Injection Drug Users Most in Need of Treatment, Study Says (HealthDay)

FRIDAY, July 15 (HealthDay News) -- Injection drug users have the greatest need for substance abuse treatment, regardless of what types of drugs they use, according to a new study.

Since injection drug users suffer higher rates of abuse, dependence and other physical and psychological problems, researchers argued their findings could help treatment programs specialize their care to target these high-risk individuals.

"Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders," said the study's lead author Scott Novak, senior behavioral health epidemiologist at RTI International in an RTI news release.

"These problems appear to characterize a treatment-resistant population in need of specialized treatments," he concluded.

The study was published in the July issue of the Journal of Addictive Diseases.

To investigate injection drug use, the researchers compiled data from the National Survey on Drug use and Health, an annual U.S. survey of about 70,000 children and adults.

Among the study's findings, researchers revealed those living in rural areas were more likely to inject drugs than those residing in either urban or suburban areas. Injection drug users were also more likely than those using drugs in other ways to be aged 35 and older, unemployed, and to not have a high school diploma.

"This study confirms a longstanding belief that injection drug users are a unique population with their own treatment needs, regardless of what drug they inject," concluded Novak. "By learning more about how routes of administration are related to user characteristics, we could improve our ability to tailor substance abuse treatment and prevention strategies to individual users."

The study's authors also noted that injection drug users are more commonly arrested or jailed than other types of drug abusers. As a result, individualized treatment for injection drug users should extend to those who are incarcerated.

More information

The National Institute on Drug Abuse provides more information on substance abuse treatment.

Medicare Part D sees falling drug costs: study (Reuters)

WASHINGTON (Reuters) – Cheaper generic drugs will continue to hold down costs for the U.S. government, insurers and patients enrolled in the federal prescription drug benefit, according to a report released on Friday.

Researchers said eight of the ten most commonly prescribed drug classes covered by the program known as Medicare Part D have fallen to an average daily cost of therapy of $1 in December 2010 from $1.50 in January 2006.

This trend toward cheaper generic drugs, as brand-name patents expire, is expected to continue through 2015, said the study by Murray Aitken of the IMS Institute for Healthcare Informatics and Ernst Berndt of the Massachusetts Institute of Technology and the National Bureau of Economic Research.

The study forecast the average cost of therapy to fall to 65 cents a day by the end of 2015, or 57 percent lower than it was in January 2006.

The findings could temper some of the concern over the growing costs of Part D that subsidizes medicines for seniors and disabled Medicare patients who pay some of the costs through insurance plans and out of pocket.

Part D went into effect in 2006 after being created under 2003 legislation passed by a Republican-led Congress and signed into law by then-President George W. Bush. It has been criticized for being insufficiently funded, a costly drag on the healthcare system and a contributor to the national debt.

Companies such as Aetna Inc, CVS Caremark Corp and Humana Inc sell the Part D plans, but are overseen by the Centers on Medicare and Medicaid Services (CMS).

Last year, 34.5 million Americans were enrolled in Part D plans, receiving an average of $1,789 in benefits, according to a report issued in May by the Medicare Trustees.

The trustees said almost $62 billion was spent on Part D prescription drug benefits in 2010 and projected that this year's spending will reach $67 billion, growing to almost $157 billion by 2020 as the aging U.S. population sees more and more people enroll.

But the authors of Friday's study said that may be overstating the costs.

"The general conclusion we draw is that cost declines observed in the first five years of Medicare Part D can be expected to continue," the researchers wrote.

"The 2006-2015 decade is one of steadily decreasing average daily cost of therapy."

Berndt, a co-author, said CMS has fairly consistently over-projected future prescription drug costs.

"(It) doesn't properly take into account reasonably predictable patent protection expirations," he told reporters on a conference call.

Medicaid Coverage 'Substantially' Improves Access to Care: Study (HealthDay)

THURSDAY, July 7 (HealthDay News) -- Expanding Medicaid coverage among low-income adults increases health care use, improves health and well-being and reduces the financial strain for people with the publicly funded health coverage, according to new research.

"This study shows that Medicaid substantially expands access to and use of care for low-income adults relative to being uninsured," co-principal investigator Katherine Baicker, professor of health economics at Harvard School of Public Health, said in a Harvard news release.

She and her colleagues looked at 10,000 low-income, uninsured adults in Oregon who were randomly selected in a 2008 state lottery to accept additional people into its Medicaid program. The health outcomes of these people were compared to the 80,000 applicants who weren't selected in the lottery.

