Underage Drinking - having celebratory family dinners and events without alcohol from time-to-time can send a powerful message to children and teens that alcohol is not necessary to having a good time.

Underage drinking - sometimes a small change in how parents think or talk about or model drinking can make a big difference.

"If you're going to drink, just don't drive."

"At least when I host the party and take away the keys, I know they're safe."

"Drinking at high school parties is a rite of passage for teens."

You've likely heard these kinds of comments from parents - perhaps even said or thought them yourself - but the way teens interpret these messages may surprise you, namely, that it's okay to drink (and in a teen's world, that's not sipping a glass of wine with dinner).

Navigating the middle school and high school years and what to say to your teen about drinking can be difficult. As parents, we want to do what's best, and we want to trust our children will do as we say. But if our actions around drinking do not model our words, the mixed messages can be confusing for our kids. To keep it clear, parents may want to consider:

1.  Not encouraging (or turning a blind eye to) underage drinking. There are scientific reasons for this. The brain is not fully developed until one's early 20s, often not until 25, and is experiencing brain changes related to puberty, cerebral cortex development, and the pruning and strengthening process. Therefore, there could be long-term consequences such as a negative impact on the memory center of the brain. Check out A Parent's Guide to the Teen Brain for more information.

2. Not drinking any amount if driving. Parents with their fully developed brains, may find they can consume a standard drink (standard drink sizes = 5 oz. of wine or 12 oz. of regular beer) with dinner at 6:00 and be okay to drive home at 9:00 p.m., but if their child is with them, their child may interpret the behavior as a message that it's safe to drink and drive.  Explain to your teen how the body processes alcohol (see #3), which is why drinking and driving has dangerous consequences. Check out this related post, as well, "National Drunk and Drugged Driving Prevention Month."

3.  Not having too much to drink in front of children.  If a parent is going to drink in front of their children, it's important to know and stay within moderate drinking limits.  This sort of modeling sets the example, and equally important, it helps parents prevent secondhand drinking for children and others. How? Typically, if a person waits until they "feel it," it's too late. This is because alcohol is not digested like other foods or liquids - it is metabolized by the liver, which takes about one hour to metabolize (rid the body) of the alcohol in one standard drink. Drinking more than the liver can metabolize changes how the brain functions.  Other considerations when it comes to parental drinking include knowing how many standard drinks are in a particular cocktail and how many standard drinks constitutes "normal" drinking. For this kind of information, visit NIAAA's website, Rethinking Drinking.

4.  Not always celebrating with alcohol. When an event involves the kids, such as a family-oriented Super Bowl party, wedding, backyard barbeque or their sports award program, and alcohol is being consumed by the adults, it sends the message that drinking is an important part of celebrations. Consider throwing an alcohol-free event, instead, to show that one can have fun without alcohol.

5. Don't leave it to the school to have the "drinking and drug talk." Parents need to talk early and talk often with their kids. If the drug and alcohol issue is talked about at home like any other health issue - getting enough rest, wearing a bike helmet, using a seat belt - from elementary school on, your teen will be better informed about the consequences of teen drug and alcohol use - especially as they affect the brain and brain health.

Merrowvista 2012: Family Group Olympics!

Recently, some members from Berlin High School's SADD group had the privilege of having an amazing weekend November 9th -11th at a Youth Leadership Conference held at the Merrowvista Educational facility in Tuftonboro, NH. Many of our members were unsure of how the weekend would be but, after only a few hours they were hooked on the experience. During the last school group planning time members were asked to write down their favorite part of the weekend and various responses were given:

-Al Aldrich from Family Group 1 (FG 1) said that her favorite part was the ropes course because she "learned how important teamwork is and how much quicker a challenge can be accomplished when working together".

-Beth Leveille from FG 2 said that, "My favorite part of Merrowvista was meeting all kinds of new friends and making memories that I'll never forget. Everyone here is so friendly and easy to get along with. These people make me want to keep coming back again and again!"

-The theme of friends was also evident for FG 3's Jane Burdick, as she wrote her favorite part was family groups. She also said, "I like how you meet total strangers and end up becoming friends. The sense of belonging was incredible".

-Colbie Ayotte from FG 4 talked about his friends and coming together to be part of the Talent Show. "We all had a really positive energy and all encouraged each other. We also got to feel closer to everyone because we were all working together".

-Sierra Sanshagrin from FG 5 said that her favorite part was the council fire. "I really love the fire because during that time of silence, I felt connected with every person there. I felt as if we were one team".

-Jill Williams from FG 6 also said that she enjoyed the council fire because "it wasn't like any other activity".

