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‘Dramatic Increase’ Seen in U.S. Deaths From Heart Failure

WEDNESDAY, Oct. 30, 2019 — Heart failure deaths are reaching epidemic proportions among America’s seniors, a new study finds.

About one in eight deaths from heart disease are from heart failure, and nine out of 10 are among those over 65 years of age, researchers report.

“We are now in the midst of a ‘silver tsunami’ of heart disease and heart failure,” said senior study author Dr. Jamal Rana, chief of cardiology at Kaiser Permanente Oakland Medical Center, in California.

“This will require both innovation in clinical care for our patients and urgent policy initiatives at the health care systems level to be better prepared for its impact,” Rana added in a Kaiser news release.

The report was published online Oct. 30 in JAMA Cardiology.

According to lead author Dr. Stephen Sidney, “The United States is now experiencing a dramatic increase in the number of older people dying from heart disease, and especially heart failure.” Sidney is a senior research scientist with the Kaiser Permanente Northern California division of research.

Heart failure is a chronic, progressive disease where the heart muscle is weakened and can’t pump blood efficiently, which increasingly reduces quality of life as patients decline.

For the study, Sidney and his colleagues used data from the U.S. Centers for Disease Control and Prevention.

The investigators found that more than 647,000 Americans died from heart failure in 2017, which was about 51,000 more deaths from heart failure than in 2011.

The rate of deaths due to heart failure increased by 21%. When the researchers added the aging population as a factor, the rate of heart failure deaths jumped to 38%.

Sidney added that since the number of Americans over 65 increased by 10 million between 2011 and 2017, and is expected to grow by another 22 million by 2030, heart failure rates will likely only worsen.

More information

For more on heart failure, head to the American Heart Association.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Pregnancy-Related Deaths Still Higher With Some Minorities

THURSDAY, Sept. 5, 2019 — Pregnancy is a far riskier undertaking for many minority women than it is for white women in the United States, a new government study shows.

The chances of dying from pregnancy complications is two to three times higher for black, American Indian and Alaska Native women than it is for white women.

“These disparities are devastating for families and communities, and we must work to eliminate them,” said lead author Dr. Emily Petersen, medical officer in the Division of Reproductive Health at the U.S. Centers for Disease Control and Prevention.

“There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths,” Petersen said in a CDC news release.

Her team analyzed national data from 2007-2016 and found that the overall rate of pregnancy-related deaths rose from 15 to 17 per 100,000 births during that time.

By racial/ethnic group, rates were 40.8 per 100,000 births for blacks, 29.7 for American Indians/Alaska Natives, 13.5 for Asian/Pacific Islanders, 12.7 for whites, and 11.5 for Hispanics.

The gap between blacks and American Indians/Alaska Natives and other racial and ethnic groups widened with age. Among women older than 30, rates among blacks and American Indians/Alaska Natives were four to five times higher than among whites.

The study also found that the rate among blacks with at least a college degree was just over five times higher than among whites with at least a college degree.

Cardiomyopathy, pulmonary embolism, and high blood pressure disorders of pregnancy were factors in more pregnancy-related deaths among blacks than among whites. Hemorrhage and high blood pressure disorders of pregnancy were factors in more pregnancy-related deaths among American Indians/Alaska Natives than among whites.

There was little change in racial/ethnic disparities between 2007 and 2016, according to the study published Sept. 6 in the CDC’s Morbidity and Mortality Weekly Report.

Most pregnancy-related deaths are preventable, according to the agency.

The CDC defines a pregnancy-related death as “the death of a woman during pregnancy or within one year of the end of pregnancy from a pregnancy complication; a chain of events initiated by pregnancy; or the aggravation of an unrelated condition by the physiologic effects of pregnancy.”

A CDC report from May that analyzed data from 13 states concluded that each pregnancy-related death was associated with several contributing factors. These included lack of access to appropriate and high-quality care, missed or delayed diagnoses, and lack of knowledge among patients and health care providers about warning signs.

The data suggested that 60% or more of pregnancy-related deaths could have been prevented by correcting these issues.

“There are many complex drivers of [pregnancy-related death]. This [new study] shows the critical need to accelerate efforts and to identify the initiatives that will be most effective,” said Dr. Wanda Barfield, director of the CDC’s Division of Reproductive Health.

More information

The U.S. Office on Women’s Health has more about pregnancy complications.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

Drugs.com – Daily MedNews

Lethal Deception: Deaths From Cocaine Laced With Fentanyl on the Rise

THURSDAY, Aug. 8, 2019 — Across the United States and Canada, people are buying cocaine only to discover too late that it contains potentially deadly fentanyl, a new report warns.

In one cluster of cases occurring in Fresno, Calif., in January of this year, four people were brought to local emergency rooms.

Two of the incapacitated cocaine users died from their inadvertent fentanyl overdose, local doctors say.

Another outbreak — this time killing one person and sickening 14 more — occurred in nearby Chico, Calif., at about the same time.

In all cases, victims “reported thinking they were snorting cocaine,” said a team led by Dr. Patil Armenian, of the University of California, San Francisco, in Fresno. Instead, they had ingested cocaine laced with fentanyl, a synthetic opioid.