The first year of the ongoing study showed that Medicaid coverage increases the likelihood of outpatient care by 35 percent, the use of prescription drugs by 15 percent, and of hospital admission by 30 percent. This leads to about a 25 percent increase in annual health care spending.

Medicaid coverage also increases the use of recommended preventive care such as mammograms by 60 percent and cholesterol monitoring by 20 percent. It also increases access to care. For example, people with Medicaid were 70 percent more likely than those without insurance to have a regular doctor's office or clinic for primary care, and were 55 percent more likely to have a particular doctor that they usually see.

Compared to uninsured people, those with Medicaid coverage were 40 percent less likely to have to borrow money or skip paying other bills to pay for health care, and 25 percent less likely to have an unpaid medical bill sent to a collection agency.

The researchers also found that the adults with Medicaid coverage were 25 percent more likely to report they were in good to excellent health, and 10 percent less likely to report being depressed.

The findings are published July 7 as a working paper (number 17190) on the website of the National Bureau of Economic Research. Support for the study was provided by the U.S. National Institute on Aging, the Centers for Medicare & Medicaid Services, the California Healthcare Foundation, and other foundations and government agencies.

"Some people wonder whether Medicaid coverage has any effect. The study findings make clear that it does. People reported that their physical and mental health were substantially better after a year of insurance coverage, and they were much less likely to have to borrow money or go into debt to pay for their care," co-principal investigator Amy Finkelstein, a professor of economics at MIT, said in the news release.

The researchers will follow the lottery participants for another year and directly measure health outcomes such as obesity, blood pressure, cholesterol and blood sugar control.

Under the Obama administration's Affordable Care Act, Medicaid coverage will be expanded to cover additional low-income adults in all states in 2014.

More information

The U.S. Centers for Medicare and Medicaid Services has more about Medicaid.

Behavioral Techniques a Better Value for Chronic Migraine Than Meds: Study (HealthDay)

FRIDAY, July 8 (HealthDay News) -- Behavioral treatments such as relaxation training, hypnosis and biofeedback to help prevent chronic migraine headaches are cost-effective alternatives to prescription drugs, a new study suggests.

Researchers compared the costs of several types of behavioral treatment with preventive prescription drugs. After six months, minimal-contact behavioral treatment was comparable with drug treatment using medicines that cost 50 cents or less per day.

In minimal-contact treatment, a patient sees a therapist a few times a year and for the most part practices the behavioral techniques at home, helped by literature or audio tapes.

After one year, minimal-contact therapy was nearly $500 cheaper than drug treatment.

The study is published in the June issue of the journal Headache.

Initially, the daily cost of prescription drugs taken as a preventive measure by many chronic migraine sufferers may not seem too high, said study co-author Dr. Donald Penzien, a professor of psychiatry at the University of Mississippi Medical Center.

"But those costs keep adding up with additional doctor visits and more prescriptions. The cost of behavioral treatment is front-loaded. You go to a number of treatment sessions but then that's it. And the benefits last for years," he said in a medical center news release.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about migraine.

Injection Drug Users Most in Need of Treatment, Study Says (HealthDay)

FRIDAY, July 15 (HealthDay News) -- Injection drug users have the greatest need for substance abuse treatment, regardless of what types of drugs they use, according to a new study.

Since injection drug users suffer higher rates of abuse, dependence and other physical and psychological problems, researchers argued their findings could help treatment programs specialize their care to target these high-risk individuals.

"Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders," said the study's lead author Scott Novak, senior behavioral health epidemiologist at RTI International in an RTI news release.

"These problems appear to characterize a treatment-resistant population in need of specialized treatments," he concluded.

The study was published in the July issue of the Journal of Addictive Diseases.

To investigate injection drug use, the researchers compiled data from the National Survey on Drug use and Health, an annual U.S. survey of about 70,000 children and adults.

Among the study's findings, researchers revealed those living in rural areas were more likely to inject drugs than those residing in either urban or suburban areas. Injection drug users were also more likely than those using drugs in other ways to be aged 35 and older, unemployed, and to not have a high school diploma.

"This study confirms a longstanding belief that injection drug users are a unique population with their own treatment needs, regardless of what drug they inject," concluded Novak. "By learning more about how routes of administration are related to user characteristics, we could improve our ability to tailor substance abuse treatment and prevention strategies to individual users."

