US Tightens Controls Over Hydrocodone Pain Killers

Today's post from webmd.com (see link below) talks about yet more controls on strong painkillers containing hydrocone, by the US Drug enforcement administration. In the battle to combat addiction and the criminality associated with it, access to hydrocone-based pain killing drugs is about to get much harder. The problem is that many neuropathy and cancer patients (to name but two) are dependent on these drugs for a decent quality of life with reduced pain. They are the innocent victims of a media-led hype about prescription drug addiction and the criminal circuit that feeds it. Surely in the most advanced country in the world it should be possible to distinguish between genuine need and potential criminal behaviour, or addiction. It's true that too many opioids are too easily available and their value on the black market even leads people to buying heroine, which is cheaper but genuine chronic pain sufferers don't abuse - they realise both the power of the drugs and the effectiveness they have in controlling their pain. In conjunction with their doctors, they plan their usage and avoid addiction. These people should not be punished for the actions of a few. Work out a sensible system America - it must be possible but blanket controls lead to a great deal of unnecessary suffering for those in genuine need.

DEA to Tighten Access to Some Narcotic Painkillers
Drugs containing hydrocodone, which include Vicodin, would be affected
WebMD News from HealthDay By HealthDay staff THURSDAY, Aug. 21, 2014

The U.S. Drug Enforcement Administration (DEA) is going ahead with tough new controls on painkillers containing hydrocodone, which has been tied to a surge in dangerous addictions across the United States.

The new restrictions would cover prescription narcotic drugs such as Vicodin, Lortab and their generic equivalents, putting them in the same regulatory class as painkillers such as Oxycontin, Percocet and codeine. Patients will now only have access to a three-month supply of the drug and will have to see a doctor to get any refills.

The new rules, posted online by the DEA on Thursday, come more than 18 months after a U.S. Food and Drug Administration advisory panel met to discuss the fate of painkillers containing hydrocodone. That 2013 meeting followed the DEA's request for an FDA panel review on the issue. The painkillers were previously classified as Schedule III drugs, but the DEA wanted them placed under the more restrictive Schedule II designation.

"Almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents," DEA Administrator Michele Leonhart said Thursday in a news release. "Today's action recognizes that these products are some of the most addictive and potentially dangerous prescription medications available."

One expert applauded the move toward stricter oversight.

"Moving hydrocodone-combination products into DEA Schedule II for controlled substances will have several important effects," said addiction psychiatrist Dr. Eric Collins, physician-in-chief at Silver Hill Hospital in New Canaan, Conn. "It will relatively rapidly reduce the now very easy availability of hydrocodone -- this will help mitigate the rapid growth we've seen in the last 20 years in addiction to opioid [narcotic] pain relievers and heroin."

Collins also believes the move will "reduce both the number of new initiates to opioid use and the number of accidental and intentional overdose deaths. This change is both most welcome and long overdue."

Janina Kean, president and CEO of High Watch Recovery Center in Kent, Conn., said she thinks the DEA's new regulations "will have more of an impact on the adult population or individuals inappropriately prescribed very strong narcotics for mild operative procedures, than it will for the nation's adolescents, a population where 96 percent of substance abuse starts."

The new regulations, Kean added, should reduce the availability of "prescription drugs developed for excruciating pain from being used to treat much less severe ailments like dental procedures or minor surgery."

But she foresees potential problems with the stricter regulations. "With access to drugs like Vicodin and Percocet limited by the regulations and harder to obtain, we may end up seeing a trend of [teens] skipping the pills and going straight to heroin," she said.

The regulation of prescription painkillers has been a contentious issue.

Supporters of a move to a more restrictive Schedule II status pointed to tragic deaths and suicides that have been the result of misuse of these prescription drugs.

But, opponents of the tougher classification fear that tightening access to the drugs would mean that people who really need them to ease pain would not be able to get them.

Few people dispute the fact that too many of these opioid drugs are too widely available, even though the pharmaceutical industry has recently developed "abuse-resistant" formulations to help fight misuse.

Overall, some 22 million Americans have misused prescription painkillers of one kind or another since 2002, according to a report released by the U.S. Substance Abuse and Mental Health Services Administration. The agency noted that prescription painkillers now rank only behind marijuana as a drug of abuse in the United States.

http://www.webmd.com/news/20140821/us-to-tighten-access-to-certain-narcotic-painkillers

WHY DOES RUNNING MAKE US HAPPY

The joy of running. That sense of well-being, freedom and extra energy that runners often experience is not just a matter of endorphins. A study at the University of Montreal Hospital Research Centre (CRCHUM) shows that the "runner's high" phenomenon is also caused by dopamine, an important neurotransmitter for motivation.

"We discovered that the rewarding effects of endurance activity are modulated by leptin, a key hormone in metabolism. Leptin inhibits physical activity through dopamine neurons in the brain," said Stephanie Fulton, a researcher at the CRCHUM and lead author of an article published in the journal Cell Metabolism.

