Leslie Glass's Blog, page 340

Teen Access To Xanax Has Led To A Dangerous New Trend

By Christine Vestal for The Huffington Post:

Teen drug use during the summer often goes unnoticed. It’s when school starts and students nod off in class, exchange pills in the hallways and fail tests that the truth becomes apparent.

This school year, addiction specialists say they’re expecting an onslaught of teens addicted to Xanax and other sedatives in a class of anti-anxiety drugs known as benzodiazepines, or “benzos.” Many teens view Xanax as a safer and more plentiful alternative to prescription opioids and heroin — with similar euphoric effects.

But addiction experts warn that the pills kids are taking, often found in their parents’ or grandparents’ medicine cabinets, can be just as deadly as opioids, especially when taken in combination with other drugs or alcohol. And it’s much harder to kick the habit.

Like any addictive substance, Xanax when used early increases the risk of addiction later in life. According to the U.S. Surgeon General’s 2016 report on drugs and alcohol, nearly 70 percent of adolescents who try an illicit drug before age 13 will develop an addiction within seven years, compared with 27 percent for those who first try an illicit drug after age 17.

Nationwide, prescription drug abuse among adolescents has dropped dramatically in the last 15 years, according to survey results published in December by the National Institute on Drug Abuse. Last year’s results indicate that about 4 percent of high school seniors misused prescription painkillers, a sharp decline from 2004, when nearly 1 in 10 teens misused opioids.

In fact, an increasing percentage of high school kids — at least 26 percent of seniors in 2014, up from 5 percent in 1976 — are abstaining from all substances, including alcohol, marijuana and tobacco, according to an historical analysis of the survey data published in July.

Even so, addiction practitioners say they’re seeing a surge in the number of young patients who are hooked on Xanax. Many take high daily doses of the drug, sometimes in deadly combination with opioids and alcohol.

Addiction treatment centers are “the tip of the spear,” said Sharon Levy, director of adolescent addiction treatment at Boston Children’s Hospital and lead author of the adolescent drug use study. “We see things first. So, I’m not surprised that the spike in Xanax use isn’t reflected in national data yet.”

“Adolescent benzo use has skyrocketed,” Levy said, “and more kids are being admitted to hospitals for benzo withdrawal because the seizures are so dangerous.” At the same time, she said, far fewer kids are seeking treatment for prescription opioid addiction.

“When I ask them if they’re using opioids, they say, ‘No. I wouldn’t touch the stuff.’”

High Doses

Marc Fishman, an addiction psychiatrist and professor at Johns Hopkins University School of Medicine, said benzos are quickly overtaking opioids as the primary prescription drug of abuse among the adolescent patients he sees at Mountain Manor Treatment Centers in Baltimore and other Maryland locations. And many of them are extreme, high-dose users, he said.

Like opioids prescribed for pain, benzodiazepines prescribed for anxiety eventually stop working, forcing users to take higher and higher doses to get the same effect. Kids who can’t get the pills at home buy them on the dark web or concoct designer versions of benzos in their bathtubs, he said.

People with mental illness are at much higher risk for developing an addiction to opioids, and Fishman said the connection between mental illness and benzos is even stronger.

Three FDA-approved medicines are available to treat the symptoms of opioid addiction: buprenorphine (most often sold as Suboxone), methadone and Vivitrol, a long-acting injectable medicine that blocks the euphoric effects of opioids and alcohol.

But no medicines exist to blunt the withdrawal symptoms and cravings associated with benzodiazepine addiction. Instead, patients typically enter residential treatment where a specialist gradually tapers them off the medication. If stopped too quickly, benzodiazepine withdrawal can result in seizures and even death.

For people who overdose on opioids, Narcan is widely available and can easily be administered by first responders, friends and family members to block the deadly respiratory depression of opioids. A similar drug, flumazenil, can block the respiratory depression of benzodiazepines, but it is rarely available outside of hospitals.

Plentiful Supply

The burgeoning abuse of Xanax and other benzodiazepines among high school kids and young adults over the last several years primarily stems from the fact that there are more of the pills out there, Levy argued.

As more adults are prescribed Xanax, Valium, Ativan and other benzodiazepines to calm their nerves and promote sleep, “we’re creating these vast reservoirs for kids to find,” she said.

The other problem, she said, is that adolescents think the benzos are safe because their parents use them. Many kids say they don’t take the pills to get high; they take them to feel normal, Levy said. “Some patients even ask me to just prescribe Xanax for them so they don’t have to buy it illegally. They think it’s good for them.”

“That one idea — that something is safe or beneficial or medical — has launched many an epidemic in the past,” Levy said. “So, my colleagues and I are watching this with trepidation.”

Easy to Love

Melissa Ellis, who grew up in Baltimore in what she described as an addiction-prone family, loved Xanax from the first time she tried it. “I noticed this new guy I was dating kept nodding off so I asked him what he was taking. He told me it was Xanax and gave me a handful of bars [the pill form with the highest dose]. I’d never heard of it before. But as soon as I tried it, I knew it was for me.

“It takes away everything you have in your mind that’s bothering you and everything you feel that hurts, and before you know it, those feelings are just gone.”

Melissa was 15 then and just entering high school. Now she’s 24 and struggling to take care of her 3-year-old son. She says she’s determined to beat her addiction to Xanax and be free of all drugs except the depression medicine she’s been taking for more than a decade. Otherwise, she said she could lose her son.

The first time Melissa tried to stop taking Xanax, she was four months pregnant. She managed to get through her pregnancy without relapsing. “But the day after my son was born, I told my friend in the hospital to bring me some. And I started all over again.”

Melissa also started injecting heroin then. “The two drugs are made for each other,” she said. “What one doesn’t have, the other one does. With the dope [heroin], the high doesn’t last as long as Xanax. So, I was more into the Xanax.”

But after she started combining the two, she overdosed, and her mom found her passed out on the floor one day. That’s when she first checked into Mountain Manor.

Melissa detoxed from both drugs, spent two weeks in residential treatment and started taking Suboxone to relieve her opioid cravings. She also attended outpatient classes and stayed sober for a year.

“I got so much closer to my son back then,” she said wistfully. “Everything was better. I was doing so good. But I started hanging out with old friends and I relapsed on Xanax.”

Now, she’s back at Mountain Manor, trying again. She hopes to leave treatment by the end of the week and move into a mother-and-child sober living facility nearby. For now, her mother is taking care of her son.

“It’s really hard,” Melissa says. Withdrawal from Xanax can cause irritability, insomnia, anxiety, panic attacks, tremors, nausea and other flu-like symptoms. And unlike opioid withdrawal, which usually lasts for about a week, it can last for months.

“Treatment is scary all around. It’s fine when you’re here. You can’t go down the street and meet your dealer. The scariest part is when you go back out there.”

