Valdiserri R.,Health-U |
Khalsa J.,U.S. National Institute on Drug Abuse |
Dan C.,Health-U |
Holmberg S.,Centers for Disease Control and Prevention |
And 4 more authors.
American Journal of Public Health | Year: 2014
Hepatitis C virus infection is a significant public health problem in the United States and an important cause ofmorbidity andmortality. Recent reports document HCV infection increases among young injection drug users in several US regions, associated with America's prescription opioid abuse epidemic. Incident HCV infection increases among young injectors who have recently transitioned from oral opioid abuse present an important public health challenge requiring a comprehensive, community-based response. We summarize recommendations from a 2013 Office of HIV/AIDS and Infectious Disease Policy convening of experts in epidemiology, behavioral science, drug prevention and treatment, and other research; community service providers; and federal, state, and local government representatives. Their observations highlight gaps in our surveillance, program, and research portfolios and advocate a syndemic approach to this emerging public health problem.
Li C.,Centers for Disease Control and Prevention |
Ford E.S.,Centers for Disease Control and Prevention |
Zhao G.,Centers for Disease Control and Prevention |
Balluz L.S.,Centers for Disease Control and Prevention |
And 2 more authors.
Diabetes Care | Year: 2010
OBJECTIVE - To assess the prevalence and correlates of undertreatment for mental health problems among adults with diabetes and serious psychological distress (SPD). RESEARCH DESIGN AND METHODS - We analyzed data of adults aged ≥18 years from the 2007 Behavioral Risk Factor Surveillance System. SPD was assessed with the Kessler-6 scale. RESULTS - The prevalence of untreated SPD was estimated to be 2.1 κ 0.1% (mean ± SE), 3.4 ± 0.3%, and 2.0 ± 0.1% in the total population, diabetic population, and nondiabetic population, respectively. Among people with SPD, those with diagnosed diabetes had a lower rate of undertreatment for mental health problems (45.0%) than those without diabetes (54.9%) (P = 0.002). Nonwhite race/ethnicity, advanced age, lack of health insurance, and currently being employed were associated with increased likelihood of undertreatment for mental health problems (P < 0.05). CONCLUSIONS - People with diagnosed diabetes may be screened for SPD and treated for specific mental health problems in routine health care. © 2010 by the American Diabetes Association.
News Article | April 22, 2016
Twas the night before 4/20, and all through the head shop, people were readying themselves to ride the green dragon on the high holy holiday of stonderdom. I was there for a different reason. “I need to beat a drug test tomorrow,” I said to the girl behind the counter. “For work?” she answered. Weed blogs had already led me to my weapon of choice: a neon orange cocktail made up of vitamins (E, B6, and B12), niacin, riboflavin, folic acid, pantothenic acid, and a whole bunch of sugar. It promised clean-testing pee for up to six hours after ingestion, with a 300 percent money back guarantee. Just 108 calories per bottle, all for $29.95. I also picked up a bottle of activated charcoal pills, which one blog pitched as a great way to absorb all the weed “toxins” in my body. You see, the practice of testing employees for traces of herb has spawned an entire industry focused on beating such tests—usually of the “pee in a cup” variety—mostly based on armchair science. This drink contains the right mixture of chemicals to “flush” you, and that pill will “detoxify” your body. This powder is supposed to “balance the pH levels” in your pee, and that vitamin ”enlarges blood vessels.” But as resourceful as stoners can be, they’re definitely not all doctors or scientists. Did any of this stuff really work, I wondered? Or were these websites just taking people for their money, and maybe even putting their health at risk? There was only one way to find out: talk to some real scientists about these folk remedies, and try some of them myself. The evening before my drug test, I smoked my last bowl for the next 24 hours and started taking the activated charcoal and drinking glass after glass of water. All I could think was: I’m going to be pissing a lot tomorrow. When you ingest marijuana, you’re taking in Tetrahydrocannabinol, or THC, which every stoner already knows as “that shit that gets you high.” Scientists prefer to call it marijuana’s “parent compound.” The THC enters the body through the lungs and is metabolized (or broken down) in the liver, before it goes to your brain via your bloodstream and, well, gets you super duper stoned. Once weed is metabolized by the liver, THC turns into THCa, an acid that has no psychoactive properties. This is known as a “metabolite,” and it’s way less fun—it’s also what