Other outbreaks linked to fentanyl-tainted cocaine have occurred recently in New Haven, Conn., Philadelphia and British Columbia, Canada, Armenian’s team reported.

Overall, “death rates involving cocaine increased by approximately one-third during 2016-2017,” the researchers added.

One emergency medicine physician wasn’t surprised by those numbers.

“Fentanyl is a powerful synthetic opioid, 50 to 100 times more potent than morphine,” noted Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. “It may lead to death by respiratory depression, especially in individuals who are ‘opioid-naive’ and consequently have not developed tolerance.”

Fentanyl may also be making its way into another recreational drug, methamphetamine, Glatter said.

In fact, “in a recent study of one million randomly selected urine drug test results from medical practices in the U.S., there was a significant increase between 2013 and 2018 in the rate of tests positive for non-prescribed fentanyl among the cocaine-positive samples (from 0.9% to 17.6%) and methamphetamine-positive samples (from 0.9% to 7.9%),” Glatter noted.

In the Fresno outbreak, three people who said they’d snorted cocaine showed up on Jan. 7 at a local emergency department. One was already in cardiac arrest and was pronounced brain-dead three days later; the other two were repeatedly given the opioid overdose antidote naloxone and survived.

On Jan. 8, a fourth victim was found in cardiac arrest when emergency medical services arrived; she died at the scene.

In all cases, lab tests revealed the presence of fentanyl in the blood and/or urine. Later in January, a “federal grand jury returned a two-count indictment … against Darnell Pearson, 40, of Fresno, charging him with distribution of fentanyl resulting in death,” according to a U.S. Drug Enforcement Administration news release.

Dr. Harshal Kirane directs addiction treatment and research at Wellbridge in Calverton, N.Y. Looking over the new report, he said that in some regions, synthetic opioids like fentanyl are “a latent adulterant that become evident only after it is too late.”

But it’s tough to know where these outbreaks will pop up, so there’s “a persistent yet unpredictable risk for all communities,” Kirane said.

In the Fresno cases, health care staff worked in conjunction with local law enforcement and the media to get the word out about the adulterated cocaine. Ordering lab tests for fentanyl in suspicious cases is also important, Kirane said, and “these tools can also be put in the hands of the public, by way of fentanyl test strips,” to help prevent fatal overdoses.

Finally, getting people the help they need to stop using drugs is crucial, Kirane added.

“Expanding access to addiction care is one of the clearly identified pathways to overdose prevention,” he said.

The new report was published Aug. 9 in the Morbidity and Mortality Weekly Report, a journal of the U.S. Centers for Disease Control and Prevention.

More information

The U.S. National Institute on Drug Abuse has more about fentanyl.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

Drugs.com – Daily MedNews

Drug, Alcohol Deaths Soar After Weight-Loss Surgery

By Donna Siegfried

HealthDay Reporter

THURSDAY, June 20, 2019 (HealthDay News) — A new study offers some sobering news about weight-loss surgery.

People who undergo a gastric bypass procedure called Roux-en-Y are three times more likely than those in the general population to die of drug- or alcohol-related causes, according to researchers at the University of Pittsburgh.

The reason isn’t clear, but laboratory studies have shown that Roux-en-Y surgery changes the way the body reacts to drugs and alcohol.

“The effect is purely physiological, not psychological,” said Dr. John Morton, chief of bariatric and minimally invasive surgery at Yale School of Medicine, who reviewed the findings. “Gastric bypass surgery removes 95% of the stomach. Alcohol receptors exist in the stomach and the liver, so by removing so much of the stomach, people lose the first pass at metabolizing alcohol.”

Morton was not involved in the study but has published research on the topic.

For this study, the Pitt researchers followed nearly 2,500 adults who had weight-loss surgery at one of 10 hospitals across the United States. About eight out of 10 were women and 86% were white. Their median age was 46, meaning half were older, half younger. The patients were followed for seven years.

During that time, 10 of the study participants died of causes directly related to drug or alcohol use.

That included six accidental drug overdoses; one intentional drug overdose; one overdose where intent was unknown; and two from alcoholic liver disease. All 10 had had a Roux-en-Y bypass, which reduces the stomach size and shortens the intestine.

As with other forms of “bariatric” (weight-loss) surgery, having a smaller stomach makes people feel full sooner, so they lose weight.

To compare patient death rates with those in the general population, researchers used a formula called “person-years.” It measures the number of people studied and number of years each participated in the study.

On average, there were 89 deaths per 100,000 person-years among Roux-en-Y patients, compared to 30.5 per 100,000 in the general population, the investigators found.

Continued

Study co-author Wendy King said, “Our study primarily focused on those who had Roux-en-Y gastric bypass surgery; it did not examine differences in drug- and alcohol-related mortality among those who had undergone” another type of weight-loss surgery called sleeve gastrectomy.

“New evidence suggests that sleeve gastrectomy may also alter the way alcohol is metabolized in the body, so there is more work to do,” she added. King is an associate professor in the department of epidemiology at the University of Pittsburgh Graduate School of Public Health.