The post Teen Access To Xanax Has Led To A Dangerous New Trend appeared first on Reach Out Recovery.

No Amount Of Alcohol Is Good For Your Overall Health, Global Study Says

From CNN:

If you’re one of the third of all humankind who drinks alcohol, take note: There’s no amount of liquor, wine or beer that is safe for your overall health, according to a new analysis of 2016 global alcohol consumption and disease risk.

Alcohol was the leading risk factor for disease and premature death in men and women between the ages of 15 and 49 worldwide in 2016, accounting for nearly one in 10 deaths, according to the study, published Thursday in the journal The Lancet.
For all ages, alcohol was associated with 2.8 million deaths that year.



Those deaths include alcohol-related cancer and cardiovascular diseases, infectious diseases such as tuberculosis, intentional injury such as violence and self-harm, and traffic accidents and other unintentional injuries such as drowning and fires.

“The most surprising finding was that even small amounts of alcohol use contribute to health loss globally,” said senior study author Emmanuela Gakidou, a professor at the University of Washington’s Institute for Health Metrics and Evaluation. “We’re used to hearing that a drink or two a day is fine. But the evidence is the evidence.”


Not surprisingly due to their large populations, China, India and Russia led the world in the total number of alcohol-related deaths in men and women. The US ranked fifth among men and seventh among women on that list; the UK ranked 21st for men and ninth for women.

“This study is a stark reminder of the real, and potentially lethal, dangers that too much alcohol can have on our health and that even the lowest levels of alcohol intake increase our risks,” Helen Stokes-Lampard, chair of the Royal College of General Practitioners in the UK, said in a statement. She was not involved in the study.

However, countered David Spiegelhalter, the Winton Professor for the Public Understanding of Risk at the University of Cambridge, “Given the pleasure presumably associated with moderate drinking, claiming there is no ‘safe’ level does not seem an argument for abstention.

“There is no safe level of driving, but governments do not recommend that people avoid driving,” Spiegelhalter, who also was not involved in the research, said in a statement. “Come to think of it, there is no safe level of living, but nobody would recommend abstention.”

The Lancet study, funded by the Bill and Melinda Gates Foundation, used data from the 2016 Global Burden of Disease report, which captured information on premature death and disability from over 300 diseases by sex and age in 195 countries or territories between 1990 and 2016. Researchers analyzed the impact of alcohol on 23 health conditions and alcohol-related risks on people between the ages of 15 and approximately 95 for the year 2016.

Drinking under the age of 15, a growing problem in the US and other countries, was not included. For purposes of the study, a standard alcoholic drink was defined as 10 grams or approximately 12 milliliters of alcohol. That measurement varies around the world; for example, a standard drink is 8 grams in the UK and 14 grams in US. It’s even higher in Italy, Portugal and Spain.


Over 1,300 studies on alcohol use by country and the accompanying disease burden, measured by both deaths and disability-adjusted life years, were analyzed by the Global Burden of Disease collaborators.

For the first time, Gakidou said, in an attempt to improve on previous research, the new analysis adjusted for the impact of tourism on local statistics in liquor sales and attempted to control for unrecorded drinking, such as home brewing or illicit trade. Another improvement over past studies, she said, was a new meta-analysis of the effects of alcohol on the 23 health outcomes, which was then used to access risk.

In independent comments published alongside the study, King’s College London alcohol researcher Robyn Burton called the study “state-of-the-art.”
“The conclusions of the study are clear and unambiguous: alcohol is a colossal global health issue,” Burton wrote, suggesting that policy makers put a priority on programs that focus on decreasing alcohol consumption.

However, the Alcohol Information Partnership, a group comprising eight of the world’s biggest liquor companies, said in a statement that “Nothing in this study challenges the array of studies suggesting that choosing to drink moderately is associated with a decreased risk of some health issues and a lower risk of death. We advocate sensible drinking by those who choose to drink and support consistent, evidence-based advice, which enables people to make their own informed choices about alcohol.”
The Distilled Spirits Council echoed that in its own statement. “Claims in the study disputing the research on potential benefits of moderate consumption do not comport with the body of scientific evidence, including a recent study in the American Heart Association Journal Circulation that found that moderate alcohol consumption is one of ‘five low-risk lifestyle-related factors’ that could help people live longer.

“The researchers make clear that they are advocating for worldwide abstention from alcohol. A more reasonable and effective approach is to address issues surrounding alcohol abuse country by country, taking into account the culture, individual alcohol consumption patterns and the marketplace.”


Globally, the study found that about 2.4 billion people drink alcohol. Twenty-five percent are women, who consumed 0.73 drinks each day. Thirty-nine percent are men, who drink an average of 1.7 drinks a day.

The countries with the highest percentage of men and women who reported drinking in the previous year were Denmark, Norway and Germany. Although they didn’t make the top 10, 85.3% of men and 81.3% of women in the UK said they had tripled in the previous 12 months. In the US, 68.8% of men and 56.8% of women said they had done so.







For ages 50 and up, cancers were the leading cause of alcohol-related deaths; road injuries, self-harm and tuberculosis were the top causes of death around the world in the 15-to-49 age group. However, in terms of total numbers, Gakidou said, “most deaths from alcohol come from cardiovascular disease and cancers when you look at average consumption by age and sex within countries.”

Potential benefits outweighed by overall risk

The results appear to fly in the face of research that indicates moderate drinking — in the United States, that’s one drink a day for women and two a day for men — might reduce the risk of heart disease and Type 2 diabetes. That might be true in isolation, Gakidou said, but the picture changes when all risks are considered.

“We too found some protective effects for Type 2 diabetes and ischemic heart disease at low levels of alcohol consumption,” she said. “But those benefits are outweighed by the overall adverse health impact of alcohol, even at moderate levels.”
Jeremy Pearson, associate medical director at the British Heart Foundation, agreed, saying in a statement, “While there may be a slight benefit to heart and circulatory health from modest drinking, many studies have shown that the overall health risks of drinking alcohol outweigh any benefits.”







University of Cambridge epidemiologist Steven Bell co-authored a separate study published in April in The Lancet that found drinking is beneficial in lowering the risk for heart attack. However, that study’s big takeaway was that even one drink a day could shorten life expectancy; long-term reduction in alcohol use added one to two years to life expectancy at age 40.
He points out that his study looked only at drinkers, but the new research compared drinkers to non-drinkers in accessing risk and is one of the first to look at data from low- and middle-income countries.





“Based on these findings,” Bell said, “at no point … is there a level of consumption that appears to lower the overall risk of developing any of the wide array of diseases investigated in comparison to non-drinking.

“The take-home message being that people shouldn’t drink under the belief that it will lower their risk of disease,” he said, “and those of us who opt to drink should minimize our intake if we wish to prolong our life and well-being.”

