Abuse rates of stimulants meant to control attention deficit are officially out of control, according to a new U.S. study of emergency room visits, and it’s young adults confirming the legend that college students use the drugs to stay awake and focus.

ER visits involving the stimulants more than doubled in five years, moving from 13,379 in 2005 to 31,244 in 2010 nationwide, according to the Substance Abuse and Mental Health Services Administration report. By far the greatest jump was in those aged 18 to 25, who saw ER visits related to the stimulants go from 2,131 to 8,148. Visits more than tripled in the next age group, 26 to 34.

Many of those visits are from abuse, or non-medical use of the stimulants. This would mean somebody using a stimulant they weren’t prescribed to do something the medication was not intended for. While the stimulants can help young people focus, they are not meant to be a “stay up all night for finals” drug. Adderall is one of the common brands associated with the ADHD drugs.

Half of the ER visits from the stimulants came from non-medical use of the drugs.

We’ll be seeking comments from local ER doctors, which we’ll add later to this blog.

Tall and slender isn’t all that, if you’re talking about lung disease anyway.

It turns out tall, thin women are at a greater risk of infection of a cousin to the organism that causes tuberculosis. Researchers at National Jewish Health also found that women with those infections had a weakened immune response associated with their fat cells.

The research is published in the current issue of The American Journal of Respiratory and Critical Care.
The key bacteria involved in the research — nontuberculous mycobacteria –are widespread in water, soil and air, but only certain people become infected, said Edward Chan, senior author and professor of medicine at National Jewish Health.

There are dozens of species of the bacteria, which can infect skin and other parts of the body — but mostly the lungs. Lung infections are difficult to treat, and can cause death. Evidence suggests such infections are on the rise.

Elderly women represent the vast majority of patients with this particular infection, accounting for 85 percent of the people seen at National Jewish Health during the study. The average age was 64. They were also almost 2 inches taller and had 5.7 fewer pounds of fat on their bodies compared to women of similar age.

In addition to body type, the female patients also differed in their immune response. Fat cells produce hormones that regulate weight and immune function, but those hormones operated differently in the taller, slender women.

Mixing academic points of view can turn up some fascinating results, and numbers-oriented Yale graduate school researchers have turned their sights on medication use in America, to great effect.

A study underway by the Yale School of Management shows disturbingly varied patterns of use of popular medications like anti-depressants, anti-psychotics and stimulants.

Analyzing patterns of prescription use finds disturbing patterns of high use of anti-depressants, for one example. This band of high prescribing is centered on Tennessee. (Source: Yale School of Management)

A band of heavy use of these drugs cuts from Texas in a curve up through Appalachia, with heaviest use of all three drug categories centered on Tennessee. You can see some of the patterns in the map here, and follow this link to more fascinating maps.

Colorado and much of the West come out very well, if you assume that less use of drugs is better.

The most intense clusters across the U.S. showed people 77 percent more likely to have a stimulant prescription, 46 percent more likely to have an anti-depressant, and 42 percent more likely to have an anti-psychotic than people living outside those clusters.

Yale researchers Marissa King and Connor Essick said the numbers correlate closely with patients having local access to health care, and geographic patterns of where pharmaceutical companies spend their money on doctor “education” and marketing. In other words, if you live close enough to a doctor who is getting wined and dined by the big drug companies, you are much, much more likely to get these pills. That seems intuitive, of course, but it’s nice to have real numbers to back up what we’ve all been suspecting.

Culling of pharmacy statistics could also help the FDA and CDC attack overuse of opioid painkillers, which is epidemic across America.

Some local highlights, or lowlights as the case may be: Alexandria, Virginia, saw 40 percent of its residents got an anti-depressant (proximity to “fiscal cliff” nonsense?), compared to a mean of 10 percent of residents nationally. Florida lived up to its reputation as an “interesting” state with a rate of anti-psychotic use of 4.6 percent in Gainesville, compared to 0.8 percent nationally.

Zeroing in on the maps can be telling, especially in areas with small towns or rural health care; in some of these highlighted regions, there may be only a couple of prescribing physicians, meaning overuse can be traced fairly directly to individual doctors or practices.

The data is based on zip code analysis of prescriptions written for about 60 percent of U.S. patients.