doctors look for in your pee to find out if you’ve been toking. Another metabolite, called cannabidivarin or CBDv, appears in urine when weed is burned and then ingested, so tests can tell if you’re more of a brownie or bong type. I knew I had a few things working against me going into the drug test. One, of course, is that I lit up the evening before, but my orange drink promised guaranteed results no matter when I smoked, so I wasn’t too worried. A 1998 study by the US National Institute on Drug Abuse also found that diluting urine by drinking fluids can produce a false negative in urine tests for subjects who toked up just 22 hours before their test. More concerning was my winter chubbiness. “Marijuana is very lipophilic, so it will adhere to fat and incorporate itself into fat cells in the human body,” Ron Flegel, director of workplace programs for the US Substance Abuse and Mental Health Services Administration (SAMHSA), told me. “If you are a person who has more fat cells in the body, marijuana can actually be stored for a much longer period of time.” So, yeah, any weed I’d smoked in the last few weeks was stored up inside me, just waiting to narc me out. Exercise breaks down the bonds that hold THCa in fat cells, Flegel said, which introduces more THCa into the body. Dehydration also concentrates THCa in urine, which increases the chances of testing positive for weed. Thankfully, I’m a lazy asshole, so I was good on the first point. As for the second, I was drinking more water than a university frosh with dry-mouth. Flegel didn’t exactly boost my confidence regarding my pincer attack plan for beating the test, courtesy of the internet. “If someone drinks it right before and that’s collected in the bladder, that’s what goes in the collection cup,” Flegel said. “But if someone’s a longtime user, or using on a frequent basis, then sometimes with the cutoffs we use—they’re at the nanogram level—sometimes we can detect that.” In other words, even if such drinks successfully dilute your pee and pump it full of vitamins instead of marijuana metabolites, they can’t mask weed remnants stored up in your body over time. As for the activated charcoal pills, it turns out that I may have been led astray by the internet. When I reached out to Nicolas Flamand, associate professor of medicine at Université Laval in Québec City, he told me that, basically, they’re bunk. “Activated charcoal will remain in your digestive system,” Flamand wrote me in an email. “So it will not trap what is inside your body fat. It will mainly trap what is in your digestive tract. Activated charcoal is mainly used to trap alcohol or medications that have been ingested and that are still in your digestive tract.” Regarding the miracle, 300-percent-money-back-guarantee, vitamin-enforced orange juice, Flamand had this to say: “If those remedies were indeed good at clearing THC out of the urine and the blood, they would also be very good at preventing you from getting high when you smoke. Drink a lot of fruit juice before you smoke marijuana and you will get your answer.” Fair enough. Things were not looking good, but at least I knew that urine tests aren’t completely foolproof, even if I was likely doomed to fail. At this point, you might be wondering why we do urine tests at all, if they can be (sometimes) fooled by shady treatments you can buy online. Drug testing at work became popular in the 80s, according to a report by Canada’s Office of the Privacy Commissioner, due to a “confusion of forces” including the global war on drugs and a widespread corporate search for the “‘perfect’ employee.” Workplace drug testing was seen as a “quick fix” to a complex social issue like drug use, the report states. Basically, the driving force behind drug testing is a hodgepodge of good old fashioned Reaganite moralizing and a search for profit by any means. But why urine testing, and not blood or mouth swabs? According to both Flamand and Flegel, the answer is pretty simple: basically, convenience. It’s easy to collect, and we’ve been doing it this way for decades. That might be changing, Flegel noted, as metabolite-detecting technology continues to improve and recreational marijuana use in everyday situations (like behind the wheel) becomes more commonplace. Soon, tests might even be able to reliably defeat the DIY tricks that armchair pot scientists sell on the internet. For example, oral fluid is one vector of testing that Flegel and his colleagues at SAMHSA are considering as the wave of the future in drug testing. “The science is catching up with oral fluid, since the amount of drug in oral fluid is about 100 times less than what you’d see in urine,” said Flegel. “It’s a harder matrix to test.” But, he added, it’s potentially much more reliable than urine, since it would be a lot tougher to dilute or spoof your spit than your pee. Flegel also noted