Confusion & Controversy Surround Blood Thinner Pradaxa

From Health Feed at the University of Utah:

If you take the blood thinner Pradaxa, recent news may have left you concerned about its safety.

Pradaxa’s manufacturer, Boehringer Ingelheim, may have knowingly withheld information about risks associated with it, according to published reports in medical journal The BMJ.

Pradaxa, prescribed to people at risk for stroke due to atrial fibrillation, was originally touted as having a lower risk than the standard treatment, warfarin, known by the brand name Coumadin. The Food and Drug Administration approved its use without the need for frequent blood tests. But new evidence suggests frequent testing may reduce the risk of serious, sometimes fatal, bleeding events.

"Boehringer Ingelheim has failed to share with regulators information about the potential benefits of monitoring anticoagulant activity and adjusting the dose to make sure the drug is working as safely and effectively as possible," Deborah Cohen, The BMJ’s investigations editor, wrote in the report.

Gregory Hawryluk M.D., Ph.D., a neurosurgeon at University of Utah Health Care, says Pradaxa may now be a less attractive option than Coumadin.

“The fact that monitoring wasn’t recommended for Pradaxa was one of the main reasons that physicians prescribed it in the face of the difficulties reversing or neutralizing it,” he explains, noting a reversal agent for Pradaxa is currently in clinical trials. Coumadin, meanwhile, is readily reversible.

People taking Pradaxa who are thinking of stopping because of the controversy should speak to their doctors first. “It is very important that patients who are taking Pradaxa continue taking it as prescribed by their physician,” Hawryluk says. “It is very clear that although there are unavoidable risks inherent to Pradaxa, Coumadin and similar agents, the risks of treatment with these drugs as they are currently prescribed and monitored is lower than the risk of stroke that patients would face without them.”

The FDA agrees. A spokeswoman tells WebMD that the agency still believe that Pradaxa provides an important health benefit and recommends that health care professionals follow the recommendations on the approved drug label.

“Treatment with either Pradaxa or Coumadin is clearly better than no treatment,” Hawryluk says.

Update: Boehringer Ingelheim released a statement regarding the report in The BMJ. Read it here.
 

World Drug Report 2009 to be released today

From United Nations Office on Drugs and Crime:

At 10 a.m. Washington D.C. local time (EDT) today, UNODC will release the 2009 edition of its flagship publication, the World Drug Report.  A webcast of the press conference and all relevant materials can be found at http://live.unodc.org.

This year, for the first time, the World Drug Report includes special sections on the quality of drug data available to UNODC, trends in drug use among young people and drug-related offences recorded by police. It also addresses the black market for drugs, one of the most formidable unintended consequences of drug control, and ways in which the international community can best tackle it.

Every year, the World Drug Report provides one of the most complete assessments of the international drug problem, with comprehensive information on the illicit drug situation. It provides detailed estimates and information on trends in the production, trafficking and use of opium/heroin, coca/cocaine, cannabis and amphetamine-type stimulants. The Report, based on data and estimates collected or prepared by Governments, UNODC and other international institutions, attempts to identify trends in the evolution of global illicit drug markets.

Through the World Drug Report, UNODC aims to enhance Member States' understanding of global illicit drug trends and increase their awareness of the need for the more systematic collection and reporting of data relating to illicit drugs.

The Report is being launched as run-up to World Drug Day on 26 June, and will be available on unodc.org.

Canada now a major exporter of methamphetamine, UN report says
From the National Post (Canada):

The UN Office on Drugs and Crime has released its 2009 World Drug Report, and among the surprisingly complete picture of the global drugs trade, it appears that in recent years Canada's traffickers have come to play an alarmingly prominent role.

Among the findings in the 306-page report is that Canada and Mexico have picked up the slack in the production of methamphetamine as efforts to close meth labs in the United States since their peak in 2004 have borne fruit.

The report says "there is evidence that Canada-based Asian organized crime groups and outlaw motorcycle gangs have significantly increased the amount of methamphetamine they manufacture and export since 2003, for the US market, but also for Oceania and East and South-East Asia.

AFP reports that the production of heroin, cocaine and cannabis decreased or stabilized in 2008, but synthetic drugs like ecstasy went up.

It also found that "Canada has grown to be the most important producer of MDMA for North America, and since 2006, all ecstasy laboratories reported have been large capacity facilities operated principally by Asian organized crime groups.

The report also says that eradication efforts in the U.S. and Canada have had the perverse effect of making the marijuana crop many times as potent as it was 20 years ago, while still being the most widely available illicit drug. Serious health and psychology side effects are now as likely among marijuana users as those who use other 'harder' drugs.

Worldwide production of heroin and cocaine falling, says UN drug chief
From the Guardian:

Drug use should be treated more as an illness than a crime, the head of the UN's Office on Drugs and Crime said today as the body's annual report announced a worldwide decline in the production of cocaine and heroin.

The report for 2009 called for traffickers to be targeted rather than users and announced that there was a worldwide growth in synthetic drugs.

It also said the UK now had the largest number of cocaine users in western Europe, although the per capita rates were higher in Spain. The purity of the cocaine on sale in the UK has declined substantially, with less than 5% purity.

Britain had the highest number of "problem" drug users – as opposed to those who use drugs occasionally – in western Europe. The UK was also seizing more amphetamines than any other country in Europe.

Antonio Maria Costa, director of the UNODC, called for universal access to drug treatment and said: "People who take drugs need medical help, not criminal retribution."

He said that was one of the best ways of shrinking the market as people with serious drug problems provide the bulk of demand. He added that legalisation of drugs was not the answer.

According to the report, opium cultivation in Afghanistan, where 93% of the world's opium is grown, declined by 19% in 2008. Colombia, which produces half of the world's cocaine, saw an 18% decline in cultivation and a 28% decline in production compared with 2007.