The nation’s most popular weight-loss surgery, sleeve gastrectomy, also removes a portion of the stomach, although not as much as Roux-en-Y gastric bypass. A third type of bariatric surgery is gastric banding, which ties off the upper portion of the stomach.

Because their stomachs hold less, people who undergo bariatric surgery tend to feel the effects of alcohol sooner and after fewer drinks. Researchers said that’s why it is important for patients to pay attention not only to how alcohol makes them feel, but also whether it interferes with relationships and daily activities.

The findings highlight the need for more education, diagnosis, treatment and tracking of alcohol and drug use as part of post-surgery care, the study authors said.

The researchers also called on primary-care doctors to be more aware of these risks as they treat patients who have had weight-loss surgery, and for more long-term follow-up. The deaths uncovered in the study occurred about five years after surgery.

Morton underscored the importance of awareness.

“Substance abuse education needs to be embedded in the pre-op process, and more counseling needs to be provided after surgery,” he said. “But people also need to remember that they are having bariatric surgery to lose weight and improve their health, and consuming alcohol doesn’t fit with those goals.”

The study was recently published online in the journal Surgery for Obesity and Related Diseases.

WebMD News from HealthDay

Sources

SOURCES: Wendy King, Ph.D., associate professor of epidemiology, University of Pittsburgh; John Morton, M.D., vice chair for quality, department of surgery, and division chief of bariatric and minimally invasive surgery, Yale School of Medicine, New Haven, Conn.; June 7, 2019,Surgery for Obesity and Related Diseases, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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ACA’s Medicaid Expansion May Have Lowered Heart Disease Deaths

WEDNESDAY, June 5, 2019 — New research supports the notion that Obamacare has improved the health of Americans: State expansions in Medicaid appear to have cut the number of deaths from heart disease.

Counties in states with expanded Medicaid experienced an average of four fewer deaths from heart disease per 100,000 people than states that didn’t accept the expansion under the Affordable Care Act.

In real terms, that’s about 2,000 fewer deaths a year among middle-aged adults.

“We believe these findings will be helpful for policymakers and health policy researchers in trying to tease out the impact of this most recent round of expansion,” said researcher Dr. Sameed Khatana, a cardiovascular medicine fellow at the University of Pennsylvania.

“We can’t necessarily say from our study that giving a person health insurance through Medicaid will save their life,” Khatana said in a university news release. The research only found an association rather than a cause-and-effect link.

“However, our study does show that at a population level, expanding Medicaid was associated with a reduction in deaths from cardiovascular disease. This was especially prominent in areas with a higher number of residents living in poverty and those areas that had greater increases in insurance coverage,” he said.

For the study, Khatana and his colleagues used data from the U.S. Centers for Disease Control and Prevention to look at county rates of heart disease deaths from 2010 to 2016 in 29 states with expanded Medicaid and 19 states without it.

They found that deaths from heart disease remained stable in states with expanded Medicaid. In states without added Medicaid, however, heart disease deaths climbed from 176 per 100,000 to nearly 181.

In addition, the largest increases in heart disease deaths were in counties with the smallest increases in insurance between 2010 and 2016.

The report was published online June 5 in the journal JAMA Cardiology.

More information

The American Heart Association offers more information on types of heart disease.

© 2019 HealthDay. All rights reserved.

Posted: June 2019

Drugs.com – Daily MedNews

Suicides Up Among U.S. Kids; Girls’ Deaths Highest

By Robert Preidt

HealthDay Reporter

FRIDAY, May 17, 2019 (HealthDay News) — Suicide rates are on the rise among American children, but the increase is greatest among girls, a new study finds.

“Overall, we found a disproportionate increase in female youth suicide rates compared to males, resulting in a narrowing of the gap between male and female suicide rates,” said study author Donna Ruch. She is a postdoctoral researcher at the Center for Suicide Prevention and Research at Nationwide Children’s Hospital in Ohio.

Suicide is the second-leading cause of death among Americans aged 10 to 19, with rates historically higher in boys than girls. However, recent reports from the U.S. Centers for Disease Control and Prevention show a greater increase in suicide rates among girls than boys.

In this study, the researchers examined data on youth suicides from 1975 through 2016.

The findings showed that youth suicide rates for both sexes fell in the early 1990s. But they have increased for both sexes since 2007, with larger increases among girls than boys, particularly among girls aged 10 to 14.

Rates of female suicides by hanging or suffocation are approaching those of males, which is troubling considering the “gender paradox” in suicidal behavior, according to study co-author Jeff Bridge, director of the Center for Suicide Prevention and Research.

Females have higher rates of nonfatal suicidal behavior, such as thinking about and attempting suicide, but more males die by suicide than females, Bridge said.

“One of the potential contributors to this gender paradox is that males tend to use more violent means, such as guns or hanging,” Bridge noted in a Nationwide news release. “That makes the narrowing of the gender gap in suicide by hanging or suffocation that we found especially concerning from a public health perspective.”

The study was published online May 17 in JAMA Network Open.

Future research should look at whether gender-specific suicide risk factors have changed in recent years and how that information could improve suicide prevention efforts, the study authors said.

Asking children directly about suicide will not trigger suicidal thinking or behavior, Bridge said.

