Ontario’s recent decision to eliminate oxycontin and delist its replacement, oxyneo, from the Ontario Drug Benefit program sends a powerful message across the province; that something needs to be done about this epidemic addiction to prescription painkillers.

Oxyneo is a tablet that is purposely difficult to crush and forms into a thick gel when added to liquid to prevent oxycodone from being extracted for use by injection.

Basically, oxycontin will no longer be manufactured in Canada and it will be replaced with a new formulation called oxyneo by the end of February 2012. Additionally, the Ontario Drug Benefit program will not list oxyneo in their formulary; therefore no coverage will exist for those using this program to fund their habit.

Dr. Irfan Dhalla of Toronto’s St. Michael’s Hospital discovered a spike in opioid-related deaths, which coincided with the addition of long-acting oxycodone to Ontario’s drug plan in 2000.

The Ontario Drug Benefit Program (ODB) offered through the Ministry of Health and Long Term Care (MOHLTC) covers most of the cost of prescription drug products listed in the ODB Formulary. It is available to people 65 years of age and older, residents of long-term care homes and Homes for Special Care, people receiving professional services under the Home Care program, Trillium Drug Program registrants and people in receipt of Ontario Works or Ontario Disability Support Program assistance.

That being said, the drug will still be available to certain individuals through the Exceptional Access Program (EAP). This program facilitates patient access to drugs not funded on the ODB Formulary, or where there is no listed alternative available. To apply for funding through the EAP, a physician must submit a request, which documents all complete and relevant medical information that provides a clinical rationale for requesting coverage including the reason(s) that other similar listed drugs are not suitable. All requests are reviewed according to the guidelines put forth by the ministry’s expert advisory committee, the Committee to Evaluate Drugs (CED), which thoroughly assesses each patient’s specific case and clinical circumstances.

In short, oxycontin will no longer be available commercially in Canada and its replacement, oxyneo, will be under more strict regulations in Ontario so that it is less available to just anyone under the ODB, thereby making it less easily abused.

However, with such great strides comes a myriad of problems when all these individuals begin to experience withdrawal. As major changes are being seen at the provincial level only, neighbouring provinces may have less or no restrictions on oxyneo, which may encourage smuggling. For instance, “Manitoba and British Columbia are among a handful of provinces that have yet to decide whether to fund OxyNeo once OxyContin is discontinued” yet Prince Edward Island and New Brunswick, like Ontario, have chosen not to pay for the new drug. Nevertheless, to avoid such great lengths, addicts may simply turn to other prescription drugs.

There is a high risk of experiencing severe withdrawal symptoms if a patient discontinues oxycodone abruptly. Therefore therapy should be discontinued gradually rather than abruptly. People who use oxycodone in a hazardous or harmful fashion are at even higher risk of severe withdrawal symptoms as they tend to use higher than prescribed doses. The symptoms of oxycodone withdrawal are the same as for other opiate based painkillers and may include "anxiety, panic attack, nausea, insomnia, muscle pain, muscle weakness, fevers, and other flu like symptoms.”

Clearly prohibiting this drug in itself will not fix the problem. Perhaps the savings from delisting this drug could be more appropriately used to fund treatment programs across the province…

OxyContin limits lauded
Exceptional Access Program (EAP)
Ontario Drug Benefit: The Program
Oxycodone

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The Crime Victims' Institute at Sam Houston State University found that roughly 1 of every 7 college students surveyed at a Texas University have deliberately cut blood flow to the brain by choking themselves or by being choked by others in order to experience a brief euphoric high.

“The Choking Game, also known as the Fainting Game, Pass Out, or Space Monkey, is played individually or in groups and involves manually choking oneself or others, applying a ligature around the neck or a plastic bag over the head, placing heavy objects on the chest, or hyperventilating to attain a euphoric feeling. This practice has led to several suffocation deaths in Texas and across the country.”

Researchers surveyed 837 students in an attempt to find out more about the type of individuals participating in such behavior and to determine how this behavior was learned. They were also seeking out an understanding as to why people would do such a thing and in what context they would use this method to get high.

Results showed that…

• 16% had played the choking game.
  
• of those who had played the game, 72% had done so more than once.
  
• males were more likely participants.
  
• on average students started playing the game at 14 years of age.
  
• 90% of those who played the game heard about it from their peers.
  