Secreted by adipose tissue, leptin helps control the feeling of satiety. This hormone also influences physical activity. "The more fat there is, the more leptin there is and and the less we feel like eating. Our findings now show that this hormone also plays a vital role in motivation to run, which may be related to searching for food," explained Stephanie Fulton, who is also a professor at Université de Montréal's Department of Nutrition.

Hormone signals that modulate feeding and exercise are in fact believed to be closely linked. Endurance running capacity in mammals, particularly humans, is thought to have evolved to maximize the chances of finding food. This study suggests that leptin plays a critical role both in regulating energy balance and encouraging behaviours that are "rewarding" for the person's metabolism, i.e., engaging in physical activity to find food.

The researchers studied voluntary wheel running in mice in cages. These mice can run up to seven kilometres a day. In a laboratory, the physical activity of normal mice was compared with that of mice who underwent a genetic modification to suppress a molecule activated by leptin, STAT3 (signal transducer and activator of transcription-3). The STAT3 molecule is found in the neurons that synthesize dopamine in the midbrain. This "mesolimbic dopaminergic pathway" is a like a motivational highway in the brain.

"Mice that do not have the STAT3 molecule in the dopaminergic neurons run substantially more. Conversely, normal mice are less active because leptin then activates STAT3 in the dopamine neurons, signalling that energy reserves in the body are sufficient and that there is no need to get active and go looking for food," explained Maria Fernanda Fernandes, first author of the study.

And is leptin as important for motivation to be active in humans? Yes. "Previous studies have clearly shown a correlation between leptin and marathon run times. The lower leptin levels are, the better the performance. Our study on mice suggests that this molecule is also involved in the rewarding effects experienced when we do physical exercise. We speculate that for humans, low leptin levels increase motivation to exercise and make it easier to get a runner's high," summed up Stephanie Fulton.

Mice, humans and mammals in general are thought to have evolved to increase the return on effective food acquisition behaviours. Ultimately, hormones are sending the brain a clear message: when food is scarce, it's fun to run to chase some down.

DOES HAVING CHILDREN MAKE US ANY HAPPIER

The birth of a first and a second child briefly increases the level of their parents' happiness, but a third does not, according to new research from the London School of Economics and Political Science (LSE) and Western University, Canada.

According to the research, published in the journalDemography, parents' happiness increases in the year before and after the birth of a first child, it then quickly decreases and returns to their 'pre-child' level of happiness.

The pattern for second births is similar, although the increase in happiness before and around the birth is roughly half of that for first births. The increase in parental happiness surrounding the birth of a third child is negligible.

Mikko Myrskylä, professor of demography at LSE and Director of the Max Planck Institute for Demographic Research in Rostock, Germany, said: "Our results show a temporary and transitory gain in parents' happiness around the birth of first and second children.

"The fact that parental happiness increases before these children are born suggests that we are capturing broader issues relating to childbearing such as couples forming partnerships and making plans for the future.

"The arrival of a third child is not associated with an increase in the parents' happiness, but this is not to suggest they are any less loved than their older siblings. Instead, this may reflect that the experience of parenthood is less novel and exciting by the time the third child is born or that a larger family puts extra pressure on the parents' resources. Also, the likelihood of a pregnancy being unplanned may increase with the number of children a woman already has -- and this brings its own stresses."

Compared to men, women gain more in happiness in expectation of, and right after, the birth of a child. Women also have steeper drops in their happiness than men between the year of the birth and the year afterward, possibly because of the larger initial gain. However, in the long run, there are no differences between the happiness levels of men and women before and after children.

Those who have children at an older age or who are more educated have a particularly positive response to a first birth. Older parents, between the ages of 35 -- 49, have the strongest happiness gains around the time of birth and stay at a higher level of happiness after becoming parents.

Those who become parents in their teens have a predominantly declining pattern of happiness that does not increase above the baseline even during the year of birth. Those who become parents between the ages of 23 -34 have increasing happiness before a first birth, however one to two years after the birth, happiness decreases to baseline or below.

Rachel Margolis, assistant professor from Western University's Faculty of Social Science, said: "The fact that among older and better-educated parents, well-being increases with childbearing, but the young and less-educated parents have flat or even downward happiness trajectories, may explain why postponing fertility has become so common."

How The US Is Changing Its Mind On Marijuana

Today's interesting post from the Australian abc.net.au (see link below) takes a slightly different look at the progress of marijuana legalisation in the United States. The gradual recognition of the benefits of medical marijuana for a variety of conditions (including neuropathic pain) has led to more and more states legalising the herb thus allowing many more people to take advantage. It's one of the few areas where the USA actually seems to be taking a more liberal stand than most of the rest of the world. Worth a read.