-Brianna Bryant from FG 7 enjoyed "going to the beaver dam and making new friends. These were my favorite because seeing a beaver flap its tail was awesome and I love meeting people".

-Megan Guitard and Kayleigh Eastman, both from FG 8, emphasized meeting new people and balancing "on the Whale Watch Platform with their family groups" as being their favorite. Megan stated, "Every time I go to something like this that is what I look forward to." Kayleigh emphasized "the teamwork they shared" to successfully master the Platform and stated that "the workshops I attended were also a lot of fun and I learned a lot."

-Two other Berlin participants from FG 9 were Emily Tennis and Julianne Plourde. Emily said her favorite was "the council fire because it felt like everyone was together as one and I enjoyed listening to everyone speaking." Julianne said she enjoyed meeting with her family group "because we got to get to know each other and bond really well."

-A-Team member Amber Roberts, said she enjoyed "being part of the A-Team which runs a bunch of activities" and that she "liked helping the participants find their way around if they didn't know where to go. It was cool to see everyone smiling, making new friends, and having an awesome time".

It is clear that all of the participants have taken back amazing memories from this conference and will never forget their time there. During the school group planning this group was inspired to make a difference in our school and change it for the better. They were excited about the experience they were having and what they were learning from their time there. They really want to make a difference and know it can definitely happen.

Youth staffer Kathryn Record, and writer of this article is saying "my favorite part was creating a bond with my family group and having a lot of fun while still getting our business done because I feel as if making these bonds and doing these things can help empower people to make a difference in their schools and communities."

Adult chaperone and advisor, Carole Chabot states her favorite being "to watch my students who are shy and reluctant come out of their comfort zone, feel completely at ease and know it's okay to be who you are."    

This conference has made a difference in people's lives. It inspires a positive energy that, when transferred back to our schools, can really make a difference. The "Merrowvista 2012" Youth Leadership Conference has made an impact like no other, and its presence will stick with this group throughout the year and influence choices that they will make.

To keep abreast of Prevention Youth Council activities,

please visit their InspireNH blog:

http://www.inspirenh.org/  

Concord - The New Hampshire Department of Health and Human Services (DHHS) Bureau of Drug and Alcohol Services (BDAS) is releasing a report showing tobacco sales to youth in New Hampshire increased over the past year.

According to recent tobacco compliance checks tobacco sales to New Hampshire youth increased by about 5% to 13.2% in 2012 from 7.8% in 2011.

"While the results of the checks were well under the federal SYNAR requirement of 20%, this does raise concerns," stated BDAS Director Joe Harding. "Research shows that lower tobacco use by youth also decreases the chance that they will use drugs or alcohol."

Data from the NH Youth Risk Behavior Survey (YRBS) demonstrated that youth tobacco use dramatically increases their use of other substances. The results of 22,000 student surveys in the 2007 YRBS revealed that 27 out of 28 high school students who smoked also reported drinking.

SYNAR is a federally mandated effort to reduce tobacco sales to youth. 291 tobacco retailers across the state were surveyed in this year's effort.

BDAS partners with the NH Division of Liquor Enforcement (DLE), to conduct and report on the results of the compliance checks. In addition, DLE has been contracted by the US Food and Drug Administration to conduct additional tobacco retailer compliance checks.

BDAS and DLE plan to increase efforts to lower the number of sales, which declined for the two previous years. These efforts will include increased coordination with local law enforcement and other educational efforts.

For more information on the SYNAR program, please visit:

http://www.samhsa.gov/prevention/synar.aspx  

*Source: Youth Risk Behavior Survey 

On Friday November 2nd, something unexpected happened during an armed robbery at the Ciampa Apothecary on Cambridge Street in Boston. As the pharmacist reflexively began filling a bag with OxyContin - the poster pill for painkiller abuse over the past decade - the masked robber shouted that he didn't want them; according to the Boston Globe, he demanded methadone, opana, and alprazolam instead.

"OxyContin? That's going out of style," says Dr. Gregory G. Davis, professor of pathology at the University of Alabama at Birmingham, and associate coroner for Jefferson County, which includes the city. "Right now it's heroin. We've gone from one or two heroin deaths per year to one to two per week."

Dr. Kevin Whaley, Assistant Chief Medical Examiner for the Commonwealth of Virginia, has seen the same thing: "There has been a decrease in oxycodone [the active ingredient in OxyContin] overdosage as a consequence of the tamper-resistant measures taken by the manufacturer," he says via email.

