the citizenry vote on legalization movements. Personally, I think I would vote against legalization, so I’m not advocating for legalization/decriminalization but to me this is a fair, equitable approach to the state vs federal conundrum.
As noted in the previous post the drug abuse and drug morbidity surge that we experience is not with the traditional illegal drugs, like heroin and cocaine, but with prescription drugs.
By far, the drug category that outpaces all others in terms of volume of people ending up in emergency departments (see the slides below) or dead (the topic of later posts) are legally prescribed opioid drugs. Examples of these drugs are oxycodone, OxyContin, hydrocodone (Vicodin, Norco), and codeine.
As you will see below, the number of emergency department visits related to legal opioids since 2004 has almost tripled. In just five years.
Also notice that emergency department visits related to heroin are stable for the same period.
legal vs illegal opioids, national
Denver shows by and large a steeper growth rate (more than 300% growth in five years) but with a leveling of the data from 2008 — 2009.
All data is from the DAWN (Drug Abuse Warning Network) at https://dawninfo.samhsa.gov/ and are lifted from my presentation, “Prescription Drug Abuse: The Hidden Epidemic”
This article from the Denver Post presents a balanced view of the legalization initiatives of marijuana which are related to but separate from the “medicalization” status in place now.
I would find a ballot initiative to vote on legalizing marijuana, along with a local community opt — out provision, as a step forward in that it would remove doctors from the equation. The role of the physician, currently integral in medical marijuana states, is really meaningless and should be treated as such.