Global coca production, at 845 tonnes, was said to be at a five-year low, despite some increases in cultivation in Peru and Bolivia.

Seismic shifts were taking place in the $50bn (£30bn) global cocaine market, the report suggested. "Purity levels and seizures [in main consumer countries] are down, prices are up, and consumption patterns are in flux. In Central America, cartels are fighting for a shrinking market."

Cannabis remains the most widely cultivated and used drug around the world. Data also shows that it is more harmful than commonly believed, said the report. The average THC content (the harmful component) of hydroponic marijuana in North America almost doubled in the past decade, which led to a big rise in the number of people seeking treatment.

The world's biggest markets for cannabis were North America, Oceania and western Europe. For cocaine, North America and some parts of western Europe remain the main markets.

While the use of amphetamines, methamphetamine and ecstasy has levelled off in developed countries, production and consumption may be growing elsewhere in the world. Industrial-sized laboratories in south-east Asia, it added, were producing massive quantities of methamphetamine tablets, crystal meth and other substances such as Ketamine.

The report concluded that illegal drug seizures were up in 2007 and all drug seizure totals were close to all-time highs; about 18 to 28 million people are heavy drug users who are likely to be "physically or psychologically dependent"; opiates and cocaine have about 16 to 21 million users each; between 11 and 21 million people inject drugs; between 16 and 51 million were amphetamine-group users in the past year; and between 12 and 23 million took ecstasy.

Posted: 6/24/2009 4:05:00 PM

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Study finds half of men arrested test positive for drugs

From USA Today:

Half of the men arrested in 10 U.S. cities test positive for some type of illegal drug, a federal study found.

Not only do the findings show "a clear link between drugs and crime," they also highlight the need to provide drug treatment, says Gil Kerlikowske, director of the White House Office of National Drug Control Policy.

Assessing offenders for drug and mental health problems and providing treatment is "important if you want to stop recidivism and recycling people through the system," says Kerlikowske, who supports drug courts that offer court-ordered drug treatment.

"There's an opportunity when someone is arrested to divert them to treatment if they need it," says Bill Piper, director of national affairs for the Drug Policy Alliance Network, a group that supports legalizing marijuana and treating drug use as a public health issue. "But people shouldn't have to get arrested to get treatment."

In 2008 researchers interviewed and obtained urine samples from 3,924 men arrested in 10 metropolitan areas: Atlanta, Charlotte, Chicago, Denver, Indianapolis, Minneapolis, New York, Portland, Ore., Sacramento and Washington, D.C.

In Chicago, 87% tested positive for drug use and in Sacramento, 78% tested positive. Many of the men — 40% in Chicago and 29% in Sacramento — tested positive for more than one drug.

Marijuana is the most common drug in every city where testing was done except Atlanta, where cocaine is most prevalent, the study found.

Methamphetamine use is concentrated on the west coast where 35% of the men arrested in Sacramento and 15% of the men arrested in Portland tested positive for the drug.

Heroin use is highest, at 29%, among men arrested in Chicago, an increase from 20% in 2007. Heroin use among arrestees declined in Portland, from 12% in 2007 to 8% in 2008.

Positive drug tests declined since 2007 among men arrested in Atlanta, Portland and Washington, the study found. Some of that decline can be attributed to law changes, Kerlikowske says.

Portland passed laws restricting access to ingredients needed to make methamphetamine, Kerlikowske says.

Cities and states need more resources for drug treatment, says Marc Mauer, executive director of The Sentencing Project, which advocates for alternatives to incarceration.

"If you just want drug treatment, in some places you are better off getting arrested and going to drug court," Mauer says.

"The federal resources that have gone into the drug war have been heavily oriented toward police and incarceration rather than treatment. We need to shift that use of resources," he says.

Posted: 6/12/2009 12:28:00 PM

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America's secret sickness exposed

From The New Zealand Herald:

Once it was cocaine, speed or heroin, but now the fashion is for legal pills, washed down by spirits.

The death of actor Heath Ledger from an accidental overdose of prescription tablets shed light on a startling trend - misuse of over-the-counter pills now kills more Americans than illegal drugs.

It is the fastest-growing type of drug abuse in the US. Even more worryingly, prescription drugs have made it on to the party scene as a legal, seemingly safe, way to recreate an illicit high.

Until last month this was a largely silent epidemic. But the death of Heath Ledger, a regular at Marquee and other nightclubs, thrust it into the spotlight. The 28-year-old actor died from "acute intoxication" caused by an accidental overdose of anti-anxiety medication and prescription painkillers.

The most commonly abused prescription medications fall into three categories: opiate-based painkillers; central nervous system depressants prescribed for anxiety and sleep disorders; and stimulants, used to treat attention deficit disorders.

"The problem has been greatly worsened by the internet, and that affects all countries," says Susan Foster, of the National Centre on Addiction and Substance Abuse at Columbia University, New York.

"As long as you have a credit card, anyone can log on and have potentially lethal drugs delivered to their door. You don't even need a prescription. You have what's called an 'online consultation' where you are asked how old you are, how bad your pain is."

One of the most popular forms of recreation among high-school students is the "pharm party".

Teenagers raid their parents' medicine cabinets, then pool their resources.

"You throw your drugs into a bowl in the middle of the room, then people pick pills out and chase them with alcohol," says Susan Foster.

"We've seen these internet recipe sites where you go online to find out how to mix drugs for a certain effect. You can trade drugs online - in fact, at one college the students reported that they had a prescription drug trade forum on the university website."

Click here for a comprehensive list of drug testing performed at NMS Labs.

Posted: 2/15/2008 11:00:00 PM

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