The study's authors also noted that injection drug users are more commonly arrested or jailed than other types of drug abusers. As a result, individualized treatment for injection drug users should extend to those who are incarcerated.

More information

The National Institute on Drug Abuse provides more information on substance abuse treatment.

Single Reading Can't Gauge Blood Pressure Control: Study (HealthDay)

By Kathleen Doheny
HealthDay Reporter by Kathleen Doheny
healthday Reporter – Mon?Jun?20, 11:48?pm?ET

MONDAY, June 20 (HealthDay News) -- Evaluating how well a person responds to medication meant to lower blood pressure requires multiple readings, new research suggests.

Blood pressure often spikes at doctor appointments, a condition known as "white coat" hypertension, so readings should also be taken by patients at home, said the study's lead author, Dr. Benjamin Powers, assistant professor of medicine at Duke University Medical Center.

''Collecting just a few, five or six, blood pressure readings from home will help your doctor make much better decisions about whether your blood pressure is in or out of control," Powers said.

For the study, Powers and his colleagues evaluated 444 U.S. veterans with high blood pressure, about 90 percent of them men with an average age of 64. All had been diagnosed about 10 years earlier. Their blood pressure was considered uncontrolled, even though most took multiple blood pressure-lowering medications. Untreated, high blood pressure can lead to stroke.

The study compared blood pressure readings taken in three settings -- at home, in a doctor's office, and at a clinical research setting -- at the study start and again at 6, 12 and 18 months. The findings are published in the June 21 issue of the Annals of Internal Medicine.

The measurements varied widely, Powers found. "Only a third of them were consistently categorized as in or out of control by all three measures," he said.

That points to the importance of getting multiple measures from different settings, said Powers, who is also with the Durham Veterans Affairs Medical Center. Using just one reading as the basis for prescribing or adjusting blood pressure medication could endanger patients who suffer from "white coat" hypertension, the study authors said.

As many as six readings were needed to obtain the best estimate of true blood pressure, the authors said, adding that doctors should average the results.

Home monitoring of blood pressure has gained respect in recent years, Powers said. About 43 percent of people with high blood pressure use home monitors, according to background information in the study. Powers and his colleagues said their results support recent calls for reimbursement of home blood pressure monitoring.

"I think patients should expect their doctors to make decisions based on home blood pressure [in addition to other measures]," he said.

Those who buy a home blood pressure monitor should get it validated for accuracy at their doctor's office, Powers added.

Patients should be advised to measure their blood pressure at different times of the day, and to sit and relax for five minutes before taking it, Powers explained. Variations are to be expected, he noted.

According to Dr. Joseph Diamond, director of nuclear cardiology at Long Island Jewish Medical Center in Hyde Park, N.Y., blood pressure readings are perhaps "the most frequent assessment that results in a change of medical therapy."

Even so, the procedure is frequently flawed because of poor measurement technique or insufficient measurements, he said.

"This study confirms the need to improve both measurement technique and the number of measurements obtained so that a therapeutic decision to start or change medication is based on more accurate information," said Diamond.

Writing in an accompanying editorial of the journal, Dr. Lawrence J. Appel and colleagues from Johns Hopkins University said the findings point to a need for regulation of blood pressure screening. "It is time to get serious about BP measurement," they wrote.

More information

To learn more about home blood pressure monitoring, visit the British Hypertension Society.

Study: Most Addicts Get Painkillers from Friends or Family, Not Doctors (Time.com)

Only 1 in 5 people who misuse opioid painkillers like Vicodin get their drugs exclusively from doctors, and 69% never obtain any of these drugs from medical sources, according to a recent study published in the Archives of Internal Medicine.

Researchers led by Yale's Dr. William Becker examined 2006-08 data from the National Household Survey on Drug Use and Health (NHSDUH), an annual survey that includes information from interviews with thousands of people about their drug habits. (See the top 10 side effects of the war on drugs.)

Information was obtained for more 3,000 people over 18 who reported having taken an opioid painkiller that was not prescribed to them or for nonmedical reasons in the last month. In line with prior research, the new study found overwhelmingly that most opioid misusers were not being treated for pain and had obtained their drugs from friends, family or dealers, not doctors.

Younger drug misusers were less likely to get their drugs from doctors than middle-age and older ones: 77% of 18-to-25-year-olds got their painkillers exclusively from nonmedical sources, compared with 52% of those older than 50.

