E-cig epidemic enforcement incoming

The FDA is getting serious about e-cigarette enforcement. In a statement released last week, the agency announced a crackdown on 1,300+ retailers and five manufacturers who make up 97% of the US market. That includes JUUL, which has been widely criticized for making vaping cool (Editor note: LOL is this really that cool?) and itself accounts for over half the US market. The FDA says vape use has increased to epidemic levels in teens, and it is intent to not “allow a whole new generation to become addicted to nicotine.” The agency expects the manufacturers to submit plans within 60 days to explain how they’ll stop teens from getting addicted to their products. If not, the agency could pull e-cigs from the market, a move which Big Tobacco is a fan of.

Gaming without frontiers

The WHO has released the 11th version of its International Classification of Diseases, which aims to provide a universal standard for coding the conditions which patients can experience. A slightly controversial inclusion in this edition is the coding of gaming disorder, characterized by a long-term addiction to gaming that causes negative health outcomes for patients. Critics say codifying something like gaming as an addiction opens the doors for all the other strange addictions… like drinking paint. Gaming is obviously not the only thing the new ICD covers. Being the first update in almost 20 years, some updates were made like moving gender incongruence from being a mental health disorder into sexual health conditions, perhaps easing some stigma for transgender patients. Happy Pride y’all.

US opioid scripts take a dive

A new study by IQVIA Institute for Human Data Science found that 12% fewer units of prescription opioids were dispensed in 2017 than in 2016. That’s the largest single-year decline since the drug peaked in 2011. On top of that, the largest declines were seen in the US states hit hardest by the scourge (New England region, West Virginia, Pennsylvania). Authors of the study attribute the decline to changing clinical guidelines, new legislation, altered reimbursement practices and broader public awareness of the addictive and destructive nature of the drug. That’s great news, of course, but overdoses from their follow-on illicit ancestors are still running rampant. Speaking of… here’s the Wikipedia page for fentanyl.  Nasty stuff. Just ask Michael Jackson, Prince, Tom Petty…

Marijuana Mythbusting

This week, two studies in Addiction took aim at some arguments medical marijuana supporters and detractors use when fighting for and against that “dank chronic” (dope list of marijuana slang here.) Medical marijuana supporters argue that opioid abusers would substitute marijuana for pain relief, leading to fewer opioid overdoses. While studies do identify a correlation between a decline in overdose deaths and the passage of medical marijuana legislation, the first study determined that the evidence doesn’t support the laws causing the drop. On the flip side, detractors warn that one of the evils of passing this legislation is more adolescents picking up a pot habit. While that could be bad, the second study couldn’t identify that trend actually occurring in legal weed states.

Revenge for the Opium Wars?

In the 1800s, the Chinese Qing dynasty found itself on the defending end of two wars designed to open closed Chinese ports to foreign trade, and essentially get the Chinese people addicted to opium. Fast forward to 2018, and one of the aggressors in those wars—the US—finds its own population dangerously addicted to opium. Well, opium derivatives at least. A US Senate investigation reported last Wednesday that Chinese e-commerce sellers are a huge supplier for carfentanil, which is: 10,000 times more powerful than morphine, mainly used as an elephant tranquillizer, and considered for use as a chemical weapon. And it’s coming right through US ports via the US Postal Service, who haven’t fully implemented suspicious package detection systems. So that’s fun!

Trump: opioids a yuuuuge problem

Just days after declaring his administration would throw law enforcement resources at the opioid crisis, The Donald referred to the crisis as a national emergency. According to an article by NPR, that stops juuuust a bit short of an official declaration of emergency status, which would carry with it access to specific legal authorities and access to government coffers for a more wide-spread, wholistic approach to dealing with the crisis. The President has indicated the official designation is forthcoming. This is significant. National emergency status has historically been used for things like natural disasters (i.e., hurricanes) and communicable diseases (i.e., the Zika virus). Here’s a list of declared U.S. public health emergencies. Once official, expect states like Ohio and New Hampshire—among the hardest hit—to seek federal funds for help.

1. Good or bad news first?

In an effort to combat the prescription drug abuse epidemic, several companies, like Purdue Pharma, have created reformulated opioids. These abuse-deterrent painkillers make it more difficult to snort, smoke or inject the drug—some estimates show that revised OxyContin has curtailed abuse by 40%. Well done, Purdue. Buuuuuut… a new study from the University of Pennsylvania and Rand Corp. shows that since the reformulation of OxyContin, heroin overdoses have surged and the increase in deaths can be attributed directly to the new-and-improved Oxys. One finding shows the number of heroin deaths tripled from 3,000 in 2010 (when reformulated Oxy was introduced) to 10,500 in 2014. InsightCity’s analysis? Addiction is painful and destructive, and the healthcare ecosystem plays too large of a role in the problem.