• most admitted that others were present the first time they played the game.
  
• curiosity about the effects of being choked was the primary motivation.
  
• learning about the potential dangers resulting from playing the game deterred most of the non-participants.

A major problem with preventing this type of addiction is that there is no substance to purchase or ingest. It can produce euphoric highs like other types of drugs and can be just as deadly, however it can be much easier to conceal. Awareness of this kind of behavior should be acknowledged and a focus on prevention should really be put into place before more and more young people get involved in such a dangerous activity.

Moreover, clearly there could be catastrophic short-term effects from choking oneself on purpose and, although there are lack of studies, there could be detrimental long-term effects. Depriving the brain of oxygen could cause moderate to severe brain cell death, which could lead to permanent loss of neurological function ranging from concentration problems to loss of short term memory capacity to severe, lifelong mental disability to death.

Other terms for this behavior include: The Fainting Game, Riding a Rocket, Airplaning, America Dream Game, Black Out Game, Breath Play, Bum Rushing, California Choke, California Dreaming, California Headrush, California High, California Knockout, Choking Out, Cloud Nine, Dumbass Game, Dying game, Dream Game, Dreaming Game, Elevator, Flatline Game, Flat Liner, Flatliner Game, Funky Chicken, Harvey Wallbanger, Hyperventilation Game, Indian Headrush, Knockout Game, Pass-out Game, Passing Out Game, Natural High, Sleeper Hold, Space Cowboy, Space Monkey, Suffocation Game, Suffocation Roulette, Teen Choking Game, Rising Sun, High Riser, Tingling Game, Trip to Heaven, Rocket Ride and Speed Dreaming, Wall-Hit, Purple Dragon, Five second high.

Dangerous Choking 'Game' Prevalent Among Teens in Texas
Fainting game

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Neuroscientists at the University of California, Berkeley, have discovered that the orbitofrontal and anterior cingulate cortex in the frontal brain regulates our choices that can result in addictive and compulsive behavior.

Jonathan Wallis, associate professor of psychology and neuroscience at UC Berkeley and the principal investigator of the study researched the phenomenon in which addicts go to any length to fulfill their cravings, despite any negative consequences to health, relationships, finances etc.

“In the new study, he and fellow researchers targeted the orbitofrontal cortex and anterior cingulate cortex -- two areas in the frontal brain -- because previous research has shown that patients with damage to these areas of the brain are impaired in the choices they make. While these individuals may appear perfectly normal on the surface, they routinely make decisions that create chaos in their lives. A similar dynamic has been observed in chronic drug addicts, alcoholics and people with obsessive-compulsive tendencies.”

To study these areas, researchers measured the neural activity of macaque monkeys as their decision making processes are similar to that found in the human brain. The monkeys had to indentify certain pictures that would result in the delivery of juice. They quickly learned to choose the pictures that would most frequently deliver the greatest amount.

"This is the first study to pin down the calculations made by these two specific parts of the brain that underlie healthy decision-making," Wallis said.

Results demonstrated that the orbitofrontal cortex regulates our ability to differentiate and make decisions on both important and minute matters. However, the neural activity does not change based on the importance of a decision for those with damage to the orbitofrontal cortex.

Furthermore, the anterior cingulate cortex allows us to make future decisions based on whether our past decisions matched our expected outcome. When this part of the brain is not functioning normally, those signals are missing and people continue to make the same poor choices again and again.

"This research is an important contribution to understanding how the disease works. The challenge going forward is to sharpen our understanding, translate this knowledge into effective medical treatments and new prevention strategies and ultimately find a cure for this disease."

Findings Offer New Clues Into the Addicted Brain

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Researchers at Duke University Medical Center along with some Australian scientists have discovered that blocking addiction-related nerve pathways in the brain can have a significant impact on sodium appetite. Basically, the nerve cells and connections affected by addictive drugs are the same as those affected by salt.

“Their rodent research shows how certain genes are regulated in a part of the brain that controls the equilibrium of salt, water, energy, reproduction and other rhythms -- the hypothalamus. The scientists found that the gene patterns activated by stimulating an instinctive behavior, salt appetite, were the same groups of genes regulated by cocaine or opiate (such as heroin) addiction.”