Prior research examining this question from the other direction - looking at the proportion of pain patients who develop first-time drug problems when given drugs by their doctors - finds that less than 3% become addicted this way. NHSDUH data also show that 80% of Oxycontin misusers have previously taken cocaine, suggesting that their addiction was not likely to have originated from being legitimately prescribed an opioid for pain. (Read "The New Drug Crisis: Addiction by Prescription.")

Nonetheless, efforts to fight opioid misuse are focused almost exclusively on trying to get doctors to write fewer prescriptions and using databases to track patients' medical records and doctors' prescribing habits. The new data suggest that it a more fruitful approach to the problem of painkiller misuse - and to the problem of legitimate pain patients not begin able to get drugs - may be to focus on what drives people with drug problems to seek out opioids and on supply sources other than doctors, including foreign drug companies, dealers and theft from factories, friends and family.

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Millions Don't Get Meds for Serious Artery Disease: Study (HealthDay)

MONDAY, June 20 (HealthDay News) -- Millions of Americans suffer from a condition known as peripheral artery disease but aren't receiving medical treatment, putting them at risk of potentially fatal heart problems, a new study finds.

Those who had the condition but didn't take medications were more likely to die of all causes during the period studied, although it's not clear how the disease specifically affected their health, the researchers noted.

The findings, released online June 20 in advance of publication in an upcoming print issue of the journal Circulation, reinforce the belief that peripheral artery disease, or PAD, is an early warning sign of possible clogged vessels elsewhere in the body, said study lead author Dr. Reena L. Pande, a cardiologist and associate professor at Harvard Medical School.

"We think of it as a manifestation of a whole-body problem," she said. "What happens in the legs can happen in other parts of the body, like the heart and the brain even."

Atherosclerosis -- or blockages in the arteries in the legs caused by plaque -- is the source of PAD. Physicians have long known about the condition, but it's only begun to receive much attention in the last couple of decades, Pande said.

People with the condition may experience cramping in the hips, thighs or calves, pain and burning sensations in the legs, ulcers and even amputation. But in many cases, no symptoms occur.

A simple test of the blood pressure in the arm and the ankle can detect the condition, and there's debate about whether the test should be routine, said Pande, who is also an associate physician at Brigham and Women's Hospital in Boston.

In the new study, funded in part by federal grants, Pande and colleagues analyzed statistics from a national survey of 7,458 people aged 40 and older. The participants were tracked from 1999 through 2004.

The researchers found that about 6 percent of the participants suffered from peripheral artery disease, translating to about 7 million adults in the United States. Of those, 25, 36 and 31 percent, respectively, took high blood pressure medication, aspirin or cholesterol drugs.

Those who took two or more of the drugs were 65 percent less likely to die of all causes during the seven years of the study, Pande said. However, she said the percentages of people who died in each group -- those who took two or more drugs and those who didn't -- weren't available.

The research "raises the question of whether we should be looking for these people to get them on the appropriate treatments," Pande said. "We don't have any studies that tell us that if we find them and treat them, they'll have a lowered risk of dying. But it makes us wonder if we should try to find these individuals with a simple screening test."

The screening test is inexpensive and can be conducted by health care professionals other than doctors, she said. As for cost, at least one of the medications in question -- aspirin -- is very inexpensive.

Dr. Jeffrey W. Olin, a vascular medicine specialist at Mount Sinai School of Medicine in New York City, said the study provides more evidence that doctors should take peripheral artery disease seriously and treat it. In many cases, he said, doctors don't prescribe medications even when they know a patient has the condition.

"We've been working on this for 15 years, trying to get health care providers to be aware of the fact that people with peripheral artery disease don't die because of their legs," he said. "They die because they have heart attacks and strokes."

More information

For more about peripheral artery disease, visit the U.S. National Library of Medicine.

Study Finds Botox Alternative Better at Smoothing 'Crow's Feet' (HealthDay)

MONDAY, June 20 (HealthDay News) -- A more recently approved version of botulinum toxin type A beat the anti-wrinkle medication Botox in a trial that compared the respective powers of each in erasing those unwanted lines of aging around the eyes known as "crow's feet."

"One month after treatment, on a two-to-one preference basis, patients picked Dysport over the Botox in terms of wrinkle improvement," said study co-author Dr. Corey S. Maas, an associate clinical professor at the University of California, San Francisco, as well as a plastic surgeon with The Maas Clinic, based in San Francisco and Lake Tahoe.

"So, we can say that when it comes to addressing the smile lines around the eyes, the crow's feet, at one month the Dysport is more effective than Botox," Maas said. "And that's a big deal, because Botox is such a recognized household name now. And it's such a great drug. But when you have something that comes in that's as good in some areas, let alone even better, it's big news for all of us, both doctors and patients."