Their “Geography of Anti-depressant, Anti-psychotic and Stimulant Utilization in the United States will be published in the journal “Health & Place.”

The FDA is dangling potentially lucrative labeling endorsements and other incentives for drug manufacturers who come up with new formulations of dangerous painkillers that would make abuse less likely, the agency said earlier this month.

The FDA said it also wants to encourage drug makers and marketers to come up with more innovative packaging for the opioid painkillers that would make it harder for the patient or unauthorized outsiders to misuse the drugs.

The safety agency is taking a new look at how consumers interact with popular drugs, including lowering the recommended dosage on common sleep aids because too many people are waking up still drowsy and impaired for important morning tasks.

The agency issued official guidelines for encouraging new formulations, usually meaning a new physical composition for the drug that would render it useless if someone tried to tamper with it and take it in nonprescription way. For example, early versions of narcotic painkillers could be crushed up and snorted to get a bigger rush, or dissolved in water that could be injected for similar abuse. More recent formulations have tried to render the pills useless to addicts or dealers, but the illegal trade is often a step ahead of government-approved protections.

The FDA wants companies to conduct studies proving new ways of delivering the drug could prevent abuse. If the FDA approves those studies, manufacturers would gain the advantage of a drug label saying the formulation has been proven to reduce abuse and therefore the liability of the doctor and the manufacturer. Such an endorsement on a label can be very attractive to providers in making their choices between drugs to prescribe, and boost the company’s sales.

“We understand the labeling influences the choices of doctors and payers,” an FDA official said in a conference call with reporters.

In making the call for new ideas, FDA officials said opioid painkillers like OxyContin, Vicodin, Percocet, methadone and others are responsible for 425,000 ER visits a year for inappropriate use, and more than 15,000 deaths from overdose. Law enforcement officials fear that younger users who get addicted to the painkillers are turning to cheaper heroin and other dangerous drugs.

In packaging, health innovators are looking at such options as locked containers that respond only to personal identification of the authorized user, or packaging that could only dispense on the proper time schedule, among other examples.

Calling all golden retrievers.

If you’ve got one, your dog could help find a cure for cancer. The veterinary school at Colorado State University is looking for healthy retrievers under age 2 with a proven three-generation pedigree.

Pet owners must agree to regular visits with their veterinarian and complete online questionnaires about lifestyle, diet, reproductive history, environment, exercise, medications and other health concerns throughout the dog’s life.

The study is expected to help not only dogs with cancer, but people too, said CSU veterinary oncologists. It’s called the Golden Retriever Lifetime Study, and it will span 10 to 15 years.

The study — by Dr. Rodney Page, director of the Flint Animal Cancer Center, and a team at the Denver-based Morris Animal Foundation — will be the largest and longest observational study ever undertaken to improve the health of dogs.

“Our donors with dogs have told us that cancer is their greatest concern,” said David Haworth, CEO of Morris Animal Foundation.

Scientists are hoping to enroll 3,000 dogs within the next two years. To sign up, visit www.CanineLifetimeHealth.org.

Cancer is estimated to be the No. 1 cause of death in dogs over the age of 2.

We don’t pass out cash here at The Daily Dose, but we’re happy to connect people with those who do.

If you know of a pregnant woman or a mom or caregiver with a child age 3 or younger, from a low-income background, steer them toward the Delta Dental of Colorado Foundation. They can get $50 for some low-pressure responses at the end of this month.

Market researchers with the foundation are working on ways to reach low-income families for better dental care, as part of the ongoing campaign to be cavity-free by 3. Research has shown that early habits stick, and in fact in-utero care can affect the long-term teeth of the baby.

The foundation researchers need people for an hour on Jan. 30 and Jan. 31.

The contact is Elle, at Elle@ameliecompany.com, or call 303-832-2700 ext. 212.

Poudre Valley Health System (handout)

Northern Colorado hospitals are asking the public to donate blood

Poudre Valley Hospital and Medical Center of the Rockies have a critical blood shortage, leading Garth Englund Blood Center to ask the public in northern Colorado to donate blood.

“We’re calling on everyone in the community to help at this critical time,” said Mandi Bornhoeft, the center’s manager.

While blood donations typically drop off during the holidays and pick up again in early January, this year the center has not seen the expected increase. Bornhoeft said the center has tried to fill in the gaps between shortages and needs by making it convenient for donors through mobile blood drives at businesses, high schools, and public events.

