Q&A with Addiction Medicine Expert: The Impact of Zohydro
By Celia Vimont | April 30, 2014 | 2 Comments | Filed in Addiction, Government & Prescription Drugs


The Food and Drug Administration’s (FDA) decision to approve Zohydro ER (extended release), a pure form of the painkiller hydrocodone, has stirred opposition from many addiction medicine experts, public health officials and legislators. Join Together spoke with Dr. Richard Blondell, Vice Chair for Addiction Medicine in the State University of New York at Buffalo Department of Family Medicine, about the issue.

Why is there such controversy about Zohydro’s approval?

Dr. Blondell: It’s a question of risk versus benefits. Zohydro, unlike combination hydrocodone products such as Vicodin, does not contain acetaminophen. The FDA says since acetaminophen has safety risks—including potentially deadly liver damage when taken at a high level—Zohydro can be a good option for patients who need high doses of the medication, without the associated liver toxicity risk. They also say it gives doctors another option for prescribing opiates, so they can rotate medications.

However, the risks are great. There is no mechanism in the Zohydro pill for tamper resistance. If people want to abuse it, they can extract high doses of hydrocodone and inject it. The risk is it will create more addiction in people who are prone to misuse and addiction.

What about the argument that more, better opiate medications are needed to treat patients in pain?

Dr. Blondell: There are already a lot of opiate medicines available—there is not a critical need for another one. Zohydro is only a slight variation from many other opiates that are already on the market, and the benefits are minimal. Zohydro is not a big new discovery that will be a watershed moment in medicine.

Why do you think Zohydro poses such an addiction danger?

Dr. Blondell: We already have experience with opioids extracted from pills causing death. Before OxyContin became tamper-resistant, people died after injecting it. Since Zohydro is not tamper-resistant, people who want to abuse it can extract a pretty stiff dose and inject it, which can be fatal for people with a low tolerance.

What needs to be done to reduce the risk of addiction to Zohydro and other opiate painkillers?

Dr. Blondell: We need to better educate our physicians about how to use these medications, how to assess patient risk for abuse, how to screen patients for the development of addiction, and how to intervene early to get patients into treatment before they ruin their lives. This is what we should be doing instead of spending all our efforts developing another opiate, when the market is already flooded with opiate products. We should instead be educating our physicians to use the products already out there.

What do you want the FDA to consider as Zohydro comes to market?

Dr. Blondell: I’m sure the cost of developing a tamper-resistant pill is high, but what is the cost of hundreds of overdose deaths each year? The success in the marketplace has to be balanced against the negative effects to human life. If we see overdose deaths from Zohydro, will the people who approved it take ownership for being part of the problem? As an addiction medicine specialist I’ve seen misery and suffering. I’ve talked to parents of children who have overdosed. I see the human cost of addiction on a daily basis. I think that it’s too big of a price to pay.

Richard D. Blondell, MD, is a Professor and Vice Chair for Addiction Medicine in the State University of New York at Buffalo (University at Buffalo) Department of Family Medicine, and is the Director of Research on Addictions for the University at Buffalo Primary Care Research Institute. Dr. Blondell is a founding member of the American Board of Addiction Medicine and the ABAM Foundation, serving on their Boards of Directors since 2008.

Heroin on College Campuses is a Hidden Issue, Experts Say
By Join Together Staff | April 30, 2014 | Leave a comment | Filed in Drugs, Prevention, Treatment, Young Adults & Youth


While most colleges focus their substance use prevention and treatment programs on alcohol, marijuana and prescription drugs, heroin use is a serious but little-discussed problem, Inside Higher Ed reports.

Campus and national surveys indicate that fewer than 1 percent of college students use heroin, the article notes.

The University of Rochester is now focusing on heroin use among its students, after a freshman died of a heroin overdose. University President Joel Seligman issued a plea to students using heroin to “please get help,” the article notes. The school’s health service director, Ralph A. Manchester, said there is little research on what types of programs are effective in helping college students who use heroin.

The University of Vermont says starting this fall, it will begin screening all patients at the school health center for hard drug use. Students who use drugs will be given a short talk on their risky behavior, and will be referred to treatment. Jon Porter, Director of the school’s Center for Health and Wellbeing, said, “The students who use opiates and heroin are immune to traditional outreach efforts that we might use for alcohol and marijuana.”

While the health center has worked with about 25 students who use heroin, the number is likely to rise since Vermont is experiencing what Governor Peter Shumlin characterized as a “full-blown heroin crisis.”

Yale University Campus Medical Director Michael Rigsby emailed students this month that “several recent incidents have raised our concern that use of drugs such as LSD, cocaine, and heroin is on the rise among college students, fueled in part by a mistaken belief that occasional use is really not that dangerous.”

Some college students who become addicted to prescription painkillers such as oxycodone switch to heroin because it is cheaper, according to Robert Reff, Substance Abuse Prevention Coordinator at Oregon State University.

NIDA Director Urges Lawmakers to Resist Legalizing Marijuana
By Join Together Staff | April 30, 2014 | 5 Comments | Filed in Drugs, Legal, Prevention & Youth

Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), urged lawmakers this week to resist legalizing marijuana. At a House subpanel hearing, she said marijuana can act as a gateway drug.

Speaking before the House Energy and Commerce Committee’s Oversight and Investigations subpanel, Volkow said studies show changes that occur in brain chemistry after people use marijuana, alcohol or tobacco can prime them for harder drugs, The Hill reports.

She told the House panel that many people think marijuana is harmless because they have heard about its potential medicinal benefits, but that more research is needed.