Researchers provoked this instinctive behavior in mice either by using a diuretic and withholding salt for a period of time or by using the stress hormone ACTH to increase their need for sodium. In doing so, this demonstrated when salt appetite genes were turned on or off and how quickly that switch can be flipped, as it took a mere 10 minutes for mice that drank a salt solution, long before sodium could even be absorbed into their bloodstream.

According to this study, even though such instincts like our hunger for salt are genetically programmed, these neural pathways can be altered through learning and cognition. As such, many scientists believe that addiction works in this same manner.

"Once the genetic program is operating, experiences that are part of the execution of the program become embodied in the overall patterns of an individual's behavior, and some scientists have theorized that drug addiction may use nerve pathways of instinct. In this study, we have demonstrated that one classic instinct, the hunger for salt, is providing neural organization that subserves addiction to opiates and cocaine" said co-lead author Professor Derek Denton, of the University of Melbourne and the Florey Neuroscience Institute.

Furthermore, the research team discovered that a certain region of the hypothalamus becomes susceptible to the effects of dopamine among animals with a healthy appetite for salt. “That suggests that the state of the instinctive need, the sodium-depleted state, "spring-loads" the hypothalamus for the subjective experience of reward which follows when animals gratify the need -- a satisfied feeling.”

Moreover, this instinctual theory of addiction may help to explain why abstinence is so difficult and maintenance approaches such as methadone are much more successful despite physical dependence.

Consequently, these findings could seriously impact the understanding of addiction as well as research and treatment, not to mention the impact on high sodium foods.

Salt Appetite Is Linked to Drug Addiction, Research Finds

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Many States are taking action against a powerful new designer drug that is rapidly gaining popularity and can be purchased legally. This synthetic drug is most commonly disguised by the name, bath salts. It is also known to many as Tranquility, Zoom, Bloom, Cloud Nine, Ocean Snow, Lunar Wave, Ivory Wave, Purple Wave, White Lightning, Blizzard, Scarface, Red Dove, Star Dust, Lovey Dovey, Snow Leopard, Aura, Hurricane Charlie and Vanilla Sky.

Still, the drug can also be purchased as products such as insect repellant or plant food with names like "Bonsai Grow". Despite serious negative effects, the drug continues to be sold legally for about $80.00USD over the internet, on the street, in convenience stores, smoke shops, gas stations, pawnshops, tattoo parlors, and truck stops etc. And, manufacturers label the product with not for human consumption to avoid prosecution.

These bath salts contain mephedrone and MDPV (methylenedioxypyrovalerone) and can be snorted, injected or ingested to create a euphoric high, similar to that of cocaine or methamphetamine.

“Mephedrone, also known as 4-methylmethcathinone (4-MMC), or 4-methylephedrone, is a synthetic stimulant and entactogen drug of the amphetamine and cathinone classes. Slang names include M4, meph, drone, and MCAT. Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties which acts as a norepinephrine-dopamine reuptake inhibitor (NDRI).”

“The drug is said to last about 3-4 hours, but remains in your system for up to 72 hours and is considered highly addictive. It has become a major cause for alarm with the DEA (Drug Enforcement Agency) and federal authorities and it has been linked to several deaths in the United States.

“I've never seen a drug progress from never heard of, never abused, never seen in a period of three months, to becoming an epidemic,” says ER physician Dr. William Dempsey.

In 2010, the American Association of Poison Control Centers’ National Poison Data System (NPDS) reported 303 calls about MDPV (bath salt) products. But as of June 30, 2011 poison centers reported 3,740 calls, where 2,371 of those calls came in as of May 31, 2011.

This increasingly popular drug raises blood pressure and increases heart rate, which can lead to chest pains, heart attack or stroke. Psychologically, users can expect to experience increased alertness and awareness, increased wakefulness and arousal, anxiety, agitation, decreased appetite and need for sleep, delusions, paranoia, hallucinations, suicidal ideation, psychosis and an intense desire to re-dose.

According to recent reports…

• Dickie Sanders, 21, shot himself in the head after using bath salts.
  
• Elijah Taylor threw himself into traffic.
  
• Johnny Salazar was high on bath salts when he burned his own son's hands when the child touched his bible.

A brief History:

MDPV was developed in the 1960s, and has been used for the treatment of chronic fatigue, but caused problems of abuse and dependence. The following depicts how quickly this drug has progressed.