The dope on legalising marijuana in the US
Ben Knight reported this story on Sunday, March 23, 2014
Listen to MP3 of this story ( minutes)

Alternate WMA version | MP3 download

ELIZABETH JACKSON: This month in the US, the District of Columbia became the latest jurisdiction to vote to decriminalise marijuana.

There's been a sea change in public attitudes towards the drug in America.

In the space of less than 10 years, public support for marijuana legalisation has gone from around 25 per cent to almost 60 per cent.

Much of that has to do with the medical marijuana revolution, which began in San Francisco back in 1996.

Ben Knight reports from Washington, DC.

BEN KNIGHT: Not surprisingly, there are lots of reasons for the shift in public support for marijuana law reform in the US.

One of them is simply demographics. As the baby boomers get older, there are simply more people who have had some kind of experience smoking dope, including this guy:

BARACK OBAMA: I didn't have a dad in the house, and I was angry about it, even though I didn't necessarily realise it at the time. I made bad choices. I got high, without always thinking about the harm that it could do. I didn't always take school as seriously as I should have. And the only difference is that I grew up in an environment that was a little bit more forgiving. So when I made a mistake, the consequences were not as severe.

BEN KNIGHT: It was a powerful message from president Barack Obama, because he didn't just admit that he'd used marijuana, but that he'd misused it, and that he'd been luckier than a lot of other teenagers - especially black teenagers.

In many places in this country, minorities make up the vast bulk of marijuana arrests. But this is an issue that unites the left and right wings of politics.

Libertarian Republicans look at the amount of taxpayer money that goes into marijuana prosecutions - and the cost to society - and they compare that to the tax dollars they see coming back in from states that have legal medical marijuana.

Others on the right take the view that the government simply shouldn't be regulating what people choose to do in their own lounge rooms.

Now the debate is of course far from over, and there are very real concerns, particularly about the effect of marijuana on young developing minds, and what kind of message legalising it - or even just decriminalising it - sends to teenagers.

But there's little doubt that either that marijuana supporters are winning that debate. And a lot of that has to do with medical marijuana.

(Rabbi Jeffery Kahn enters)

BEN KNIGHT: Jeffery, how are you?

JEFFERY KAHN: Great. Welcome - delighted that you're here.

BEN KNIGHT: Thank you, great to be here.

(Voiceover): This is the Takoma Wellness Centre in Washington, DC.

JEFFREY KAHN: This door leads to the dispensary.

BEN KNIGHT: Wow, look at it.

(Voiceover): There are thousands of centres like this in 20 states across the US. The owner of this one is Rabbi Jeffrey Kahn.

JEFFREY KAHN: Many of our patients are older. They have never had an experience with cannabis.

BEN KNIGHT: He started this business with his wife Stephanie in 2010.

Their only experience with marijuana was through Stephanie's parents, both of whom used medical marijuana but who had to do it illegally.

STEPHANIE KAHN: We really saw what it could do, but we also saw the fear that they had.

BEN KNIGHT: Stephanie's father was first, after he was diagnosed with multiple sclerosis.

STEPHANIE KAHN: Back in the 70s, the doctors started saying 'try marijuana.' And this was the 70s - he had a teenage daughter, and he was a very straight-laced businessman - and he was like, 'no, I'm not going to.'

But eventually he ended up trying it and it made a huge difference. It helped his spasms, it helped his neuropathies in his fingers and his feet, and it helped pain - it really helped him.

But we were all scared to death. I mean this was, again, the 70s and my parents particularly were afraid that someone was going to go knocking down their door and arrest them.

BEN KNIGHT: Then, after her father died, the family moved from Miami to Washington, where Stephanie's mother was diagnosed with cancer.

STEPHANIE KAHN: We hadn't been living here, we didn't know anybody, we couldn't get anything for her, she couldn't. And so she essentially was diagnosed in June 2009, and died in august 2009, and she wasted away. And the doctor kept saying 'you really need to try some of this and to use it just so you can take something down - eat something.'

BEN KNIGHT: This was at exactly the time that the District of Columbia voted to legalise medical marijuana. Stephanie and Jeffrey didn't think twice about opening their own dispensary.

STEPHANIE KAHN: I just fell in love with the idea. This would be something in my parents' memory. We can open some place that they could have gone to, that people like them could go to and feel safe and get help.

I get choked up every time I talk about this.

It was really important that we could do something here in their neighbourhood. It just meant a lot.

BEN KNIGHT: Tell me about your patients. I mean, do they remind you of your parents?

STEPHANIE KAHN: Yes, a number of them do, it's really amazing.

JEFFREY KAHN: I think that we're going to find some form of legalisation in just about every state. It's what's happening - there really isn't significant opposition, and I think that the old laws just don't really make any sense to anyone anymore.

BEN KNIGHT: This is Ben Knight in Washington for Correspondents Report.

http://www.abc.net.au/correspondents/content/2014/s3969374.htm