that spit is much easier and less invasive to collect, and could be done on the roadside, for example. This is of particular importance for Canada as the country moves closer to legalizing recreational marijuana use, and scenarios for regular drug testing move out of the office and into the streets. Several companies in Canada and the US are also developing breathalyzer tests for marijuana use that can be deployed on the roadside. The latest comes from University of British Columbia engineering professor Mina Hoorfar, who told The Huffington Post that even if other devices and testing methods have a problem with false positives, “there won't be any false positive with ours." Two hours before my urine test, I cracked open my miracle clean pee juice and glugged it down. I had to drink the entire bottle down in under three minutes, or else it might not work. The best way I can describe the taste is like McDonald’s orange juice—the kind they’d serve watered down in big jugs at track and field day in elementary school—but with a distinct… spiciness. It was tougher to down than I thought. I peed twice in the 45 minutes after drinking the cocktail, per the instructions, and walked into a clinic. “You’d like to do a urine test for cannabinoids?” the doctor, a young guy with horn-rimmed glasses, asked. “Today?” “Yeah,” I replied. “Weird day.” “Totally.” I peed in a cup, and left. I haven’t received my results yet, but whether I test positive or negative, I had to wonder, what would it even mean?
Nearly 21 million Americans ages 12 and older had a substance use problem in 2015, according to a new federal estimate. Among those with a substance use disorder, three out of four people (or about 15.7 million) had a substance use disorder related to alcohol, Kana Enomoto, the principal deputy administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), said at a news conference today (Sept. 8). In addition, 1 in 3 people with a substance use disorder had a disorder related to drug use, and 1 in 8 people had a disorder involving both drugs and alcohol, Enomoto said. For the report, the federal government used the definitions of substance use disorders as they are explained in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. People are considered to have a substance use disorder if, for example, they have strong urges to use a substance or can't control their use of it, or if their use impairs them in social situations or leads to risky behavior. The report also said that an estimated 27.1 million people in the U.S. used an illegal drug in the past month. The national estimates are based on the findings of the National Survey on Drug Use and Health, an annual survey on drug use. The 2015 survey included interviews with about 67,500 people. The survey also revealed that, in 2015, about 1 in 12 Americans needed some form of substance use treatment, Enomoto said. But only about 11 percent of these people actually received treatment, she said. [The Drug Talk: 7 New Tips for Today's Parents] Marijuana remains the most commonly used drug, Enomoto said. Among people who reported having used any drugs in the previous month, 87 percent said that they had used marijuana, she said. And more people reported using marijuana during 2015 than during any single year between 2002 and 2013, according to SAMHSA. But notably, marijuana use didn't increase among adolescents, Enomoto said. Rather, the overall increase was driven largely by more use of the drug among adults ages 26 and older, according to the report. In 2002, 4 percent of adults ages 26 and older who were surveyed reported using marijuana, but in 2015, that number was 6.5 percent. Among those who reported using opioids in the past year, prescription drugs were the most common type used, Enomoto said. An estimated 3.8 million people in the U.S. currently misuse prescription pain relievers, according to the report. An estimated 830,000 people in the U.S. used heroin in 2015, Enomoto said — more than double the number from 2002. She noted that there was a slight decrease, however, in heroin use from 2014 to 2015, but it was not statistically significant (meaning it could have been due to chance). In addition, nearly 300,000 people knowingly used the drug fentanyl in the past year, Enomoto said. Fentanyl is a prescription painkiller that is up to 100 times more potent than morphine and is often linked to fatal overdoses. In many cases, people who use heroin may unknowingly use fentanyl, because heroin may be laced with fentanyl. However, the findings also suggest that the prevention efforts do work to curb substance use, Enomoto said. For example, although alcohol remains a problem among adolescents, the rate of teens who reported using alcohol in the past month has decreased significantly in the past 13 years, Enomoto said. In 2015, 9.6 percent of teens reported drinking in the past month — down from 17.6 percent of teens in 2002, according to the report. There also has been a reduction in cigarette smoking among teens, Enomoto said. In 2002, nearly 1 in 8 teens reported having smoked in the past month, but in 2015, just 1 in 20 teens reported having smoked in the past month, according to the report. Copyright 2016 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