“Parents need to be aware of the warning signs of suicide, which include a child making suicidal statements, being unhappy for an extended period, withdrawing from friends or school activities or being increasingly aggressive or irritable,” he explained.

“If parents observe these warning signs in their child, they should consider taking the child to see a mental health professional,” Bridge advised.

WebMD News from HealthDay

Sources

SOURCE: Nationwide Children’s Hospital, news release, May 17, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Many Pregnancy-Related Maternal Deaths Occur Months After Delivery: CDC

TUESDAY, May 7, 2019 — Too many women still die from pregnancy-related causes, some up to a year after delivery, according to a new report from the U.S. Centers for Disease Control and Prevention.

About 700 pregnancy-related deaths occur in the United States each year, and 3 out of 5 are preventable, data show.

Nearly 31% of the deaths happen during pregnancy, and another 36% occur during delivery or the week after.

But a full third of deaths happen up to a year after a woman gives birth, the CDC found.

“These are women in their prime who leave loved ones behind often stunned at what has happened,” CDC Principal Deputy Director Dr. Anne Schuchat said at a media briefing.

For the study, the CDC analyzed national data on pregnancy-related deaths between 2011 and 2015, and more detailed data from 13 states gathered between 2013 and 2017.

The CDC defines pregnancy-related death as one occurring within a year of the pregnancy’s end. The cause could be a related complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated medical condition by pregnancy.

Heart disease and stroke caused about 1 in 3 deaths, researchers found. Other leading causes included infections and severe blood loss.

“Our new analysis underscores the need for access to quality services, risk awareness and early diagnosis, but it also highlights opportunities for preventing future pregnancy-related deaths,” said Dr. Wanda Barfield, director of the Division of Reproductive Health in CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“By identifying and promptly responding to warning signs not just during pregnancy, but even up to a year after delivery, we can save lives,” Barfield said in an agency news release.

The cause of death generally depends on timing, the CDC noted:

  • Obstetric emergencies such as severe bleeding caused most deaths during delivery.
  • In the week after delivery, new mothers were more likely to die from high blood pressure, infection and severe blood loss.
  • A weakened heart muscle (cardiomyopathy) caused most deaths up to a year after delivery.

These deaths were associated with several factors related to prenatal care, CDC said.

In some cases, women died because they lacked access to good health care, resulting in delayed or missed diagnoses of crucial medical problems. Women and their health care providers also appeared to lack knowledge about the warning signs of a troubled pregnancy, according to the report.

Serious racial disparities also exist. Black and American Indian/Alaska Native women were about three times as likely to die from a pregnancy-related cause as white women.

CDC officials said the data suggest that the majority of deaths, regardless of when they occurred, could have been prevented by tackling these key problems:

  • Providers can better help patients manage chronic conditions and teach them warning signs.
  • Hospitals and health systems can coordinate efforts between providers and support efforts to improve care during and after pregnancy.
  • States and communities can develop policies that improve access to care and ensure that women at high risk can give birth at hospitals with special training and equipment for troubled pregnancies.

“Making some of these improvements will not be easy. It could require reworking systems that have been in place for years,” Schuchat said. “The good news, though, is that there are already systematic approaches being developed and implemented in many areas around the country that can be used as a model to support improvements to save the lives of women.”

Dr. Megan Gray, an obstetrician-gynecologist at Orlando Health Winnie Palmer Hospital for Women and Babies in Florida, said obstetricians and nurse-midwives have work to do.

“It is crucial that hypertensive disorders during and after pregnancy, infections, sepsis, hemorrhage and cardiomyopathy be recognized early and promptly managed,” she said. “This includes educating patients about early warning signs and providing pregnant women with access to quality care.”

Gray said women should be seen sooner and more often after pregnancy than the standard six weeks after delivery, so that complications can be detected and addressed.

CDC Director Dr. Robert Redfield said ensuring quality care for mothers during and after pregnancy should be among the nation’s top priorities.

“I urge the public health community to increase awareness with all expectant and new mothers about the signs of serious pregnancy complications and the need for preventative care that can and does save lives,” Redfield said in the release.

The study appears in the CDC’s Morbidity and Mortality Weekly Report.

More information

The U.S. Office on Women’s Health has more about pregnancy complications.

© 2019 HealthDay. All rights reserved.

Posted: May 2019

Drugs.com – Daily MedNews

Amid Opioid Crisis, Cocaine, Meth Deaths Soar

By E.J. Mundell

HealthDay Reporter

THURSDAY, May 2, 2019 (HealthDay News) — As the United States battles an ongoing epidemic of opioid abuse and deaths, new data shows that fatalities tied to cocaine and methamphetamines are also surging.

In fact, of the more than 70,000 lives lost to drug overdoses in 2017, “nearly a third involved cocaine, psychostimulants or both,” reports a team led by researcher Mbabazi Kariisa, of the U.S. Centers for Disease Control and Prevention.

Psychostimulants include drugs such as methamphetamines (meth), the “club drug” MDMA, Ritalin, and even caffeine.

National vital statistics data on causes of death found that in 2017, 1 in 5 drug overdose deaths (nearly 14,000 cases) involved cocaine, representing “a 34.4% increase from 2016,” Kariisa and colleagues reported.