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Alcohol Not Safe At Any Level

From The Washington Post By Joel Achenbach To minimize health risks, the optimal amount of alcohol someone should consume is none. That’s the simple, surprising conclusion of a massive study, co-authored by 512 researchers from 243 institutions, published Thursday in the prestigious journal the Lancet.











A wine tasting in France. (Georges Gobet/AFP/Getty Images)
The researchers built a database of more than a thousand alcohol studies and data sources, as well as death and disability records from 195 countries and territories between 1990 and 2016. The goal was to estimate how alcohol affects the risk of 23 health problems. The number that jumped out, in the end, was zero. Anything more than that was associated with health risks.

“What has been underappreciated, what’s surprising, is that no amount of drinking is good for you,” said Emmanuela Gakidou, a professor of global health at the University of Washington and the senior author of the report.

“People should no longer think that a drink or two a day is good for you. What’s best for you is to not drink at all,” she said.

The report found that 2.8 million people across the globe died in 2016 of alcohol-related causes, which is about the same proportionally as the 2.0 million who died in 1990. For people ages 15 to 49, alcohol is the leading risk factor for experiencing a negative health outcome.

This is a sobering report for the roughly 2 billion human beings who drink alcohol. The report challenges the controversial hypothesis that moderate drinking provides a clear health benefit. That notion took hold in the 1990s after news reports on the “French paradox”: The French have relatively low rates of heart disease despite a fatty diet. Some researchers pointed to red wine consumption among the French as potentially protective.

How alcohol could increase cancer risk

Scientists in Cambridge warn that there could be an increased cancer risk for drinkers.(Reuters)

Numerous peer-reviewed studies found evidence that people who have a drink or two a day are less likely to have heart disease than people who abstain or drink excessively.

But the new study, while noting the lower risks of heart disease from moderate drinking, as well as a dip in the diabetes rate in women, found that many other health risks offset and overwhelm the health benefits. That includes the risk of breast cancer, larynx cancer, stroke, cirrhosis, tuberculosis, interpersonal violence, self-harm and transportation accidents.

“Current and emerging scientific evidence does not suggest that there are overall health benefits from moderate drinking,” said Robert Brewer, who directs the alcohol program at the U.S. Centers for Disease Control and Prevention and was not involved in the new research. He pointed out that alcohol studies have long been dogged by “confounders” — factors that create a misleading impression of cause and effect.

“People who report drinking in moderation tend to be very different from people who don’t drink at all. They tend to be a healthier population, they tend to exercise more, they tend to be more affluent, they tend to have more access to health care,” Brewer said.

The National Institutes of Health had sponsored a massive clinical trial, largely underwritten by the alcohol industry through funding given to a nonprofit foundation, to test the moderate-drinking hypothesis. A New York Times report in March revealed that researchers had been in communication with representatives of the alcohol industry, and a subsequent NIH investigation concluded that the study design was flawed.

Lead author Max Griswold of the University of Washington said this new report is the largest alcohol study conducted to date.

It follows another, less-sweeping analysis of alcohol and mortality published in the Lancet in April. The earlier one suggested that mortality rates begin to rise when people drink more than 100 grams of pure alcohol (roughly what’s in seven standard American beers) a week.

Drinkers may take some reassurance from the fact that the new Lancet report focuses not on individuals but on populations. It estimates risks of alcohol-related diseases and disabilities per 100,000 people as a function of alcohol consumption. The authors do not suggest that there is significant danger in having a sip of alcohol. The risks spike dramatically with heavy drinking.

The U.S. dietary guidelines define low-risk drinking as one drink a day for women and two a day for men (and none for people under 21 or pregnant). Brewer of the CDC said that if people stick to the guidelines, “the risk of harms across the board is going to be low. It’s not going to be zero. But it’s going to be low.”

Gakidou echoed that.

“It’s a very small risk at one drink a day. It goes up when you go to two drinks a day. It all depends on all the other risk factors that the individual has, as well,” she said. “For a given individual, having a drink a day may not hurt them.”

In an email, she crunched the numbers further. She said that at one drink a day, a person’s risk of developing one of the 23 conditions associated with alcohol increases by 0.5 percent — “a small increase in risk,” as she put it. At two drinks a day, the risk is 7 percent higher. At five drinks a day, it’s 37 percent higher, she said.

The report’s authors suggest that public health officials across the planet need to pay more attention to alcohol. Any reduction in average consumption in a population should produce a health benefit.

U.S. health officials have highlighted the problem of binge drinking and have said that lawmakers should consider a variety of actions, including alcohol taxes and limits on the density of alcohol retailers.

“Alcohol consumption is very responsive to price,” Brewer said.

The United Kingdom is already conducting an experiment of sorts, setting a minimum price for each unit of alcohol sold in Scotland. A similar minimum is planned for Northern Ireland and Wales. England will not have a minimum. The proponents believe they will soon see a divergence in health outcomes to prove that the Scottish model pays off, according a commentary published in the Lancet.

“We need to change the pricing. It’s disproportionately cheap,” said David Nutt, a professor at Imperial College London who reviewed the Lancet report but was not a part of the research team. “We’ve got to get rid of cheap alcohol — the discounted beers and lagers and wines and sherries.”

The new report contains some eye-opening numbers on alcohol consumption. In Denmark, just about everyone drinks: 97 percent of men and 95 percent of women. The United States is relatively moderate, with 73 percent of men and 60 percent of women drinking. That puts it in 51st and 47th place globally for men and women, respectively. The statistics cover people age 15 and older.

The heaviest-drinking nation is Romania, where men on average consume 8.2 drinks a day. That’s followed by Portugal at 7.2. Luxembourg, Lithuania, and Ukraine all average 7.0 among men.

For women, the heaviest consumption is in Ukraine, with 4.2 drinks a day on average, followed by Andorra, Luxembourg, Belarus and Sweden.

By contrast, a number of Muslim-majority countries report almost no alcohol consumption. The average for women in Iran is essentially zero, registering at 0.0003 drinks a day, the lowest rate globally. The lowest for men is in Pakistan, with an average of 0.0007 drinks daily.

Americans should note that this study used a relatively conservative (or what someone ordering at a bar would consider ungenerous) definition of a drink: 10 grams of pure alcohol. In the United States, a “standard drink” is 14 grams — about as much alcohol as found in a typical 12-ounce American beer or a 5-ounce glass of table wine.

The averages on consumption are elevated by the heaviest drinkers, Griswold notes. The study did not distinguish among beer, wine and liquor.

Griswold noted that he still drinks alcohol — but added, “Not as much, after this study.”