Maas and his colleagues report the findings in the June 20 online edition of the Archives of Facial Plastic Surgery.

In 2002, the U.S. Food and Drug Administration first approved a particular form of botulinum toxin type A; this drug is popularly known as Botox and is manufactured by Allergan Inc.

An alternate version of the same botulinum toxin was approved in Europe in 2001 for general cosmetic applications. The drug, known as Dysport, is manufactured by Medicis Aesthetics; this version of botulinum was approved for use in the United States in 2009.

To compare the efficacy of both, the research team focused on 77 women and 13 men aged 18 and up between 2009 and 2010. None had previously undergone a facelift, brow lift or laser/chemical resurfacing. None had been exposed to botulinum in any form in the six months prior to the study launch, nor had any experienced adverse side effects as a result of previous exposure to botulinum.

Pre-procedure photographs were taken of all the patients, both while at rest and while contracting their foreheads and eyebrows. Wrinkling was subsequently graded on a five-point scale.

Next, the team the launched a so-called "split face" study, in which the right and left sides of each patient's face were each exposed to one of the drugs. Calculating that the strength ratio of the two drugs is about three-to-one, the researchers injected 10 units of Botox into the crow's feet region of one side of the face, compared with 30 units of Dysport on the other, according to the report.

One month following injection, the patients were asked to contract their muscles as hard as they could, while photographs were again taken.

The result: both the researchers and a majority of patients concurred that Dysport appeared to produce a better outcome. Specifically, two-thirds of the patients expressed a preference for Dysport, ranking Dysport nearly one point higher on the five-point wrinkling scale.

The authors noted, however, that when the patients relaxed their faces there was no appreciable difference between the Dysport and Botox sides.

"Now we want to be careful not to overplay this," stressed Maas. "From our findings, it's clear that there's a better smoothing effect and clearing of lines around the eyes with Dysport. But does that also mean that Dysport is better at achieving the same thing around the mouth or forehead or neck? We really can't make that conclusion."

Maas added that, "the cost of the two amounts respectively are about the same. Maybe actually a little bit less for Dysport, but not substantially less."

He also acknowledged that although the manufacturers of both drugs were approached to support the current investigation, only the maker of Dysport ultimately contributed funding to the effort.

"And what I would personally say about that," noted Maas, "is that if you already own 90 percent of the market why would you fund a study where if you tied you lost? But I will add that Allergan didn't like the dosing or the statistical analysis we used, despite the fact that I believe the body of scientific evidence supports the way we handled both."

But Allergan issued a statement Monday that challenged the findings on several grounds, which included the small size of the study, the short length of the trial and, most importantly, the dosing ratio the researchers used when deciding how much of each product to use on the patients' faces.

"It is important to understand that no two botulinum toxins are alike and each has a unique molecular structure, formulation, potency and safety profile," the company said in its statement. "In fact, the U.S. FDA-required product labels for BOTOX Cosmetic and other botulinum toxins state that different botulinum toxin products are not interchangeable and no consistent dose ratio exists among botulinum toxin products."

"The most significant flaws in this study's design were the attempted dose conversion and injection pattern. In this study, patients were treated with 10 units of BOTOX Cosmetic and 30 units of Dysport. As stated above, BOTOX Cosmetic and Dysport are not interchangeable and there is no established dose conversion, meaning 10 units of BOTOX Cosmetic does not equal 30 units of Dysport. When patients are treated with BOTOX Cosmetic for its approved indication in the glabellar (vertical frown lines between the eyebrows), they typically receive 20 units, which is the FDA-approved dose. In addition to specific dosing regimens, BOTOX Cosmetic also has a unique injection pattern for proper administration, pending the treatment area and individual patient."

Dr. Doris Day, a dermatologist with Lenox Hill Hospital in New York City, also cautioned that the attempt to analytically stack two "very similar" drugs against one another can pose difficulties.

Commenting on the study, she said, "The problem with any study trying to compare them is that there are variations in the reconstitution measures and final numbers of units used for each drug, and that can have a large impact on the final effect of the treatment. Because these are biologics, and because there are slight differences in the manufacturing process, there will be some differences in how the final product works."

Day pointed out that both drugs are FDA-approved and have good safety track records to date.

More information

For more on botulinum toxin, visit the U.S. Department of Health and Human Services.