Similarly, nearly 15% of all fatal drug ODs for 2017 (about 10,000 cases) involved psychostimulants, a jump upwards of 37% over the previous year.

These numbers reflect a recent, troubling trend: The CDC team noted that between 2015 and 2016, rates of drug overdose deaths involving cocaine, psychostimulants or both had already risen by 42.4%.

Why have coke, meth and the like become even more deadly? According to the researchers, in many cases, deaths also involved the use of opioids, including super-potent drugs such as fentanyl.

“Nearly three-quarters of cocaine-involved deaths in 2017 also involved opioids,” they reported, as did about half of deaths involving psychostimulants such as meth. Synthetic opioids — fentanyl, most prominently — often played a key and deadly role.

An emergency physician on the front line of the drug overdose epidemic wasn’t surprised by the numbers.

“While much attention continues to focus on addressing opioid abuse and misuse, it’s vital that we don’t ignore the dangers that cocaine and other psychostimulants present,” said Dr. Robert Glatter, who practices at Lenox Hill Hospital in New York City.

In many cases, drug abusers may not even know that the substances they are using are laced with fentanyl or other drugs, he added. The trend “could be partly related to people unaware of the tainted product they were using,” Glatter said.

Continued

But even used alone, cocaine raises a person’s odds for death, he said.

“Cocaine use elevates blood pressure, weakens the heart muscle, promotes formation of plaque in the coronary arteries, thereby increasing the risk of heart attack,” Glatter explained. “It also may precipitate a stroke by virtue of its effects on plaque formation in blood vessels that supply the brain.”

The CDC team found that some demographics are being hit harder by the resurgence of cocaine and psychostimulant abuse than others.

When it comes to gender and age, the upward trend in fatalities was most pronounced for young women aged 15 to 24, although young men were similarly affected. Cocaine-related deaths were most common in the Midwest, while the West had the highest rate of fatal overdoses involving psychostimulants, the CDC researchers said.

The data suggests an increasingly complex “poly-substance landscape” of drug abuse across America, Kariisa’s group said.

“Drug overdoses continue to evolve along with emerging threats, changes in the drug supply, mixing of substances with or without the user’s knowledge, and poly-substance abuse,” they wrote. More can and must be done to provide addicts with “tailored and effective prevention and response strategies” to help curb these trends, the researchers said.

The new report was published in the May 3 issue of the CDC journal Morbidity and Mortality Weekly Report.

WebMD News from HealthDay

Sources

SOURCES: Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; May 3, 2019,Morbidity and Mortality Weekly Report

Copyright © 2013-2018 HealthDay. All rights reserved.

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Ten Infant Deaths Linked to Fisher-Price Rock ‘N Play Sleepers

By EJ Mundell

HealthDay Reporter

MONDAY, April 8, 2019 (HealthDay News) — Ten infants are known to have died in the Fisher-Price Rock ‘n Play sleeper since 2015, the U.S. Consumer Product Safety Commission (CPSC) warns.

In a joint statement with Fisher-Price, the CPSC said it voted to announce that “the health and safety of the public requires immediate notice” of the danger to babies.

All of the infants died after rolling from their back to their stomach or side while unrestrained. All 10 infants were aged 3 months or older.

Infants typically begin to roll over at 3 months, the CPSC noted. Because of this, the agency says parents and caregivers should stop use of the Fisher-Price Rock ‘n Play sleeper when infants reach 3 months of age or when they begin rolling over.

Previously, the agency had warned parents and caregivers to use restraints in infant-inclined sleep products.

To provide a safe sleep environment for infants in a crib, bassinet, play yard or inclined sleeper, never add blankets, pillows, stuffed toys or other items, and always place infants to sleep on their backs, CPSC said.

On its website, Fisher-Price said the company “will continue to work closely with the Consumer Product Safety Commission, and other international regulators, to encourage the safe use of our products and find ways to keep your little ones happy, healthy and above all — safe.”

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Sources

SOURCE: Consumer Product Safety Commission news release, April 5, 2018, Fisher-Price

Copyright © 2013-2018 HealthDay. All rights reserved.

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Local Leaders Back Narcan to Stop Overdose Deaths

April 1, 2019 — As America’s opioid epidemic continues, seemingly without end, states and other local governments have searched for ways to stem the tide of overdose deaths.

More and more, the answer appears to be a fairly new twist on an old drug designed to reverse opioid overdose: naloxone.

The FDA first approved naloxone, a medication that can revive someone who has stopped breathing from an overdose in a matter of seconds, in 1971. At first, emergency medical personnel gave patients the drug through an IV and did so with dramatic results.

Naloxone can also be given as a shot into the thigh with a prefilled auto-injector.

But in November 2015, with the opioid crisis raging, the FDA approved Narcan, a nasal spray version of naloxone, in the hopes that the new formulation would make it easier for caregivers, family, and friends to use it and save more lives.

The CDC’s most recent data show that 70,237 people died in 2017 from a drug overdose. Nearly 48,000 of those were from opioids. As an EMS captain with the Washington, D.C., Fire and Emergency Medical Services Department, it’s a number that hits Mark Baker hard. Those same statistics put D.C. and four states in the top five for the highest rate of overdose deaths.

