Prescription overdose rate reaches epidemic levels in NYC

Contact: Stephanie Berger sb2247@columbia.edu 212-305-4372 Columbia University’s Mailman School of Public Health

Fatality rate for white males is 3 times higher than for blacks; Deaths from prescription opioids like Oxycontin soared to 7 times the rate of 1990

The rate of drug overdose from prescription opioids increased seven-fold in New York City over a 16-year period and was concentrated especially among white residents of the city, according to latest research at Columbia University’s Mailman School of Public Health. The study is one of the earliest and most comprehensive analyses of how the opioid epidemic has affected an urban area.

The findings are published in Drug and Alcohol Dependence.

There are two classes of prescription opioids: analgesics, or painkillers like Oxycontin (oxycodone), and methadone, which is used to treat heroin addiction but which carries a risk of overdose. Using data from the city’s Office of the Chief Medical Examiner for the period 1990-2006, the researchers examined the factors associated with death from prescription opioids versus heroin, which historically has been the most common type of opioid fatality in urban areas.

They found that the increase in the rate of drug overdose was driven entirely by analgesic overdoses, which were 2.7 per 100,000 persons in 2006 or seven times higher than in 1990. Meanwhile, methadone overdoses remained stable, and heroin overdoses declined.

Whites were much more likely to overdose on analgesics than blacks or Hispanics. By 2006, the fatality rate among white males was almost two times higher than the rate among Latinos and three times higher than the rate among blacks.

Deaths were mostly concentrated in neighborhoods with high-income inequality but lower-than-average rates of poverty.

“A possible reason for the concentration of fatalities among whites is that this group is more likely to have access to a doctor who can write prescriptions,” says Magdalena Cerdá, DrPH, assistant professor of epidemiology at Columbia’s Mailman School of Public Health and the lead author on the study. “However, more often than not, those who get addicted have begun using the drug through illicit channels rather than through a prescription.”

Price may also play a role, since heroin costs less than analgesics. Additionally, users of prescription opioids may perceive they are safer than other drugs.

Although methadone overdose rates did not increase overall, fatalities among whites increased almost nine-fold while among blacks decreased by 2%. This shift may reflect a change in the nature of methadone use, from a treatment for heroin addiction to a treatment for chronic non-cancer pain.

The study suggests that the profile of a recreational prescription opioid user is very different from the heroin consumer, with less involvement in street-based forms of drug-trafficking and use of other drugs such as cocaine. Because of the different demographics between heroin and prescription opioid users, a different public health approach is needed to target the latter group, say the authors. “It’s a different type of drug with a different profile, and we need a different type of response to it,” said Dr. Cerdá.

Over the last 20 years, prescription drug overdoses have risen dramatically in the U. S. By 2006, overdose fatalities exceeded the number of suicides, and by 2009, they exceeded the number of motor vehicle deaths.

Most studies on recreational opioid use have focused on rural areas, which have been hit the hardest by the epidemic, but this study suggests that urban areas are contending with a growing health burden from opioid use.

The authors recommend regulating the aggressive marketing of potent drugs like Oxycontin, controlling over-prescribing of analgesics, and taking stricter measures to regulate sales. They also say there should be more law enforcement measures to identify illicit networks of distribution of these drugs and education outreach for physicians and patients.

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The research was supported by grants from the National Institute on Drug Abuse (DA06534, T32 DA007233, and K01 DA030449-01), and a grant from the National Center for Injury Prevention and Control at the Centers for Disease Control to the Columbia University Center for Injury Epidemiology and Prevention (1 R49 CE002096-01).

About Columbia University’s Mailman School of Public Health

Founded in 1922, Columbia University’s Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master’s and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), the National Center for Disaster Preparedness, and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu

Single dose of hallucinogen may create lasting personality change – psilocybin

Johns Hopkins study of ingredient in ‘magic mushrooms’ found participants exhibited more ‘openness’

A single high dose of the hallucinogen psilocybin, the active ingredient in so-called “magic mushrooms,” was enough to bring about a measureable personality change lasting at least a year in nearly 60 percent of the 51 participants in a new study, according to the Johns Hopkins researchers who conducted it.

Lasting change was found in the part of the personality known as openness, which includes traits related to imagination, aesthetics, feelings, abstract ideas and general broad-mindedness. Changes in these traits, measured on a widely used and scientifically validated personality inventory, were larger in magnitude than changes typically observed in healthy adults over decades of life experiences, the scientists say. Researchers in the field say that after the age of 30, personality doesn’t usually change significantly.

“Normally, if anything, openness tends to decrease as people get older,” says study leader Roland R. Griffiths, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

The research, approved by Johns Hopkins’ Institutional Review Board, was funded in part by the National Institute on Drug Abuse and published in the Journal of Psychopharmacology.

The study participants completed two to five eight-hour drug sessions, with consecutive sessions separated by at least three weeks. Participants were informed they would receive a “moderate or high dose” of psilocybin during one of their drug sessions, but neither they nor the session monitors knew when.

During each session, participants were encouraged to lie down on a couch, use an eye mask to block external visual distraction, wear headphones through which music was played and focus their attention on their inner experiences.

Personality was assessed at screening, one to two months after each drug session and approximately 14 months after the last drug session. Griffiths says he believes the personality changes found in this study are likely permanent since they were sustained for over a year by many.

Nearly all of the participants in the new study considered themselves spiritually active (participating regularly in religious services, prayer or meditation). More than half had postgraduate degrees. The sessions with the otherwise illegal hallucinogen were closely monitored and volunteers were considered to be psychologically healthy

“We don’t know whether the findings can be generalized to the larger population,” Griffiths says.

As a word of caution, Griffiths also notes that some of the study participants reported strong fear or anxiety for a portion of their daylong psilocybin sessions, although none reported any lingering harmful effects. He cautions, however, that if hallucinogens are used in less well supervised settings, the possible fear or anxiety responses could lead to harmful behaviors.

Griffiths says lasting personality change is rarely looked at as a function of a single discrete experience in the laboratory. In the study, the change occurred specifically in those volunteers who had undergone a “mystical experience,” as validated on a questionnaire developed by early hallucinogen researchers and refined by Griffiths for use at Hopkins. He defines “mystical experience” as among other things, “a sense of interconnectedness with all people and things accompanied by a sense of sacredness and reverence.”

Personality was measured on a widely used and scientifically validated personality inventory, which covers openness and the other four broad domains that psychologists consider the makeup of personality: neuroticism, extroversion, agreeableness and conscientiousness. Only openness changed during the course of the study.

Griffiths says he believes psilocybin may have therapeutic uses. He is currently studying whether the hallucinogen has a use in helping cancer patients handle the depression and anxiety that comes along with a diagnosis, and whether it can help longtime cigarette smokers overcome their addiction.

“There may be applications for this we can’t even imagine at this point,” he says. “It certainly deserves to be systematically studied.”

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Along with the National Institute on Drug Abuse, this study was funded by the Council on Spiritual Practices, Heffter Research Institute and the Betsy Gordon Foundation.

Other Hopkins authors of the research include Matthew W. Johnson, Ph.D, and Katherine A. MacLean, Ph.D.

Johns Hopkins Medicine Media Relations and Public Affairs Media Contact: Stephanie Desmon 410-955-8665 sdesmon1@jhmi.edu