A supposed treatment, called gay conversion therapy, that aims to change the same-sex attractions of gay people should not be offered to minors as it can cause serious psychological harm, according to a newly released federal agency report. Advocates of such conversion therapy hold that people can change their sexual orientation. The counseling is typically offered to youngsters who identify as lesbian, gay, bisexual or transgender (LGBT). But the new report, which was released by the Substance Abuse and Mental Health Services Administration, concludes that the technique is based on the faulty premise that there is something wrong with being gay or lesbian. "Conversion therapy perpetuates outdated views of gender roles and identities as well as the negative stereotype that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development," the authors of the report write. "Most importantly, it may put young people at risk of serious harm." [5 Things You Should Know About Gay Conversion Therapy] The term gay conversion therapy covers a wide range of practices, from talk therapy to electroconvulsive therapy to hormones that dampen libido. During the 1960s, for instance, gay men (who were often mandated by court to attend therapy) were forced to watch pornography while consuming nauseating substances. In recent years, psychologists have relied on talk therapy, often pinning the blame for being gay or transgender on dysfunctional family dynamics. In 2012, the American Psychological Association conducted a review of 83 studies on gay conversion therapy conducted between 1960 and 2007. Though most were too poorly designed to draw conclusions, the few higher-quality studies found that people rarely switched sexual orientation, even after years of therapy, the report found. The authors of the new report cited that review, finding that "no research has been published in the peer-reviewed literature that demonstrates the efficacy of conversion therapy efforts with gender-minority youth, nor any benefits of such interventions to children and their families." In fact, several other research studies suggest that being gay is not a choice. Though the science behind being gay isn't fully developed, there are some hints that genetics or epigenetics — chemical tags on genes that alter their expression — may play a role in whether someone identifies as gay. Either way, orientation tends to be fixed in men by puberty. Though women tend to show greater "erotic plasticity" than men, even women who switch from identifying as gay to straight don't stop finding women attractive, according to a 2012 study in the journal Archives of Sexual Behavior. On a more fundamental level, the report authors also took issue with the notion that someone's identity or orientation needs to be changed in the first place. They said that same-gender sexual attractions are part of the normal spectrum of sexual orientation. In general, psychological associations frown on mental health treatments focused on achieving a "fixed outcome," because these treatments can be harmful, the report authors wrote. [Top 10 Stigmatized Health Disorders] The main problem with gay conversion therapy, however, is that it can fuel self-hatred, depression and anxiety, the report authors found. Many teens subjected to the practice have attempted suicide, while others have struggled for years with feelings of self-hatred or loss of sexual feeling. The report authors also note that people who are gay, lesbian and transgender already face higher risks of suicidal thoughts and depression, as well as substance abuse problems, and an increased likelihood of experiencing victimization, violence and homelessness. However, those higher risks aren't inherent to being gay or transgender, but may instead arise due to hostility and discrimination from family, friends and society, the report authors found. Instead of trying to "fix" someone's orientation or identity, mental health professionals should try to help teens explore their identity while also dealing with negative familial and societal reactions, the scientists said. "Appropriate therapeutic approaches with sexual and gender-minority youth should include a comprehensive evaluation and focus on identity development and exploration that allows the child or adolescent the freedom of self-discovery within a context of acceptance and support," the report stated. Copyright 2015 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.