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Quitting Alcohol

Quitting alcohol seemed unnecessary when I decided to do it. After all, I am not an alcoholic, I would have said. I have always had a stop button. Alcohol was not my problem. I stopped swallowing at one-and-a-half martinis. (Actually, that’s quite a lot.) I never fell down, got arrested, cracked up the car, lost my job, or made a spectacle of myself. Well, I did make a spectacle of myself once or twice in heated political discussions. But that may not have been just the alcohol.

Anyone who likes vodka more than food is going to get loud. I admit that once, after my kid was newly sober, I preferred to stay home and have a martini to taking the sober kid to dinner. After all, the sober kid had stood me up so many times and done so many bad things I couldn’t even begin to count.

Drinkers Do Know They Are Dependent On Alcohol

I knew the day of standing up the sober kid, that alcohol actually mattered to me. Surprise. The fact that the sober kid was still a whiner at the time, wasn’t loving life yet, and didn’t seem to care much for me, was not the point. See, if you’re a drinker you think about it all the time, even if you only drink in moderation. Alcohol and substances are powerful tools to alter your moods. Sugar and caffeine are intoxicants, too. Hundreds of millions of people are dependent on alcohol and other substances. No judgment. It’s just the truth. I’m having a coffee right now.

Quitting Alcohol Is Weird And Changes Your Life

I quit alcohol and substances (except for aspirin) because I wanted to honor my sober kid by not having a valium when I was terrified on a plane, and not having that one martini every day at 5PM. I wanted to know what being sober in a drinking world felt like. I did it for solidarity with “the sober community.” I found out that not drinking in a drinking world is weird. But wonderful and much less expensive. My sober kid actually cared. But the major benefits of sobriety were to me and only me.

Ten Years After Quitting Alcohol My Life is Really Different

I like not thinking about alcohol.
Life is fun and funny all the time. I crack myself up.
There is a lot less turbulence and drama.
I don’t have to worry about driving home impaired.
I don’t need Xanax or Valium either to sleep or to fly.
I have grandchildren. And much Gratitude.
I am more tuned in to nature.
They say I’m nicer.
Relationships are awesome.
Whatever happens, I am not afraid.

Now my favorite drink is Lemonade. I have one and a half lemonades every single day.

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Cannabis And Some Conditions Hasten Brain Aging

From Medical News Today:

By studying a large number of imaging scans, researchers have identified conditions and behaviors that could make the brain age prematurely, including schizophrenia, bipolar disorder, alcohol use, and the use of cannabis.

Cannabis use — alongside schizophrenia, bipolar disorder, and alcohol consumption — can age the brain prematurely.

For what is thought to be the largest study of its kind, the researchers analyzed brain scans of 31,227 people aged 9 months–105 years.

In a paper that now features in the Journal of Alzheimer’s Disease, they describe how they identified “patterns of aging” from the brain scans.

These were done using single photon emission computed tomography (SPECT) and came from people with psychiatric conditions such as attention deficit hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder. They were all attending a psychiatric clinic that was based at several locations.

Each participant underwent two SPECT brain scans — one during a resting state, and another during completion of “a concentration task” — giving a total of 62,454 scans.

The scientists found that they could predict a person’s age from the pattern of blood flow in their brain.

Brain circulation varied over lifespan

They observed that blood flow varied from childhood into older age throughout the lifespan. They also saw that brain aging was more visible in scans of men and those with schizophrenia, anxiety, bipolar disorder, and ADHD.

Brain aging was also more strongly associated with use of cannabis and alcohol.

“Based on one of the largest brain imaging studies ever done,” says lead study author Dr. Daniel G. Amen, a psychiatrist and founder of Amen Clinics in Costa Mesa, CA, “we can now track common disorders and behaviors that prematurely age the brain.”

He suggests that improving the treatment of these disorders could “slow or even halt the process of brain aging.”

The main reason for the study was to learn more about how aging affects the risk of Alzheimer’s disease.

Alzheimer’s and brain aging

Increasing age is a “known risk factor” for Alzheimer’s disease. Most cases are diagnosed in people aged 65 and older. The risk of developing it “doubles every 5 years” after this, and nearly a third of people over 85 years old have it.

“Understanding the influence of aging on the brain,” note the study authors, “remains a challenge in determining its role as a risk factor for Alzheimer’s disease.”

The brain might only account for about 2 percent of body mass, but it receives up to 20 percent of blood pumped by the heart. This blood travels through some 370 miles of microvessels in the brain.

There is increasing evidence that sporadic Alzheimer’s disease — that is, the type that does not run in families and accounts for most cases — is primarily a disease of the blood vessel system.

There is also evidence that nearly all risk factors for Alzheimer’s disease involve a component that reduces delivery of blood in the brain, and that problems with microvessels precede changes in brain tissue and cognition.

Yet, the brain’s system of blood vessels is an “under-investigated area of brain aging.”

The study analyzed 128 brain regions

Dr. Amen and his colleagues analyzed blood circulation patterns in 128 brain regions on the SPECT scans.

They used a statistical tool to identify average age trajectories for the age range of the group and used another statistical tool to identify clusters of brain regions that best predicted chronological age.

They then used that model to determine a “brain estimated age” for each person from their brain scans. Accelerated brain aging was calculated as the difference between chronological age and brain estimated age.

Further analysis revealed links between premature brain aging and certain behaviors and disorders, as shown in the following list:

schizophrenia — 4 years of premature brain aging


cannabis use — 2.8 years


bipolar disorder — 1.6 years


ADHD — 1.4 years


alcohol abuse — 0.6 years

There was no association between depression and premature brain aging.

The researchers suggest that their findings will help further study into how psychiatric disorders alter patterns of blood flow in the brain.

The cannabis abuse finding was especially important, as our culture is starting to see marijuana as an innocuous substance.”

Dr. Daniel G. Amen

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How Much Guacamole Should You Eat

 

From Time Guacamole has a solid reputation as a crowdpleaser, for sports fans and health nuts alike. Even the Aztecs indulged in ahuaca-mulli, or avocado sauce. But is guacamole good for you? Here’s what the experts say.

What’s in guacamole?

Guacamole’s main ingredient is avocado, a creamy green fruit full of heart-healthy, easy-to-digest monounsaturated fats. It’s typically mixed with salt and lime juice. Some recipes also call for onion, cilantro, tomato, garlic and spices like cayenne pepper or cumin. “It’s easy to spice up your guacamole by adding in jalapeños, chili peppers and hot sauce, too,” says Jordan Badger, a registered dietitian at Boston University’s Sargent Choice Nutrition Center. “If you crave a sweeter flavor profile, you can add fruits such as diced pineapples, dates and grilled figs.”

What are the health benefits of guacamole?

