Screening pregnant women for drug use

Medical Groups Say All Pregnant Women Should be Screened for Drug Use

The American Congress of Obstetricians and Gynecologists (ACOG) has joined other medical organizations in calling for all pregnant women to be screened for drug use, with a follow-up urine test if necessary, to reduce the growing number of infants born with neonatal abstinence syndrome (NAS), which is caused by maternal opioid use during pregnancy. The American Medical Association (AMA) and the Association of State and Territorial Health Officials (ASTHO) also have adopted policies calling for universal screening of pregnant women.

A 2012 study published in the Journal of the American Medical Association found that every hour, an infant is born in the United States with symptoms of NAS, which is marked by constant high-pitched crying, vomiting, diarrhea, low-grade fever, seizures and tremors. Premature infants with NAS may experience respiratory distress and need to be placed on ventilators.

Specifically, the new ACOG policy supports the idea of a “screening dialogue” with pregnant women. The group says urine drug tests should be used only to confirm suspected or reported drug use, and conducted only with the patient’s consent. Physicians also should inform women of any legal consequences of a positive drug test, such as the need to alert child protective services.

Source: American Congress of Obstetricians and Gynecologists. Pregnant women & prescription drug abuse, dependence and addiction. Toolkit on State Legislation. ACOG: 2014.

Even More Illness Caused by Smoking than Previously Estimated

In a newly published report, CDC researchers estimate that 14 million U.S. adults experienced at least one major medical condition attributable to smoking in the year 2009. The researchers based their estimate on two existing national datasets—the National Health Interview Survey (for a general estimate of all smoking-related diseases) and the National Health and Nutritional Examination Survey (NHANES) (to account for underreporting of COPD).

Pointing out that cigarette smoking harms nearly every organ and organ system in the body, the report’s authors also estimated that smoking is linked to 2.3 million cases of heart attack, 1.3 million cases of cancer, 1.2 million cases of stroke, and 1.8 million cases of diabetes. They add that, for each annual death, there are 15 to 20 persons living with major disease caused by smoking,” said senior author Terry Pechacek of the CDC. He added: “Smoking not only will kill you, it will damage your health and make your life worse.”

Source: Rostron BL, Chang CM & Pechacek PF. Estimation of cigarette-smoking attributable mortality in the United States. JAMA Internal Medicine. 2014 Oct 13 [Epub ahead of print].

Heroin Overdose Deaths Rise as Prescription Opioid Overdose Deaths Fall

The death rate from heroin overdoses doubled from 2010 to 2012, according to a new study from the Centers for Disease Control and Prevention (CDC). However, as overdose deaths associated with heroin rose, those involving  prescription opioids declined. The study’s authors speculate that some individuals may have switched from prescription medications to illicit drugs in response to laws aimed at reducing prescription drug abuse.

Between 1999 and 2011, overdose deaths involving prescription opioids quadrupled, from 4,030 to 16,917. However, in 2012 the number of such deaths declined by 5 percent, to 16,007. However, overdose deaths associated with heroin increased by 35 percent between 2011 and 2012, from 4,397 to 5,927.  The largest increase in heroin overdose deaths occurred in the New England states, followed by the South.

The study also found that 75 percent of heroin users in opioid treatment programs who started using heroin after 2000 say they first abused prescription opioids but later switched to heroin. Many said they made the switch because heroin was easier to obtain, less expensive and more potent than the prescription opioids they had been using. In contrast, more than 80 percent of subjects who began using heroin in the 1960s reported that they did not begin by abusing another drug.

Source: Rudd RA, Paulozzi LJ, Bauer MJ et al. Increases in heroin overdose deaths — 28 States, 2010 to 2012. MMWR. 2014 Oct 3;63(39);849-854.