Breaking Bad at the Pharmacy

April 25, 2014

By Medical Discovery News


Drug abuse is not confined to street drugs like methamphetamine, heroin, and cocaine. America is facing an epidemic of prescription drug abuse, particularly with pain relievers, depressants, and stimulants. In 2010, 7 million Americans abused prescription drugs every month.

People are able to abuse such medications by taking medicines prescribed for someone else, using them in excess, or by taking them in a way not prescribed, such as crushing and snorting pills or liquefying and injecting them to hasten the effects needed to produce a high.

Depressants, sedatives, and tranquilizers are abused by more than 2.5 million people each month. The mood-altering drug Zoloft ranks sixth on the list of abused pharmaceuticals and earned more than $500 million in sales. It is prescribed for depression, obsessive compulsive disorder, post-traumatic stress disorder, and social anxiety disorder. The 10th most abused prescription drug is Xanax (alprazolam), called Xany, blue footballs, Xanybars, or just bars on the street. Xanax had sales of almost $275 million in 2012. This drug is intended to treat anxiety or panic disorders. It is often abused because it creates what is described as a sense of wellbeing, but can be fatal when abused.

The sleeping pills Ambien and Lunesta are the fourth and seventh most abused drugs from the pharmacy, with sales of $670 and $450 million respectively in 2012. Both are used to treat difficulties falling or staying asleep but can produce hallucinations when abused. Tom Brokaw of NBC News inadvertently experienced these symptoms from Ambien while covering the last presidential campaign.    

Drugs used to treat attention deficit hyperactivity disorder (ADHD) are also widely abused, usually by students seeking a way to stay awake and intensely focus on a project or test. Other than marijuana and synthetic marijuana, Adderall is the most-used drug by high school seniors and the eighth most abused prescription drug in the country. Its sales top $400 million. Other stimulants of the central nervous system, Ritalin and Concerta, are the third and fifth most abused pharmaceuticals. Stimulants can have significant side effects like irregular heartbeat, heart failure, seizures, and behavioral changes like paranoia or hostility. 

Some of the most abused drugs are opioid analgesics used clinically as pain relievers. These drugs are involved in 75 percent of all pharmaceutical overdose deaths – more than 16,000 people a year. An estimated 5.1 million people abuse these drugs each month. This included the most abused pharmaceutical drug – Oxycontin. In 2012, sales of this drug reached about $2.5 billion. The second most abused prescription drug, Suboxone, is used as a maintenance treatment for opioid dependence. Its sales brought in almost $1.4 billion. Another opioid, Opana ER (oxymorphone), ranks ninth on the list of most abused pharmaceuticals and is used to treat severe and chronic pain. It earned $300 million in sales in 2012.

Prescription drugs like these are a double-edged sword. They do a lot of good for a lot of people, and many genuinely need them to function. New regulations that govern the use of these drugs, while annoying for people who need them, help limit some of the abusive behavior of those breaking bad.

Inside a Hoarder’s Brain

Jan. 25, 2013

By Medical Discovery News

Most people who watch an episode of the TV show “Hoarders” can’t tear their eyes away from the screen. Oftentimes what’s shown is too hard to believe – tall stacks of old newspapers, broken lightbulbs, empty water bottles, bag after bag of unopened inexpensive household items, and all kinds of objects the owner can’t imagine throwing away. One episode of the show featured a man who had to crawl on his stomach to dodge the piles of junk paper he had accumulated over years.

Hoarding was thought to be an obsessive compulsive disorder (OCD), which drives someone to do something as a result of repeated thoughts, feelings, or ideas. But recent studies, especially a new finding published in the “Journal of the American Medical Association,” shows hoarding is not a form of OCD, but rather its own dysfunction.

The new study led by David Tolin, director of the Anxiety Disorders Center at the Institute of Living, shows hoarders have unusual brain activity in areas responsible for decision making. Tolin’s team recruited 40 hoarders, 33 healthy adults, and 31 with OCD. Each was asked to bring 50 ordinary objects from home and their brains were scanned while they decided whether to keep or destroy the items one by one. They also had to decide to keep or destroy 50 similar items that did not belong to them.

Functional magnetic resonance imaging (fMRI) monitored subjects’ brains for changes in blood flow and activity in key regions of the brain, the anterior cingulated cortex and insula – a decision-making network that helps a person determine whether something should be kept or tossed.

When faced with deciding whether to throw away one of their own items, hoarders felt more anxiety and indecisiveness compared to the others. The fMRI revealed a massive increase in activity in these two decision-making regions of the brain.

In contrast, when making decisions about items that were not theirs, the brain scans of hoarders showed no activity in these regions compared to the other two groups, showing an extreme lack of engagement with things that do not belong to them. Yet, the overstimulation of these regions leads to overwhelming angst and the inability to discard anything. Thus, the malfunction of this brain decision-making network may explain hoarders’ behaviors, including how they can ignore the massive amounts of clutter in their own homes.

Should the upcoming Diagnostic and Statistical Manual of Mental Disorders recognize hoarding as its own disorder, drug companies may be more incentivized to develop medication to treat the symptoms. Combined with cognitive therapy, doctors believe people can overcome hoarding. Two to five percent of the population suffers from hoarding, twice the number of people who live with OCD.

Hoarding can also become a health and fire hazard for others. Recent studies show homes of hoarders caused one-fourth of fire-related fatalities, and damages are eight times more than non-hoarding homes. Addressing the hoarding problem and helping hoarders overcome their disorder can have a ripple effect.

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