Guacamole serves up an array of health benefits, and most are due to the avocado itself: specifically its monounsaturated fats. “These are healthy fats that play an important role in the structure and function of our brain and other cell membranes throughout the body,” says Badger.

Because of their fats, avocados also help maintain healthy cholesterol levels and make people feel full and satisfied, Badger says. (The fiber also helps; a serving of guacamole has about 2 grams of fiber per serving.) Eat avocados alongside carbohydrate-rich foods, she adds, and the healthy fats will help control your body’s glycemic response, which is how foods affect blood sugar levels.

Avocados also contain about 20 different vitamins and minerals, and the fruit is a good source of folate, a B-vitamin crucial for cell and DNA health, and vitamin K, which is key for bone, heart and brain health.

Guacamole is typically lower in calories than other dips, like those using ranch or sour cream, says Dana Hunnes, an adjunct assistant professor at UCLA’s Fielding School of Public Health and a registered dietitian. It’s also made of natural, whole foods, which come with their own health-promoting benefits (like fiber from the added vegetables).

Any dish that contains minimally-processed plant foods, instead of refined grains and starches, added sugars, highly-processed ingredients and trans fats, promotes better nutrition and health, says Ryan Andrews, a registered dietitian and author of A Guide to Plant-Based Eating — and guacamole certainly fits the bill.

How much guacamole should you eat?

The standard serving size for guacamole is about two tablespoons, which contains 45 calories. But even though the serving size is small, guacamole has an advantage over sour cream and mayo-based dips: it’s a bit harder to overeat, since it contains more filling fiber.

In general, despite the reports of over-the-top avocado consumption, you probably don’t have to worry much about eating more than you should — even if you over-dip every once in a while. “While we continue to eat more avocados than we did 30 years ago, we’re only consuming about seven pounds of them per person, per year,” says Andrews. Compared to how much meat and fish Americans eat each year (181 pounds per person, according to the United States Department of Agriculture) or added sugar (131 pounds per person) that amount is relatively small. “It’s possible to overdo any food, but non-communicable disease rates likely aren’t skyrocketing in North America because we’re all eating too many avocados,” Andrews says.

How do you make guacamole in the healthiest way?

If you’re making your own guacamole, skip the unhealthier add-ins like mayo and add beans or your favorite vegetables, like red and green peppers. Guacamole is great on its own as a snack (dip in carrots or peppers instead of salty tortilla chips), or use it as a spread on a whole-grain sandwich or lettuce wrap in place of Italian dressing, ranch or mayo. “It also tastes great atop a hearty salad,” says Badger.

Homemade guacamole is usually the healthiest type, since you control the ingredients. For packaged options, try to pick a product with the simplest ingredient list. Some store-bought guacamole brands have added sugar, artificial flavorings or large amounts of sodium, so compare labels before you buy — a good tip for any packaged food.

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9 Post-Workout Foods That Will Help You Build Muscle and Recover Faster

From Men’s Health:

If you want to build muscle and reach lofty new fitness goals, downing the right fuel after a workout is nearly as important as exercise itself.

“Nailing your post-workout nutrition promotes quicker recovery, reduces muscle soreness, builds muscle, improves immune system functioning, and replenishes glycogen — all key building blocks in priming you for future workouts,” says sports dietitian and Ironman athlete Marni Sumbal, M.S., R.D. So if you give little thought to your post-training nutrition, your time at the gym might produce lackluster results.

It’s usually a good idea to eat and drink something within an hour or so of your workout to maximize those benefits — but what exactly should you reach for? The following science-backed options will speed up your recovery so you can head back to the gym faster and stronger.

1) Tart cherry juice.

Tart cherry juice is loaded with antioxidants and various anti-inflammatory compounds and has been shown to help athletes recover from intense training. Many studies have demonstrated that tart cherry juice can help with recovery after an intense exercise sesh, but it’s not just limited to weight training: one recent study in the Scandinavian Journal of Medicine & Science in Sports found that tart cherry juice improved various aspects of exercise performance in cyclists. As an added bonus, tart cherry juice also lowered their systolic blood pressure 90 minutes after exercise compared to the placebo. And heck, there’s even data suggesting it may help with sleep.

Post-workout boost: You can find Montmorency tart cherries in dried, juice, canned, concentrate and frozen forms at your local retailer.

2) Whole eggs.

Eating whole eggs can help you get ripped. In a recent study from the University of Illinois, researchers asked men who regularly lifted to eat either three whole eggs, or a mixture of egg whites containing 18 grams of protein, after exercise. Then they measured their rates of protein synthesis, or the driving force behind your muscle gains.

Even though they contained the same amounts of protein, the muscle-building response from whole eggs was about 40 percent greater compared to egg whites alone. The study authors theorize the nutrients found in the yolk — like healthy fats, vitamins, and minerals like phosphorus and iron — allow your worn muscles to use the high-quality protein in the whites more efficiently.

3) Ricotta Cheese.

As little as 9 grams of dairy may be enough to kick-start the muscle-building process, according to research in the Journal of the International Society of Sports Nutrition.

For the study, men chugged either a milk-based drink with 9 grams of protein, or a carbohydrate-only beverage equal in calories after a lower body strength training session. While the carb-only placebo did little to bolster the muscle-building process post-workout, the 9 grams of dairy protein sufficiently ramped things up.

“In response to loading muscles with training stress, the mTOR protein in our muscles is activated, which is a key to stimulating protein synthesis,” says Sumbal. “And mTOR is highly sensitive to the amino acids found in dairy.”

Go for a 1/2-cup serving of ricotta, which offers about 14 grams of milk protein. It’s also a good source of whey protein, meaning it’s high in the essential amino acid leucine, which is especially effective at signaling mTOR to spark new muscle growth, says Sumbal. As an added bonus, British researchers found that pairing whey protein with carbs after a workout can help make your bones stronger, too.

Post-workout boost: Stir together 1/2 cup park-skim ricotta cheese and 1/2 teaspoon vanilla extract in a bowl. Top with 1/3 cup granola and 1/2 cup berries.

4) Smoked Salmon.

It’s possible that omega-3s work their way into your muscle cells, where they help reduce the exercise-induced damage that causes painful inflammation. More reason to go fish for your post-workout fuel: Research out of the Washington University School of Medicine shows that omega-3 fats can fire up pathways in your body that increases muscle protein synthesis.

Post-workout boost: Spread 2 tablespoons cream cheese on a small whole grain wrap and top with 3 ounces sliced smoked salmon, 1/4 cup sliced pickled beets and a handful of arugula.

5) Cottage cheese.

Over the past several years, Greek yogurt has gained all the attention while poor cottage cheese has fallen by the wayside. While both are great, cottage cheese actually has more protein gram for gram, as well as just under 3 grams of leucine per 1 cup. This amount has been shown to help with building and/or maintaining muscle post-workout.