"Pathology covers the front lines of medicine," notes Davis, who is a spokesman for the American Society for Clinical Pathology. "We are in a position to see all of these changes as they occur and document them through careful laboratory analysis." In other words, pathology provides the most objective account of what is actually happening in terms of drug abuse. And while he cautions that trends in illegal drug consumption wax and wane, and differ from region to region, as supply dictates demand, a recently published study in the Journal of Pain - along with anecdotal evidence from law enforcement - suggests that the age of OxyContin abuse - as we know it - could be drawing to a close, thanks to the introduction of an abuse-resistant version of the painkiller. Indeed, the results are positive enough that one leading pain expert in the US argues the Food and Drug Administration (FDA) should only license abuse resistant painkillers.

Released in August 2010, the new OxyContin turns into a gummy mush when you attempt to crush it, instead of the fine powder of its predecessor, which addicts snorted or injected to get a swift and powerful high. The original OxyContin was, initially, seen as a breakthrough in pain relief because it would slowly release its active ingredient, oxycodone, over 12 hours, allowing people with chronic pain to be able to take fewer pills, sleep through the night, and generally be less tortured by their condition.

But if you defeated the time-release mechanism, you'd get the impact of the drug all at once. This is what made it so attractive to addicts, especially after lurid stories showing how to abuse the drug hit the media during 2001. The effect was immediate: overdose admissions to ERs involving OxyContin shot up and the popularity of the drug, often dubbed "hillbilly heroin," surged. The original version was discontinued days before the release of the newer version, and is no longer available in the US.

Of course, given the failure to anticipate that the first version of OxyContin would be abused in the way it was, there is a considerable caution about pronouncing version two a success. But the new observational study (Abuse Rates and Routes of Administration of Reformulated Extended-Release Oxycodone: Initial Findings From a Sentinel Surveillance Sample of Individuals Assessed for Substance Abuse Treatment), suggests a breakthrough.

Researchers tracked 140,496 people who were assessed for substance abuse treatment at 357 U.S. centers between June 1, 2009, and March 31, 2012. The goal was to see how this population would react to the introduction of abuse-resistant OxyContin after establishing a baseline of abuse with the same group for the original version. Using various measures - such as whether addicts tried to snort it or inject it - the researchers saw an impact. For example, abuse of the original version over the past 30 days ran at 5.4 cases per hundred, while abuse of the new version settled quickly at about 2.4 cases per hundred.

One strength of this research - the first of eight epidemiological studies to be carried out on the drug by its manufacturer Purdue Pharma as demanded by the Food and Drug Administration - is its large sample size. And while past-30 day use is a "self-reported" measure, it is one long used in the field to assess abuse rates.

It also confirms an earlier, smaller study, published as a letter in the New England Journal of Medicine last July, which tracked 2,566 patients with opioid dependence before and after the introduction of the new OxyContin. While the older version had been the primary drug of abuse for 35.6 percent of this group, just 12.8 percent were choosing the abuse resistant version at the end of the study. Interviews with a sample of abusers who had used both versions "indicated a unanimous preference for the older version," the researchers, led by Washington University St Louis's Theodore J. Cicero, reported.  As one abuser told them, "Most people that I know don't use OxyContin to get high anymore. They have moved on to heroin [because] it is easier to use, much cheaper, and easily available."

As for weaknesses, the new study can only point to abuse that hasn't taken place; it can't guarantee that addicts won't figure out a novel way of breaking the drug down. As the researchers put it, their study should be seen as a "proof of concept." But the proof of concept - and other preliminary data showing a drop in abuse of oxymorphone after a tamper resistant version was introduced is drawing praise from those who have been in the trenches of pain treatment for years.

"It has exceeded what I thought possible," says Dr. Steven Passik, Professor of Psychiatry and Professor of Anesthesiology at Vanderbilt University's School of Medicine. "The pill mills stopped prescribing it, the drug dealers didn't want it anymore - it's made a real dent in the problem."

Indeed, when Canada licensed six generic versions of the old OxyContin last month, a day after Purdue's patent ran out, Canadian pain experts reacted furiously, warning that it would undermine the use of the abuse-resistant version. "We as physicians need all the help we can get in managing the problem of prescription opioid abuse, including help from our Federal governments, who by allowing generic long-acting oxycodone to be available without conditions (risk management programs, MD education etc.) will in fact make our job harder and risk harming the very public we are trying to serve," says Dr. Mark A. Ware, Director of Clinical Research at McGill University's Alan Edwards Pain Management Unit, via email.

"I can't understand it, says Dr. Lynn Webster, the incoming president of the American Academy of Pain Medicine, and author of "Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners, "Canada has just taken a very dangerous step." He believes, by contrast, that in the US, the Food and Drug Administration should "only approve drugs with abuse resistant properties."