• 1969: Boehringer Ingelheim files a patent application for MDPV.
  
• 2005: MDPV appears as a recreational drug; first mention on Drugs-Forum.
  
• 2007: First seizure of MDPV as a recreational drug, by customs officials in the German state of Saxony. The drug had been shipped from China.
  
• 2008: First seizure of MDPV in the United States.
  
• 2009: MDPV made illegal in Denmark.
  
• 2010: MDPV made a controlled drug in the UK, Sweden, Germany, Australia and Finland. First reports of the widespread retail marketing of 'bath salts' containing MDPV in the US. The US considers both Mephedrone (July, 2010) and MDPV (December, 2010) "a drug and chemical of concern".
  
• 2011: MDPV sale and possession are banned in the US states of Alabama, Florida, Idaho, Louisiana, Michigan, Mississippi, New Jersey, North Carolina, North Dakota, Pennsylvania (60 days after June 23, 2011), and Utah, with legislation being introduced in many other states.

To date, New York and 33 other states have already banned this deadly drug.

Cocaine-like drug sold as 'bath salts' at corner store
Comprehensive Drug Information on MDPV, Mephedrone ("Bath Salts")
Bath salts: America's newest drug addiction
Mephedrone
Methylenedioxypyrovalerone

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According to researchers at The Scripps Research Institute, an “immunopharmacotherapy” type of treatment for heroin could be on the horizon. Their proven research with animal models confirms that they have developed a vaccine that counteracts the heroin high.

Additionally, the antibodies produced by this new vaccine are also capable of preventing other psychoactive compounds that are metabolized from heroin from reaching the brain and producing euphoric effects.

“‘In my 25 years of making drug-of-abuse vaccines, I haven't seen such a strong immune response as I have with what we term a dynamic anti-heroin vaccine,’ said the study's principal investigator, Kim D. Janda, the Ely R. Callaway, Jr. Chair in Chemistry and a member of The Skaggs Institute for Chemical Biology at Scripps Research. ‘It is just extremely effective. The hope is that such a protective vaccine will be an effective therapeutic option for those trying to break their addiction to heroin.’”

Regrettably, authors of this study claim that heroin abuse and addiction are not only incredibly destructive to the addict, but to the world as a whole, as the cost of this disease is estimated at $22 billion in productivity loss, criminal activity, medical care, and social welfare, in the United States alone. Not to mention the high rates of HIV transmission due to needle sharing.

As a result, many other researchers have attempted to create such a vaccine without success partially because heroin is an elusive target that metabolizes into multiple substances that all generate psychoactive effects. Because of this, researchers in this study developed a vaccine that targets a chemical called 6-acetylmorphine (6AM) and morphine in addition to heroin. And, like heroin, 6-acetylmorphine (6AM) easily crosses the blood-brain barrier to latch onto opioid receptors in the brain. Essentially, the vaccine produces antibodies that neutralize a constantly changing target.

“The researchers linked a heroin-like hapten (a small molecule that elicits an immune response) to a generic carrier protein called keyhole limpet hemocyanin or KLH, and mixed it with Alum, an adjuvant (vaccine additive), to create a vaccine "cocktail." This mixture slowly degraded in the body, exposing the immune system to different psychoactive metabolites of heroin such as 6AM and morphine.”

Researchers observed differences in rats injected with a vaccine that acted on morphine alone in comparison to the dynamic vaccine, which acted on several chemical compounds. Results showed that the dynamic heroin vaccine created an immune response that generated strong polyclonal antibodies against heroin.

“In addition, the study found that addicted rats were less likely to "self-administer" heroin by pressing on a lever after several booster shots of the vaccine. Only three of the seven rats that received the heroin vaccine self-administered heroin. In contrast, all of the control rats, including those given the morphine vaccine, self-administered the drug.”

Fortunately, the heroin vaccine is highly specific as it only produces antibodies in response to the heroin and 6AM, therefore it will not interfere if used in combination with other treatments, such as methadone, naltrexone, and naloxone.

“The Scripps Research team has recently begun an exciting collaboration with researchers at the Walter Reed Army Institute of Research to see if it is feasible to develop a dual-purpose vaccine against HIV and for the treatment of heroin addiction in a single shot, Janda said.”

Scientists Create Vaccine Against Heroin High

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