Post-workout boost: Make it simple – Good Culture single serve Cottage Cheese(plain or flavored, available in stores at Target) is a great on-the-go option.

6) Sweet potato.

Sorry, keto fans — when it comes to post-workout recovery, carbs are indeed your friend. A report in the Journal of Applied Physiology shows that consuming carb-rich foods like potatoes, grains, and fruit can help lessen the drop in your immune system that may occur after intense exercise.

But don’t worry — your six-pack won’t take too much of a hit. The carbs you eat after training are more likely to be used as energy than stored as fat, Sumbal says.

7) Herbal tea.

It might come down to compounds like phenol antioxidants, which are naturally found in the leaves of the Ilex paraguariensis shrub where mate comes from. Since yerba mate also contains some naturally occurring stimulants, drinking it before a workout may help boost your energy, too.

Post-workout boost: Heat a liter of water to just under a boil. Place in a jug along with 4 yerba mate tea bags or 1 tablespoon loose leaf mate. Let steep in the fridge for at least 4 hours and then stir in the juice of 1 lemon. Chug back a cupful after hitting the weight room.

8) Whole-grain bread.

Bread certainly gets a bad rap these days, but carbs help fuel working muscles (not to mention your brain). Quality carbs like those found in whole-grain bread go a long way in helping to replenish your muscles.

Post-workout boost: Don’t overthink it. A basic sandwich can go a long way. Try an egg salad sandwich using Dave’s Killer Bread ($26 for 2 loaves, buy it here). It’s rich in whole grains, fiber, and protein, and contains no artificial ingredients, artificial preservatives, or fillers.

9) Quinoa.

This powerful little grain is a great addition to any diet, but it’s especially ideal for those following a gluten-free, vegan or vegetarian diet who are looking to increase their protein and fiber intake — it’s loaded with both.

The post 9 Post-Workout Foods That Will Help You Build Muscle and Recover Faster appeared first on Reach Out Recovery.

What Is Gaming Disorder?

From Medical News Today:

In 2018, the World Health Organization (WHO) classified gaming disorder in their International Classification of Diseases (ICD-11). The ICD-11 is a list of diseases and medical conditions that health professionals use to make diagnoses and treatment plans.

According to the ICD-11, people with gaming disorder have trouble controlling the amount of time that they spend playing digital or video games. They also prioritize gaming over other activities and experience negative effects from their gaming behaviors.

The WHO decided to classify the condition after reviewing the research and consulting with experts. The WHO claim that this classification will result in an increased focus on gaming disorder and its prevention and treatment.

Gaming disorder shares similarities with internet gaming disorder (IGD), which is a condition that the American Psychiatric Association (APA) have labeled in their Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as requiring further study. The APA does not currently recognize IGD as an official condition.

In this article, we discuss the signs and symptoms of gaming disorder and explore what its classification may mean for gamers.

Signs and symptoms

According to the WHO’s definition, a person who has gaming disorder will show the following characteristics for at least 12 months:

lacking control over their gaming habits
prioritizing gaming over other interests and activities
continuing gaming despite its negative consequences

For a diagnosis, these behaviors must be so severe that they affect a person’s:

family life
social life
personal life
education
work

According to some research, gaming addiction may co-occur with other mood disorders, such as:

anxiety disorders
depression
stress

People who remain physically inactive for extended periods due to gaming may also have a higher risk of obesity, sleep problems, and other health issues.

Gaming disorder and addiction

The WHO have listed gaming disorder as a disorder due to addictive behavior in the ICD-11.

Addiction to gaming is similar in many ways to other types of addiction. People with the disorder often spend many hours playing games, have a strong emotional attachment to this behavior, and may experience fewer social connections as a result.

As with other addictions, gaming disorder can have a negative impact on family life, relationships, and work or education. This may lead to irritation with those who criticize gaming, or it may cause feelings of guilt.

Diagnosis

Although the WHO classification defines the behaviors that may lead to a diagnosis of gaming disorder, it is not yet clear how medical professionals will assess these behaviors.

Experts will probably need to devise diagnostic tests, such as questionnaires and structured interviews, to help determine whether or not someone has gaming disorder. They may use something similar to the Internet Gaming Disorder Scale (IGDS), a standard measure of computer and video game addiction.

Treatment

Gaming disorder is a new classification, so there is no clear treatment plan in place yet. However, it is likely that treatments for other addictive behaviors, such as gambling addiction, will also be relevant for gaming disorder.

Treatment for compulsive gambling may include therapy, medication, and self-help groups.

According to a 2017 study on the treatment of IGD, it may be beneficial to combine several types of treatment. In the study, researchers used the following treatments:

Psychoeducation. This involves educating the person about gaming behaviors and their effects on mental health.
Treatment as usual. It is possible to adapt addiction treatment to fit gaming disorder. The treatment focuses on helping the person to control cravings, deal with irrational thoughts, and learn coping skills and problem-solving techniques.
Intrapersonal. This treatment helps people to explore their identity, build self-esteem, and enhance their emotional intelligence.
Interpersonal. During this treatment, the individual will learn how to interact with others by working on their communication skills and assertiveness.
Family intervention. If gaming disorder is negatively affecting relationships with others, family members may need to take part in some aspects of therapy.
Development of a new lifestyle. To prevent excessive gaming, people should explore their skills and abilities, set goals for themselves, and find activities other than gaming that they enjoy.

This is just one proposed treatment model. It is likely that other researchers will suggest alternative treatments for gaming disorder.

Any co-occurring conditions, such as anxiety and depression, may also require treatment.

What does it mean for gamers?

There is no doubt that some gaming behaviors are problematic. Excessive gaming has even resulted in death in some cases. But the majority of people who play computer and video games do not need to worry.

According to research on IGD, most people who play online games do not report negative symptoms and do not meet the criteria for IGD. Researchers report that only 0.3–1.0 percent of people are likely to qualify for an IGD diagnosis.

Those who do meet the criteria for video game addiction tend to have poorer emotional, physical, mental, and social health, according to another study.

It is important to note that both of these studies used the APA’s criteria for IGD rather than the WHO’s criteria for gaming disorder, but there is some overlap between the symptoms of the two disorders.

Some experts believe that playing video games can offer some benefits, especially for children. Research suggests that gaming may have positive effects on children’s cognitive and social skills.

Even though gaming disorder is not widespread, people should be aware of the amount of time that they spend playing games. They should also monitor the effect that gaming has on their other activities, their physical and mental health, and their relationships with others.

Sometimes, excessive gaming can mask another issue, such as depression or anxiety. Seeking help for the underlying issue may put a stop to the over-reliance on video games.

Support and criticism

The classification of gaming disorder in the ICD-11 has generated both support and criticism.

