Vermont Governor Devotes Entire State of the State Address to Drug Addiction

From yesterday's NY Times:

In Annual Speech, Vermont Governor Shifts Focus to Drug Abuse

In a sign of how drastic the epidemic of drug addiction here has become, Gov. Peter Shumlin on Wednesday devoted his entire State of the State Message to what he said was “a full-blown heroin crisis” gripping Vermont.

“In every corner of our state, heroin and opiate drug addiction threatens us,” he said. He said he wanted to reframe the public debate to encourage officials to respond to addiction as a chronic disease, with treatment and support, rather than with only punishment and incarceration.

“The time has come for us to stop quietly averting our eyes from the growing heroin addiction in our front yards,” Governor Shumlin said, “while we fear and fight treatment facilities in our backyards.”

...

Read the rest of the story here: 

http://www.nytimes.com/2014/01/09/us/in-annual-speech-vermont-governor-shifts-focus-to-drug-abuse.html

Poor and Non-Whites Less Likely to Receive Opioid for Pain in ERs

Race and Socioeconomic Status Affect Emergency Department Opioid Prescribing for Pain

Prior research suggests that factors besides pain—such as patient race and ethnicity—affect opioid prescribing for pain, but those studies have often not adjusted for socioeconomic status (SES). In this study, investigators examined the association between race, ethnicity, and neighborhood SES on prescription of an opioid during an emergency department (ED) visit for moderate or severe pain in the National Hospital Ambulatory Care Survey. During 4 years there were over 183 million visits and opioids were prescribed during 50,264 of them.

• Compared with patients living in areas with the highest SES, patients living in areas with the lowest SES were less likely to receive opioids (39% versus 49% when neighborhood poverty was >20%; 41% versus 47% when median income was <$33,000; and 43% versus 46% when <13 a="" bachelor="" degree="" held="" li="" s="">
• Black (39% versus 46% for white) and Hispanic (40% versus 45% for non-Hispanic) patients were less likely to receive opioids.
• All differences were significant in analyses adjusted for race, ethnicity, SES, sex, pain severity, injury, hospital type, past ED visits, and geography.

Comments:

This study adjusted for neighborhood rather than individual SES. Nonetheless, it does provide support for the hypothesis that race, ethnicity, and SES impact opioid receipt for pain. Clinicians should be aware that this may happen, and researchers should attend to discovering why, with an eye toward eliminating any inappropriate disparities.Richard Saitz MD, MPH

Reference:

Joynt M, Train MK, Robbins BW, et al. The Impact of Neighborhood Socioeconomic Status and Race on the Prescribing of Opioids in Emergency Departments Throughout the United States. J Gen Intern Med. 2013 [Epub ahead of print]. PMID: 23797920.

New Report Outlines Global Strategy to Reduce Harmful Drinking

New Report Recommends Public Health Focus on Harmful Drinking vs. Eliminating Consumption

Tuesday, February 26, 2013

International Center for Alcohol Policies (ICAP)  

Findings Run Counter to Current Public Health Approach, Discredit Traditional Perspectives

WASHINGTON, DC--(Marketwire) - The traditional public health perspective on alcohol and noncommunicable diseases is indicted in a new report from the International Center for Alcohol Policies (ICAP). "Alcohol misuse and global health: The case for an inclusive approach to harmful drinking" discredits the traditional public health perspective that focuses on a narrow group of stakeholders and ignores individual factors and social norms.

"Unfortunately, some widely-held public policy perspectives on reducing harmful drinking are based on questionable and misleading data," said ICAP President Marcus Grant. "This report draws on a wide pool of research to clarify misconceptions and propose a more effective model that involves a broader group of stakeholders and resources, including alcohol producers."

In the past decade, there is greater recognition of the impact of noncommunicable diseases (NCDs) in both developed and developing countries. Harmful alcohol consumption is a contributing lifestyle factor for several of the most widespread and harmful of these diseases, with alcohol misuse accounting for four percent of global disease burden.

The report notes that a reduction in heavy-drinking patterns will have a more significant impact on public health than limiting alcohol's physical and economic availability. Unlike tobacco use, which is harmful at any level, light to moderate drinking can have healthful benefits for some groups. There is little to be gained from stigmatizing what is, for many people, a normal behavior.

The WHO Global Strategy to Reduce the Harmful Use of Alcohol recognizes this distinction, and that including a wider array of stakeholders than historically have been engaged contributes to a more effective public health response. In an era of shrinking economies, the fight against such a critical public health issue cannot afford to exclude key influencers, such as alcohol producers, or the unique resources they can provide.

The focus of the public health community, policymakers, non-governmental organizations and yes, even producers, should be on mitigating the risk of unhealthy consumption patterns, rather than eliminating consumption altogether.

"Alcohol misuse and global health: The case for an inclusive approach to harmful drinking" is available:

http://icap.org/LinkClick.aspx?fileticket=C35rkfX54Mk%3d&tabid=159

The International Center for Alcohol Policies (ICAP; www.icap.org) is a not-for-profit organization supported by major international producers of beverage alcohol. Established in 1995, ICAP's mission is to promote understanding of the role of alcohol in society and to help reduce harmful drinking worldwide. ICAP's efforts to foster dialogue and partnerships in the alcohol policy field are shaped by its commitment to pragmatic and feasible solutions to reducing harm that can be tailored to local and cultural considerations and needs. ICAP has been recognized by the United Nations Economic and Social Council (UN ECOSOC) as a non-governmental organization in Special Consultative Status.

New Documentary on Alcohol Prohibition

PBS PROHIBITION Premieres October 2nd, 3rd & 4th, 2011 at 8 PM on PBS PROHIBITION is a three-part, five-and-a-half-hour documentary film series directed by Ken Burns and Lynn Novick that tells the story of the rise, rule, and fall of the Eighteenth Amendment to the U.S. Constitution and the entire era it encompassed. The culmination of nearly a century of activism, Prohibition was intended to improve, even to ennoble, the lives of all Americans, to protect individuals, families, and society at large from the devastating effects of alcohol abuse. But the enshrining of a faith-driven moral code in the Constitution paradoxically caused millions of Americans to rethink their definition of morality. Thugs became celebrities, responsible authority was rendered impotent. Social mores in place for a century were obliterated. Especially among the young, and most especially among young women, liquor consumption rocketed, propelling the rest of the culture with it: skirts shortened. Music heated up. America's Sweetheart morphed into The Vamp. Prohibition turned law-abiding citizens into criminals, made a mockery of the justice system, caused illicit drinking to seem glamorous and fun, encouraged neighborhood gangs to become national crime syndicates, permitted government officials to bend and sometimes even break the law, and fostered cynicism and hypocrisy that corroded the social contract all across the country. With Prohibition in place, but ineffectively enforced, one observer noted, America had hardly freed itself from the scourge of alcohol abuse – instead, the "drys" had their law, while the "wets" had their liquor. The story of Prohibition's rise and fall is a compelling saga that goes far beyond the oft-told tales of gangsters, rum runners, flappers, and speakeasies, to reveal a complicated and divided nation in the throes of momentous transformation. The film raises vital questions that are as relevant today as they were 100 years ago – about means and ends, individual rights and responsibilities, the proper role of government and finally, who is — and who is not — a real American. http://www.pbs.org/kenburns/prohibition/