That won't solve all the problems of diversion and abuse, he says, given that one in five Americans has a genetic vulnerability to "rewarding substances," be they alcoholic beverages, illegal narcotics, or opioid medicines. But it will make it easier to address the suffering of those in legitimate need of pain relief. "There are a lot of people not getting treatment," Webster says, "and a lot of physicians not willing to take the risk of prescribing opioids."

As a 2003 position paper by the College on Problems of Drug Dependence, which included representatives from, the University of Chicago, Johns Hopkins University, and Memorial Sloan-Kettering Cancer Center, and the Drug Enforcement Administration, noted, "the overall consensus in the pain management community is that the majority of chronic pain patients on long-term opioid therapy are not abusing these drugs."

So what has changed ten years on? In 2011, the Centers for Disease Control declared in a Morbidity and Mortality Weekly report that a worsening "epidemic" of overdose deaths associated with opioid medicines. These, as the report put it, "were involved in 14,800 deaths (73.8 %) of 20,044 prescription drug overdose deaths." But what exactly did "involved" mean  - and did it mean that there was no other history of narcotic use in those who died? The CDC's data was frustratingly opaque as to the causative nature of the relationship, as it simply noted that the numbers were based on medical examiner reports, coded for accidental poisoning, intentional poisoning (i.e. suicide), homicidal poisoning, and undetermined poisoning. And while the number of overdose deaths had increased over time (from 4,000 in 1999), the CDC was unable to plot this against the increased availability of such drugs except in the broadest of terms, so it was impossible to say whether the underlying death rate was increasing, plateauing, or decreasing.

"There is no persuasive evidence that individuals with no previous history of substance abuse are at risk for becoming addicted when exposed to prescription opioids," says Dr. Martin Cheatle, Director of the Pain and Chemical Dependency Program at the University of Pennsylvania's Center for Studies of Addiction. He points to a 2008 evidence-based review (Fishbain et al.) of chronic pain patients exposed to chronic opioid analgesic therapy found very low reported abuse and addiction rate - 3.27 percent, which is far below the accepted prevalence of addictions in the general population (10 percent). And this fell to .19 percent when you excluded patients who had a previous history of drug use or addiction or were currently abusing illegal drugs. Additionally, a systematic review of the literature on whether chronic pain patients were likely to abuse opioids (Turk et al.) found that the strongest predictors were a personal history of illicit drug and alcohol abuse.

Davis, after consulting his new database, didn't see much evidence of an epidemic of accidental deaths from painkillers alone. Most of the victims he had examined had a history of drug abuse and overdose deaths reflected a wide range of drugs. Whaley said that from 2007 in Virginia, the pathology data showed 16.8 percent of drug overdoses were for oxycodone alone.

"I think that accidental deaths from prescription narcotics is still much more a function of unintentional misuse or chronic habituation and overuse, rather than an epidemic of addicts enabled by unscrupulous prescribers," says Henry Carson, a pathologist in Iowa City, via email. Though some of the sensational media stories are accurate (even in "homespun Iowa," he says, there are cases of doctors trading prescriptions for sex or a share of the medication), "most fatalities that arise from polypharmacy are not due to one doctor's or clinic's loose-leaf prescription pads, but due to multiple prescriptions from multiple doctors that are filled by multiple pharmacies. The medications then end up being used in combinations that turn out to have been dangerous."

He gives the example of one victim from his 2008 study on the kinds of drugs found in multiple drug intoxication in suicides and accidents. The man had chronic lower back pain and was taking a "modest" painkiller, prescribed to him by his family doctor, as well as another painkiller from a legitimate pain clinic. Then one night, he combined both with a few beers and announced to his family that he felt fantastic; he didn't wake up in the morning. "I was surprised when his toxicology screen came back with modest levels of therapeutic drugs, none of them in overdose range," says Carson. "The synergy of the substances was enough to cause death."

Such deaths, which are typically the result of mixing pain meds are difficult to "see" in the CDC data, and speak to the need for better surveillance and epidemiology. The CDC admits as much, having issued a request for better guidelines for determining opioid abuse in order to measure the problem.

These deaths also speak to the underlying problem in treating pain: it's easier to blame a particular medication or class of drugs, rather than the way the healthcare system has evolved to treat pain.

The age of OxyContin may well be ending, at least in terms of abuse; but America's state of pain is only going to get worse, and dealing with that will take more than fixing a pill.

To view the entire OP/ED, please visit:

 http://www.forbes.com/sites/trevorbutterworth/2012/12/13/is-the-era-of-oxycontin-abuse-over/