“We revive people who have overdosed on narcotics daily,” Baker said. “Narcan is a wonderful drug for opioid overdose and narcotics.”

But it’s not a cure, he cautions, so there should always be a follow-up by a medical professional.

Last year alone, D.C. Fire dispatched 4,363 overdose calls. Baker says while he still prefers giving someone the drug in a vein, the nasal spray is now being used more often.

“It’s just a safer route, safer way to administer. The less needles we have floating around, the less possibility people get stuck. It’s a lot safer for everybody in general.”

It’s so safe that today, 49 states and the District of Columbia offer this lifesaving drug without a prescription. Only Hawaii does not. These states have issued standing orders that allow a prescription-only medication to be sold without a prescription at the pharmacy. Anyone in those states can now simply walk into a pharmacy and get Narcan — and an explanation of how to use it — from a pharmacist.

How the Drug Works

Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), one of 27 institutes and centers at the National Institutes of Health, has done research on Narcan.

Naloxone works by taking over opioid receptors in the brain. It forces out opioid drugs like heroin and fentanyl to block their effects, she says.

“In the breathing centers of the brain, naloxone displaces the opioids drugs, thus restoring breathing during an overdose,” she says.

Volkow told WebMD that Narcan works for any opioid drug when people are no longer breathing on their own, and she says the side effects are as low as it gets for a medication.

“It’s actually quite safe. It’s an amazing medication in this respect,” she says. “I haven’t seen anything as dramatic as how you restore breathing with naloxone. We want to do whatever it takes to make naloxone as widely available as possible, because it makes the difference between someone dying and someone not dying.” 

Volkow says she’s very comfortable with it being so available, and that includes to libraries, colleges, universities, and even high schools. 

Maryland-based pharmaceutical company Emergent BioSolutions announced in October that it would supply two doses of Narcan to every public library branch in the country. Three years ago, Adapt Pharma, Narcan’s manufacturer, worked with the National Association of School Nurses to provide free Narcan to every high school in the country. Currently, 2,185 high schools in 48 states — all but West Virginia and Wyoming — and Washington, D.C., take part in that program.  A year later, colleges and universities were added.

Georgia is one of those states. In 2014, then-Gov. Nathan Deal signed Georgia’s Medical Amnesty Law. It increases access to naloxone and provides immunity from civil or criminal liability to both those receiving and giving the drug.

The Georgia Department of Education says schools began to stock Narcan after that law was passed.  Each school district decides whether they will stock the drug, and they are not required to report it to the state.

‘We Are Empowering Families and Friends’

Some 600 miles away, Baltimore is a city that has struggled with drug addiction and abuse for many years.  Jennifer Martin, a deputy commissioner at the Baltimore City Health Department, told WebMD that last year alone, residents saved 1,178 lives with Narcan.

“Through our naloxone education and training efforts, we’ve really been able to put a lifesaving medication into the hands of tens of thousands of Baltimore residents,” she says. “We are empowering families and friends of individuals who suffer from the disease of addiction to be able to save their loved one’s life if necessary.”

Martin says the city has had an overdose education and response program in place since 2004. 

“But in 2015, that was when we issued a citywide prescription around naloxone specifically to address the growing opioid crisis here in the city,” she says. 

More than 51,000 Baltimore residents have been trained to use naloxone in the past 3 years, Martin says. City residents successfully used naloxone more than 4,400 times from 2015 to 2018.

It’s a common refrain: Narcan saves lives. Narcan is safe. So much so that NIDA

is doing a study to evaluate what policies are more likely to make Narcan as widely available as possible. That research evaluates the effects of making it available over the counter as opposed to the standing orders now in place at pharmacies.

And the FDA, it seems, is on board. In January, it announced efforts to support making naloxone over-the-counter (OTC).  It has come up with a model drug facts label (DFL) — required for all OTC medications — and did comprehension testing to make sure consumers understand the label instructions and use Narcan in the right way.

Still, Volkow stressed, it’s just one piece of the puzzle.  “Without it during an opioid overdose, that’s it for that particular individual.  However, by itself naloxone is not going to solve the opioid crisis.  You need to treat; you need to prevent opioid use disorders. The combination of prevention, treatment, and overdose reversal strategies, along with the policies and resources to sustain them, is what’s going to actually solve the crisis.”

Sources

American Libraries, “Company to Supply Free Narcan to Libraries.”

Mark Baker, emergency medical services captain, Washington, D.C., Fire and Emergency Medical Services Department.

Nora Volkow, MD, director, National Institute on Drug Abuse.

Jennifer Martin, deputy commissioner, Baltimore City Health Department.

Adapt Pharma, news release, “Adapt Pharma Teams with Smith Medical Partners to Support Distribution of Free NARCAN® (Naloxone HCl) Nasal Spray Offer to All U.S. High Schools.”

FDA.gov, “The Clinical Use of Naloxone.”

National Institute on Drug Abuse, news release, “FDA approves naloxone nasal spray to reverse opioid overdose.”

CDC.gov, “Drug Overdose Deaths in the United States, 1999–2017.”