To make an appointment to donate blood, go to pvhs.org/bloodcenter or call the Fort Collins center at (970) 495-8965 or the Loveland center at (970) 624-1550. All blood types are needed. The most critical needs are for O Positive and O Negative.

Bardolf & Co.

Deborah J. Cornwall’s “Things I Wish I’d Known” compiles advice from spouses, relatives and friends who have been caregivers for cancer patients

Deborah J. Cornwall, a volunteer, consultant and former board member associated for more than a decade with the American Cancer Society and its Cancer Action Network, is a survivor of breast cancer who works with caregivers who support with cancer patients.

“Things I Wish I’d Known” is the result of interviews with 86 caregivers sharing their frustrations, advice on cutting through bureaucracy and inefficiency, their insights into developing an honest relationship with cancer patients and their families, coordinating help, coping with insurance and medical debt problems and more. It’s worth reading just for the advice on insurance snafus, especially because insurance companies + paper glitches = “insurance churning,” a fairly common problem that the Affordable Care Act (Obamacare) should (but doesn’t always) prevent.

Cornwall separates the book into fairly succinct chapters on getting a clear diagnosis, making treatment decisions (including advice on choosing treatment partners), resources, coping with late-stage cancer and mourning, and thoughts on the changes associated with caregiving.

A trio of public advocacy groups released findings from their focus groups and consumer surveys on what people want and need to effectively use the Colorado Health Benefits Exchange, the key portal for many uninsured under the Affordable Care Act.

The portal needs to open this coming fall in order to have consumers signed up for insurance plans beginning Jan. 1, 2014. The exchange is where individuals and small businesses or nonprofits will learn about affordable (they hope) insurance plans, how they compare, and what it will cost after any available federal subsidies. To successfully draw in potentially hundreds of thousands of people who are currently uninsured, underinsured or simply unhappy with the plan they get through other means, the exchange must have a consumer friendly design and help people navigate a deeply complex system. It must welcome everyone from the extremely sharp and frustrated small business owner, to uninsured patients long out of the system who may have language issues, literacy issues or a general low tolerance for maneuvering in a bureaucracy.

What consumers need most from the health insurance exchange (Credit: handout from consumer advocacy groups)

Some of the early work in designing a system falls to the Colorado Consumer Health Initiative, the Colorado Center on Law and Policy, and the Colorado Public Interest Research Group Foundation. They have been gatherings reactions, advice and demands, and on Monday released some of their findings.

To me the most striking thing about today’s release is the graphic above about what people think they need on the site to help make their decisions. Under “Consumer Exchange website needs,” the first suggestion is a TurboTax style interaction, and that seems exactly right: A smart web site would begin with a simple series of questions for the customer, and go deeper depending on the answers. If the customer can’t handle it by themselves, a trained navigator sits with them and goes through the questions: “Do you currently have insurance? Are you single, or with a family? Will your employer offer insurance? Do you want dollar one coverage, or a high deductible? Do you want to use your current doctor, or is saving money more important? Are extra mental health benefits important to you? How much income do you expect next year?” And then, very soon, a calculation of how much federal tax subsidy will qualify for, and how much of their monthly income will be taken up by the proposed health policies.

Everyone has seen bad software, at home or work, that requires you to be a programmer yourself to do routine tasks. The health exchange needs to keep thinking like TurboTax, or better yet, keep asking, “WWSJD?” What would Steve Jobs do? Or have done? He would have kept it simple, and reminded everybody at every step of the process about the confused consumer sitting at the terminal on the other end of the Internet.

Follow the link above to see the graphic presentations in greater detail, with a wide range of questions and recommendations.

Lots of speculation, some informed, much not, about how bad this particular flu season is. We’ve tried to put it in perspective on these pages and elsewhere: It’s serious, but it’s not so extraordinary this year that public health officials are sounding loud alarms. Colorado hospitals, contrary to some reports, are not sequestering patients in a different way then they usually do, or calling off visitation. Hospital cases of flu spiked early this year, but are not close to touching the recent peak of 2009-10. The vaccine this year is not a perfect match in all cases, but health officials consider it at least moderately good in stopping a large number of infections.

Read more…