In a message on the NIDA website last year, Volkow wrote, “Regular marijuana use in adolescence is part of a cluster of behaviors that can produce enduring detrimental effects and alter the trajectory of a young person’s life—thwarting his or her potential. Beyond potentially lowering IQ, teen marijuana use is linked to school dropouts, other drug use, mental health problems, etc. Given the current number of regular marijuana users (about 1 in 15 high school seniors) and the possibility of this number increasing with marijuana legalization, we cannot afford to divert our focus from the central point: Regular marijuana use stands to jeopardize a young person’s chances of success—in school and in life.”

Navy Campaign Aims to Reduce Prescription Drug Abuse
By Join Together Staff | April 30, 2014 | Leave a comment | Filed in Military, Prescription Drugs & Prevention

The U.S. Navy has announced a new campaign aimed at reducing prescription drug abuse among sailors, according to the Navy Times.

The campaign, “Prescription for Discharge,” will educate sailors about correctly taking their medication, reporting their prescriptions and disposing of unneeded extra medicines.

In the first seven months of this fiscal year, 524 sailors have tested positive for illegal prescription drug use. The Navy is on track to surpass last year’s total, the article notes.

About one-fourth of sailors are prescribed some type of medication, LaNorfeia Parker, Deputy Director of the Navy Alcohol and Drug Abuse Prevention Office, told the newspaper. The most commonly prescribed medications are amphetamines, hydrocodone, hydromorphones, oxycodone and oxymorphones. In 2012, the Navy added benzodiazepines (such as such as Ambien, Xanax and Valium) and hydrocodones (such as Vicodin) to standard urine drug tests.

Focus groups have found many sailors think it’s acceptable to take medication prescribed to a family member, and do not think prescription drugs can be “illicit” drugs.

A government report released earlier this year concluded the Department of Defense needs to do more to prevent prescription drug abuse among members of the military. Some branches of the military are doing a better job than others in medication management policies, the report concluded.

The report, by the department’s Inspector General’s office, examined policies related to troops wounded in combat who are taking multiple medications. The Army aggressively guards against “doctor shopping” and using the same prescription to obtain more medication than has been prescribed, the report notes. The Army closely monitors a soldier’s prescriptions when he or she is receiving four drugs, including one controlled substance.

The Navy’s medication management policies vary by location; in some locales, close monitoring occurs only when a sailor or Marine receives five controlled substances. “Medication management policies, especially for the high-risk patient population of wounded warriors, need to be standardized,” the report states.

Two States to Consider Banning Powdered Alcohol
By Join Together Staff | May 1, 2014 | Leave a comment | Filed in Alcohol, Community Related, Legislation & Prevention


Legislators in Minnesota and Vermont have introduced measures that would ban powdered alcohol, The Washington Post reports. The federal Alcohol and Tobacco Tax and Trade Bureau approved labels for a powdered alcohol product called “Palcohol,” but earlier this month said the approval was a mistake. Lipsmark, the company that makes Palcohol, has resubmitted an application, the article notes.

Lipsmark says it plans to offer powdered alcohol in six varieties, including rum, vodka, Cosmopolitan, Mojito, Powderita and Lemon Drop. According to the company, a package of Palcohol weighs about an ounce and can fit into a pocket. It warns people not to snort the powder.

Minnesota state Representative Joe Atkins this week introduced a bill that would ban powdered alcohol sales in his state. A similar bill is being considered in Vermont. Some health experts are afraid the product could be easily misused or abused.

“Virtually every possible use for powdered alcohol is nefarious, not to mention potentially dangerous,” Atkins said in a news release. “The different flavorings make it appealing to children and students who could easily sneak packets into school. This powder could also be inhaled or snorted, bringing a whole new world of problems into play. With how quickly this is moving, we shouldn’t wait until next session to deal with this issue. We need to move quickly to protect public health.”

Vermont state Senator Kevin Mullin, who introduced the measure to ban powdered alcohol in his state, told VPR News, “You can’t buy a bottle of gin at the liquor store if you’re 16. But there’s nothing that I can see in Vermont statute that would prohibit you from buying powdered alcohol, if it was available. So think about kids walking around with packets of powdered alcohol in their pocket – hard to detect.”

Sales of Drugs on Silk Road Website Bounce Back After Government Shutdown
By Join Together Staff | May 1, 2014 | Leave a comment | Filed in Drugs & Marketing And Media

Six months after the FBI shut down the website Silk Road, which sold illegal drugs, the site has reopened and sales have bounced back, CNET reports.

The findings come from a new report by the group Digital Citizens Alliance. “What we see on Silk Road today is more drugs, increasing vendors, and an even greater commitment by this community to keeping their ‘movement’ alive,” said Digital Citizens’ Senior Fellow Garth Bruen.

The report noted Silk Road 2.0, the new version of the site, had 13,648 drug listings as of April 2, just slightly more than the 13,000 listings before the arrest of Silk Road’s founder, Ross Ulbricht, last fall.

The original Silk Road could only be accessed by using encryption software called Tor, which shields computers’ IP addresses, allowing people to make purchases anonymously. Silk Road facilitated more than $30 million in sales annually. It had been online since February 2011.

The website also sold other illegal items, such as forged documents and untaxed cigarettes. The site did not use credit cards, instead relying on “Bitcoins,” an untraceable digital currency that is available through online currency exchange services. The website told sellers to make shipments using vacuum-sealed bags so that drug-sniffing dogs would not detect the packages.

The Digital Citizens Alliance say Silk Road 2.0 is designed to look and operate much like the original website, but has better security.