Dr. Richard Graham, an expert in technology addiction, has supported the WHO’s validationof gaming disorder, but he has also expressed some concern that worried parents may mistake enthusiastic gaming for gaming disorder.

Some scholars contributed a paper to the Journal of Behavioral Addictions outlining their concerns about the classification of gaming disorder. They echo Dr. Graham’s worries regarding moral panic around gaming habits and people getting an inaccurate diagnosis, especially children and young people.

The authors question the quality of the research base for gaming disorder and stress the difficulties of making a diagnosis. They also take issue with using substance abuse and gambling disorders to formulate the criteria for gaming disorder.

Takeaway

Gaming disorder is a newly classified condition in the WHO’s ICD-11. However, it is likely that only a small percentage of people who play online and video games will meet the criteria for gaming disorder. Controversy surrounds the diagnosis, and it is clear that further research is necessary.

Those who are worried that gaming may be negatively impacting their health or relationships should speak with a doctor or a mental health professional.

The post What Is Gaming Disorder? appeared first on Reach Out Recovery.

9 Signs You’re In A Toxic Relationship

From Sarah Fielding @ Men’s Health: Stop us if this sounds familiar: you’re in a relationship with someone who’s just plain bad for you. You fight all the time, you’re constantly complaining about each other, and your friends and family members can’t stand them. But every time you think about breaking up (and you think about it a lot), you just can’t bring yourself to do it, because it just seems like more effort to leave than to stay.

If this is the case, then you’re probably trapped in a toxic relationship. It can be difficult to know if the relationship itself is actually toxic, or if you’re just going through a rough patch. “You are going to have bad days and so is your partner. Happy couples still have bad days. What they do is solve problems and they don’t make it personal when they encounter challenges,” Kevin Gilliland, PsyD., executive director of the counseling service Innovation360, tells MensHealth.com.

But if you’ve been struggling with your relationship for a long time, and you find that your partner is making you feel worthless, stupid, or small, that’s a huge problem — and you need to take drastic action. Here are 9 signs to help you determine if you’re in a toxic relationship — and what you can do about it.

1. Your Partner Decides What You Can And Cannot Do

In a healthy relationship, each partner should feel free to pursue their own interests and spend time away from the other person. If your partner gets angry or suspicious when you want to do something apart from them, that’s a major red flag. “Whether they’re jealous, controlling, or have major anxiety issues, it’s unhealthy if your partner tries to restrict your freedom,” Anita A. Chlipala, LMFT and author of First Comes Us: The Busy Couple’s Guide to Lasting Love, tells MensHealth.com.

Of course, none of this is to say that you should have free rein to do whatever you want to do; if your partner, say, can’t stand the idea of you hanging out alone with your ex, that’s a fairly reasonable concern and it’s one you should talk through together. “You have to take another person’s needs into consideration when you’re in a relationship,” says Chipala.

But if your partner outright forbids you from hanging out with certain people or going to certain places, to the point that it’s not even up for a discussion, that’s a problem. “It’s toxic if it’s a threat or ultimatum versus an ongoing dialogue,” says Chipala. “You need to understand each other, and compromise.”

2. Your Partner Doesn’t Encourage You To Grow As A Person

It doesn’t matter if you’re in your 20s or in your 90s — you’re growing and learning every day. In a healthy relationship, your partner should support you as you grow and encourage you to become the best version of yourself. In a toxic relationship, however, “your self-improvement is viewed as a threat,” psychologist Gregory Kushnick tells MensHealth.com. If you, say, express interest in learning another language or picking up a new skill, and your partner mocks you or dismisses you, that could be a sign that they’re not interested in supporting your personal growth and it may be time to move on.

3. They Are Gaslighting You

A reference to the 1944 classic movie Gaslight, in which a man psychologically manipulates his wife and causes her to question her own reality, gaslighting is incredibly common in toxic relationships. If you express concerns about your relationship, and your partner waves them off or causes you to question the legitimacy of your own emotions, that could be a sign that you’re being gaslit. “If a guy expresses concern about another guy’s comments on his girlfriend’s social media and she responds with, ‘You’re so jealous. I can’t believe you don’t trust me,’ that could be gaslighting,” Chlipala says. “Or you might tell her that you feel disconnected and she accuses you of wanting to know her every move.”

Your feelings are legitimate, and no one should make you feel differently. If your partner is flipping your concerns back to you instead of addressing them head-on, it’s important to step back and see that technique for what it is: gaslighting.

4. They Don’t Respect You

It might sound obvious, but respect is the foundation of a healthy relationship. “A pattern of disrespect wears us down and creates things like anxiety and dread. It makes us feel like we have to keep our guards up or prepare for the argument or attack before it happens. We begin to dread bringing things up because we ‘know what they are going to say,” Gilliland says.

This feeling of constantly being on the defense is a sign that your partner doesn’t have sufficient respect for you — or, at least, that they’re not making enough of an effort to show it. “Defensiveness is a killer. It basically keeps us from solving problems and relationships are a never-ending series of solving problems,” says Gilliland.

5. They Use Sex To Manipulate You

If you get the feeling that your partner only expresses sexual interest in you if there’s something they can get out of it — or, conversely, if they withhold sex as a way to achieve some sort of end goal — that’s a classic sign of a toxic relationship. “It’s understandable that if your partner is upset, angry, or feels like you don’t care about their feelings, they won’t have sex with you in that moment,” says Chipala. “It’s another if they withhold sex to manipulate or control you.”

6. You Feel Like You Can’t Open Up To Them

Whether you consider yourself a talker or more of a strong and silent type, being able to discuss important issues with your partner is critical. “Opening ourselves up to our partner leaves us feeling exposed, at risk for rejection, etc.,” says Chipala. “But it’s an important part of a healthy and intimate relationship.”

If you feel like you’re being penalized for sharing your true feelings with your partner, that is never a good sign. “Both partners are responsible for creating the conditions in their relationship for the other to be vulnerable. You should be able to share your thoughts and feelings without punishment,” Chipala says.

7. You Feel Like You’re Being Bullied

If you find that “you’re being frequently bullied, belittled, abused and manipulated,” by your partner, Kushnick says its a clear sign you’re in a toxic relationship. Chances are you were bullied enough in middle school. You don’t really need a partner who replicates this behavior in adulthood as well.

8. They’re Totally Unwilling To Compromise

Compromise is not one of the most fun parts of a relationship. But it is the most necessary. “Relationships require ongoing dialogue, working on understanding each other, negotiating, and compromising,” Chipala says. “If it’s only their way, they show a lack of respect for what’s important to you and making the relationship work for both of you.”

9. Your Parents Hate Your Partner

Your friends and parents shouldn’t be the only factor determining the success of your relationship (after all, you’re dating your partner, not them), but they can be helpful in determining whether the relationship is a toxic one.