Heathline.com: “Drug That Reverses Opioid Overdoses Now Easier to Get at Local Pharmacies.”

The Atlanta Journal-Constitution, “Gov. Nathan Deal signs dozens of bills into law.”

© 2019 WebMD, LLC. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });
WebMD Health

Gun Deaths Up Sharply Among America’s Schoolkids

By Robert Preidt

HealthDay Reporter

FRIDAY, March 22, 2019 (HealthDay News) — Gun-related deaths among school-age children in the United States are increasing at alarming rates, researchers report.

In 2017, gun violence claimed more 5- to 18-year-olds than police officers or active-duty members of the U.S. military, according to a chilling new study led by investigators from Florida Atlantic University.

“It is sobering that in 2017, there were 144 police officers who died in the line of duty and about 1,000 active duty military throughout the world who died, whereas 2,462 school-age children were killed by firearms,” study senior author Dr. Charles Hennekens said in a FAU news release. He’s a professor of medicine at the university’s Schmidt College of Medicine.

The nationwide study found nearly 39,000 gun-related deaths among 5-to-18-year-olds between 1999 and 2017. That included almost 6,500 deaths among kids between 5 and 14 years of age, and more than 32,400 among older teens.

Significant increases began in 2009, with a wave of shootings among 5- to 14-year-olds, followed by a similar wave among teens starting in 2014. Both waves — which researchers described as epidemics — continued through 2017, the most recent year for which data are available.

Gun-related deaths over the period accounted for 5.6 percent of deaths in the younger group and nearly 20 percent among older kids.

Researchers also found statistically significant increases in gun-related deaths among black children aged 5-14, starting in 2013.

Hennekens likened attempts to halt the epidemic without gun control to trying to curb lung cancer deaths due to cigarettes without reducing tobacco use.

The analysis of data from the U.S. National Center for Health Statistics also looked at causes of death among school-age children. It said 61 percent were the result of assault; 32 percent were from suicide; 5 percent were accidental; and 2 percent undetermined.

Blacks accounted for 41 percent of all deaths, and 86 percent were in boys.

The authors said the findings, published March 21 in the American Journal of Medicine, reveal significant public health and policy challenges.

WebMD News from HealthDay

Sources

SOURCE: Florida Atlantic University, news release, March 21, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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WebMD Health

Gun Deaths Up Sharply Among America’s Schoolkids

FRIDAY, March 22, 2019 — Gun-related deaths among school-age children in the United States are increasing at alarming rates, researchers report.

In 2017, gun violence claimed more 5- to 18-year-olds than police officers or active-duty members of the U.S. military, according to a chilling new study led by investigators from Florida Atlantic University.

“It is sobering that in 2017, there were 144 police officers who died in the line of duty and about 1,000 active duty military throughout the world who died, whereas 2,462 school-age children were killed by firearms,” study senior author Dr. Charles Hennekens said in a FAU news release. He’s a professor of medicine at the university’s Schmidt College of Medicine.

The nationwide study found nearly 39,000 gun-related deaths among 5-to-18-year-olds between 1999 and 2017. That included almost 6,500 deaths among kids between 5 and 14 years of age, and more than 32,400 among older teens.

Significant increases began in 2009, with a wave of shootings among 5- to 14-year-olds, followed by a similar wave among teens starting in 2014. Both waves — which researchers described as epidemics — continued through 2017, the most recent year for which data are available.

Gun-related deaths over the period accounted for 5.6 percent of deaths in the younger group and nearly 20 percent among older kids.

Researchers also found statistically significant increases in gun-related deaths among black children aged 5-14, starting in 2013.

Hennekens likened attempts to halt the epidemic without gun control to trying to curb lung cancer deaths due to cigarettes without reducing tobacco use.

The analysis of data from the U.S. National Center for Health Statistics also looked at causes of death among school-age children. It said 61 percent were the result of assault; 32 percent were from suicide; 5 percent were accidental; and 2 percent undetermined.

Blacks accounted for 41 percent of all deaths, and 86 percent were in boys.

The authors said the findings, published March 21 in the American Journal of Medicine, reveal significant public health and policy challenges.

More information

The American Academy of Pediatrics has more on gun safety.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

Drugs.com – Daily MedNews

Rate of U.S. Deaths Tied to Dementia Has More Than Doubled

THURSDAY, March 14, 2019 — Dementia is now one of the leading killers in the United States, with the rate of deaths linked to the disease more than doubling over the past two decades.

“Overall, age-adjusted death rates for dementia increased from 30.5 deaths per 100,000 in 2000 to 66.7 in 2017,” say a team of researchers from the U.S. Centers for Disease Control and Prevention.

In sheer numbers, the new analysis of death certificate data shows that dementia was noted as the primary cause for nearly 262,000 deaths in 2017, with 46 percent of those deaths due to Alzheimer’s disease.

That’s up from about 84,000 deaths attributed to dementia in 2000.

“It’s a huge increase from 2000 to 2017,” said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association. “It’s a big problem, and it’s getting bigger.”

America’s aging population is probably fueling this increase in dementia-related deaths, said lead researcher Ellen Kramarow, a CDC health statistician.