Allow the people who care about you to offer an unbiased perspective into your relationship. “Is there a pattern to what different people see and observe when you are with your partner? Do two or more of your friends and family that don’t know each other, say the same concerns? If they do, you have a problem to solve,” Gilliland says.

If any of the above signs resonate with you, and you’re interested in salvaging the relationship, the first step is “deciding if you want to work on the relationship through methods such as counseling,” says Gilliland. Having a couples’ therapist serve as an unbiased mediator is a good way to have the conversations you need with your partner without them feeling attacked.

At the end of the day, however, you should acknowledge the possibility that the relationship may be beyond saving. “In the end, as much as you care about or love someone, they may not be able to provide you with the supportive, healthy relationship you undoubtedly deserve,” says Gilliland. “It’s practically impossible to be rational when you care about someone, but forcing yourself to be can allow you to find true happiness. What’s more important than that?”

Did you know the 12 Steps, which have helped millions find recovery, can also help you recover from a toxic relationship? Check out our latest book, Find Your True Colors In 12-Steps.

The post 9 Signs You’re In A Toxic Relationship appeared first on Reach Out Recovery.

Complex New Street Drugs Puzzle ER Docs

From Science News Daily: At a time when drug overdoses are becoming more prevalent and lethal, a new report provides a snapshot of regional illicit drug use and, for the first time, highlights the complexity of detecting and treating patients at hospital emergency departments for a severe drug-related event.

The objective of the study, which began in 2016, was to identify illicit drugs that caused overdoses in patients at two hospital emergency departments in Maryland.

Emergency physicians were battling a spike in accidental drug overdoses and related deaths, thought to be linked to a group of designer drugs called synthetic cannabinoids that mimic the chemicals in marijuana, known on the street as Spice or K2. One doctor described “atypical overdoses,” patients with breathing difficulties and constricted pupils who responded well to the opioid overdose-reversing drug naloxone, and then required sedation for acute agitation, violence and hyperactivity, all unrelated to opiate withdrawal.

The physicians believed that knowing which drugs were in use might help tailor patient treatment.

At the same time, researchers at the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park, with the support of the U.S. Office of National Drug Control Policy, were generating a number of reports detailing illicit drug use patterns in criminal justice settings. The researchers used sophisticated analyses of de-identified urine samples to detect drugs.

The substance abuse researchers decided to expand their urine testing technique for the first time to hospital settings, and link the test results to de-identified patient medical records. Hospitals typically use urine tests to detect just a handful of drugs and medical conditions.

The CESAR researchers enlisted the participation of emergency physicians at the University of Maryland Medical Center Midtown Campus (UMMC Midtown) in Baltimore, and the University of Maryland Prince George’s Hospital Center in Cheverly, a suburb of Washington, DC.

Test Results

The urine specimens, 106 from Prince George’s and 69 from UMMC Midtown, were sent to the Armed Forces Medical Examiner System laboratory in Delaware where they were tested for 26 synthetic cannabinoids, 59 designer drugs and 84 other illicit and prescription drugs.

With the results, the researchers realized the substances used by these emergency department overdose patients were much more complex than anticipated.

“We were thoroughly amazed that in a study where we thought everyone was having a synthetic cannabinoid-related problem, only one specimen tested positive for synthetic cannabinoids,” says principal investigator Eric Wish, PhD, Director of CESAR at the University of Maryland, College Park, College of Behavioral & Social Sciences.

It was clear the street drugs had been tweaked into new combinations that weren’t being detected. Still, about a year later, after the lab expanded their tests for synthetic cannabinoids from 26 to 46 metabolites, only a quarter of the samples tested positive for synthetic cannabinoids, much smaller than anticipated.

Also clear was the huge mismatch between the drugs patients said they had taken and physician suspicions of drug use, compared to the actual drugs detected. “We had cases where the doctors thought so, the patient thought so, but urinalysis showed no use of synthetic cannabinoids,” says Bradford Schwartz, MD, an emergency physician at the University of Maryland Prince George’s Hospital Center and an adjunct assistant professor of emergency medicine at the University of Maryland School of Medicine.

Marijuana was the most common individual drug detected at both hospitals. Moreover, a fifth to a third of specimens at each hospital tested positive for a new psychoactive substance other than synthetic cannabinoids.

Most striking, two-thirds of patients at both hospitals tested positive for multiple substances, and some specimens contained as many as six substances, potentially complicating an overdose diagnosis.

Regional Drug Use Variations

In Baltimore, after marijuana, people tested positive primarily for fentanyl, a highly potent synthetic opioid; in Prince George’s County, the drug detected was PCP, an illegal hallucinogenic drug that can trigger aggression and other behavior changes.

The Baltimore region has a long history of opioid-related problems, beginning with heroin, then more recently transitioning to fentanyl and its relatives. At UMMC Midtown, non-fentanyl opioids including morphine and codeine were found in 51 percent of urine samples, while 28 percent tested positive for fentanyl. Midtown emergency physician Zachary D.W. Dezman, MD, says the deaths of nearly 700 people in Baltimore were linked to opioids in 2017.

At UM Prince George’s, 47 percent of specimens had PCP and patients were three-to-four times more likely than those at Midtown to show “bizarre or aggressive behavior,” according to the physicians.

The study was not designed to determine differences in mortality, but emergency physicians at both hospitals say anecdotally that despite the constantly changing soup of drugs patients take, treating the patient based on their symptoms seemed to work. “These results suggest that supportive care is safe in patients suffering from acute intoxication from synthetic cannabinoids,” says Dr. Dezman, also an assistant professor of emergency medicine at the University of Maryland School of Medicine.

The addition of fentanyl screening to the standard drug tests used in hospitals would be useful, Dr. Dezman says. While the results of the urine drug screen are not critical to the patient’s emergency care, “it is important to inform patients of the risks of their substance use once they are stabilized.”

He says a number of patients have requested substance abuse treatment once they learned they had inadvertently used fentanyl. As well, he says hospital testing could illuminate the bigger fentanyl picture.

“Policy makers and public health officials cannot make informed policy decisions about combating fentanyl if we do not know the prevalence of fentanyl use in the community.”

“This report underscores one of the benefits of cross-campus collaboration to harness research and clinical synergies that translate to improved patient care,” says E. Albert Reece, MD, PhD, MBA, executive vice president for medical affairs at the University of Maryland, the John Z. and Akiko K. Bowers Distinguished Professor and dean of the University of Maryland School of Medicine.

One of today’s most deadly substances, Fentanyl is showing up everywhere, even in litter on playgrounds. ROR’s pop-graphic Fentanly Poster is a smart way to keep the public informed. Perfect for libraries, doctors offices, schools, and government buildings.

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