“Part of what is likely happening is people are living to older ages, and those are the ages where your risk of dementia is the highest,” Kramarow said. “If you haven’t died of heart disease or cancer or something else and you get to the very oldest ages, your risk for getting dementia is higher.”

Not only are people living longer, but older people now make up a larger percentage of the overall population, said Fargo, who wasn’t involved with the study.

Some portion of the observed increase could also be attributed to better records being kept of dementia-related deaths, Fargo added.

“Doctors are getting better at identifying dementia and putting it on the death certificate,” he said.

Even then, this report probably understates the number of people actually dying from dementia, Fargo said.

“We know death certificates underrepresent the true death rate from Alzheimer’s and other dementias,” he said.

To that point, the new report also noted another 129,700 deaths in 2017 where dementia was listed on the death certificate as a contributing factor but not the main cause of death, Kramarow pointed out.

Dementia is a progressive brain disease, and it proves fatal if the person doesn’t die from some other cause first, Fargo said.

“It begins with brain changes and ends with death,” he said. “Fundamentally, Alzheimer’s is a universally fatal brain disease.”

For this latest study, Kramarow and her colleagues reviewed death certificate data for four reasons of death related to dementia — Alzheimer’s disease, dementia with no specified cause, vascular dementia and other degenerative diseases of the nervous system.

The death rate was higher for women (about 73 per 100,000) than men (56.4).

Dementia death rates were higher among whites (70.8) than either blacks (65) or Hispanics (46), the researchers found.

Previous research has shown that both blacks and Hispanics are more likely to develop dementia than whites, creating a “little bit of a puzzle,” Kramarow said.

“It could be that those groups are more likely to die of other things before they would die of dementia,” she said.

As expected, the death certificate data also shows that age plays a major factor in dying from dementia. Death rates were about 57 per 100,000 among people 65 to 74, but 2,707 per 100,000 among those 85 and older.

The key to driving these numbers down is further research into dementia and Alzheimer’s, Fargo said.

“If you look at the same kind of CDC statistics for the other major killers, almost all of them are trending down over that same time period,” he said.

“They have all been taken seriously by society to the point where we have invested billions of dollars per year into defeating those diseases, and we have a great record of success that when we decide to defeat a disease through biomedical research, we can do it. We have to take that same approach with Alzheimer’s and the other dementias,” Fargo noted.

The study was published March 14 in the CDC’s National Vital Statistics Reports.

More information

The U.S. National Institute on Aging has more about end-of-life care for people with dementia.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

Drugs.com – Daily MedNews

Opioid OD Deaths Quadruple, Centered in 8 States

By Robert Preidt

HealthDay Reporter

FRIDAY, Feb. 22, 2019 (HealthDay News) — U.S. opioid overdose deaths have quadrupled in the last two decades, and the highest rates are now seen in eight Eastern states, a new study shows.

Those states are: Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire and Ohio.

The researchers also found that the death rate from opioids has increased the fastest in the District of Columbia, more than tripling every year since 2013, and that opioid death rates in Florida and Pennsylvania were doubling every two years.

“Although opioid-related mortality has been stereotyped as a rural, low-income phenomenon concentrated among Appalachian or Midwestern states, it has spread rapidly, particularly among the Eastern states,” the researchers wrote.

The analysis of data from the U.S. Census and the National Center for Health Statistics suggests that the opioid overdose epidemic has evolved as three waves.

The first wave, from the 1990s until about 2010, was associated with prescription opioid painkillers (such as OxyContin). The second wave, from 2010 until recently, was associated with a large increase in heroin-related deaths. The third and current wave, which began around 2013, involves a rapid increase in deaths associated with synthetic opioids, such as tramadol (Ultram) and fentanyl.

It’s likely that synthetic opioids have also contaminated the production process of illegal drugs, such as cocaine and methamphetamines, and is no longer limited to heroin, said study author Mathew Kiang, a postdoctoral scholar at Stanford University.

“People aren’t aware their drugs are laced and more potent than they expected, putting them at higher risk of overdose,” Kiang explained in a university news release.

The researchers also found that opioid overdose deaths are occurring in a wider range of people, and there have been significant increases in opioid overdose deaths among black Americans.

The 26 percent increase in opioid overdose deaths among blacks between 2016 and 2017 is the largest increase among any racial group, according to the U.S. Centers for Disease Control and Prevention.

The new study was published online Feb. 22 in JAMA Network Open.

Continued

“The identification and characterization of opioid ‘hot spots’ — in terms of both high mortality rates and increasing trends in mortality — may allow for better-targeted policies that address the current state of the epidemic and the needs of the population,” Kiang and his colleagues reported.

The study authors noted that states are trying to tackle the opioid crisis through policies such as restricting the supply of prescription opioid painkillers and expanding treatment and access to the opioid overdose-reversing drug naloxone (Narcan).

“Treating opioid use disorder should be our top priority to curb the problem,” Kiang said. “Similarly, we have the ability to counteract the effects of an overdose. These lifesaving drugs should be easily accessible and widely available.”

WebMD News from HealthDay

Sources

SOURCE: Stanford University, news release, Feb. 22, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Pagination

WebMD Health

Global Rate of Suicide Deaths Is on the Decline