By Rachael Rettner
MyHealthNewsDaily

A proposed bill in Oregon to make the possession of cigarettes illegal is well-intended, but from a practical standpoint, it's unlikely to happen, bioethicists and public health experts say.

The ban, sponsored by State Rep. Mitch Greenlick of Portland, would make nicotine a controlled substance, and says possessing more than 0.1 milligrams would be illegal, punishable by a year in prison or a $6,250 fine. Exceptions would be made for people who had a doctor's prescription for the drug,   according to the bill.

Tobacco clearly takes a significant toll on the lives of Americans, causing 450,000 premature deaths each year, and drastic measures should be taken to eliminate the habit from our lives, including, some say, banning cigarettes. But others argue that, in today's society, such a goal is overly idealistic, and would be extremely difficult to implement.

"As someone who's looking out for public health, I think it’s a great thing," said Dr. Bradley Flansbaum, a hospitalist at Lenox Hill Hospital in N.Y. "Knowing that tobacco is public enemy No. 1 in preventive illness...I don’t think I can endorse smoking for any reason," Flansbaum said.

However, "Politically, it's going to be a tough if not impossible sell," Flansbaum said.

In 2009, the Food and Drug Administration banned the manufacture and distribution of flavored cigarettes, such as chocolate and cherry, over concerns that the products encouraged youth smoking. However, banning all cigarette products is a different matter entirely. Barriers to passing such a ban include the power of big tobacco companies, the cost of enforcing such a law, and the rise of a black market for cigarettes, experts say.

"Once you have a substance out there like tobacco in wide use it's hard to turn around and make it illegal," said Arthur Caplan, a bioethicist at New York University School of Medicine's Division of Medical Ethics, "You can certainly tax it, you can certainly stigmatize it," and educate against its use.  But ban it?  "In reality, it's not going to happen," Caplan said.

"Smoking has been around too long, and the industries that profit from it are huge and will fight to the end," Caplan said.

Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corp., a nonprofit research organization, said she was surprised to hear of the bill. "The policy would require an enormous cost to enforce if it is to have any teeth, which most states are not in a position to absorb," Pacula said.

However, others argued such barriers should not deter the action.

"That's really the ultimate goal — to have the world free from the death and destruction it causes," said Dr. Amy Lukowski, clinical director of Health Initiatives Programs for the National Jewish Health Center in Denver. "How we do that? That's the million-dollar question." Although anti-smoking policies have made strides in reducing the number of people who smoke, "I think we have to do something drastic about this," Lukowski said. "[It's] taking the lives of Americans every day." Indeed, a study published today (Jan. 24) in the New England Journal of Medicine found that smoking takes at least 10 years off a person's life.

"I think we should try," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. "What's possible begins with what we try to do. I think there is a strong argument for never allowing another child to become addicted to tobacco," Katz said. "This would never be approved for sale today, and we should get rid of it."

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Kerry Grens
Reuters

Fewer than five percent of patients prescribed narcotics to treat chronic pain become addicted to the drugs, according to a new analysis of past research.

The finding suggests that concerns about the risk of becoming addicted to prescription painkillers might be "overblown," said addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine.

"If you're a person that doesn't have a history of addiction and doesn't have any major psychiatric problems, narcotics are relatively safe as long as your doctor doesn't give you too much and uses the right medication," Fleming, who was not involved in the new study, told Reuters Health.

Some recent research has concluded the same thing, but another expert remained skeptical about the new report because many of the studies it included were not considered the best quality research, and they varied widely in their results.

"I think the jury's still out" on how worrisome prescription opioid addiction is, said Joseph Boscarino of the Geisinger Clinic in Danville, Pennsylvania, who studies pain and addiction.

Opioid painkillers, which include oxycodone, fentanyl and morphine, have only recently become available for patients with chronic pain, said Boscarino, who was not part of the new study.

In the past, the drugs were almost exclusively reserved for cancer patients and people with short-term pain - on the theory that in the first category of patients the need outweighed the risk, and in the second group, short term use was unlikely to lead to long-term addiction.

"They opened up (to chronic pain patients), and since then there's been a wave of addiction, especially in the last five years," Boscarino said.

One recent study found that the number of people diagnosed with a substance abuse problem increased by 70 percent from 2001 to 2009, and doctors suspect the increased popularity of prescription painkillers is a primary driver (see Reuters Health story of October 22, 2012).

Of course, not all these cases reflect patients who are using the drugs as directed - or who even have a prescription to treat chronic pain.

To get a sense of how addictive opioid painkillers are for those patients who do have a prescription, researchers from The Cochrane Collaboration, an independent group that reviews research on medications, collected the results from 17 studies covering more than 88,000 people.

All of the patients had been prescribed opioids to treat chronic pain, and nearly all of them had pain unrelated to cancer.

In 10 of the studies, patients used the painkillers for anywhere from three months to several years, while one study included just short-term use of several days and the others did not report the length of time patients were on the drugs.

Taken together, the studies found that 4.5 percent of people developed a dependency on the painkillers.

"It's a low percentage," said Dr. Silvia Minozzi, lead author of the study and a member of the Cochrane Drugs and Alcohol Group in Rome.

Although 4.5 percent was the most common rate of addiction among the studies, Minozzi pointed out there were large differences in the rates each study found - ranging from zero to 31 percent.

For instance, a study by Boscarino and his colleagues that was included in Minozzi's review found that 25 percent of patients became addicted.

The group of patients Boscarino surveyed had a high rate of alcoholism and illegal drug use, though.

He said the disparities among the various studies could also be a result of how people were surveyed about their behaviors.

"We surveyed the patients about their pain in their homes (where) they were relaxed," he said. "I think they were more inclined not to try to hide their symptoms."

Minozzi's review found that, among the three studies with information on substance abuse, people with a history of drug use were more likely than other patients to develop an addiction to their prescription pain pills.

For most people, addiction "does happen, but it's not very common," Fleming told Reuters Health. "But if you give a big bottle of Percocets to someone who has an addiction history, who may or may not be using cocaine and marijuana at the same time, they have pain and maybe they should be treated, but they're much more likely to get into trouble with that."

Knowing this can help physicians screen patients to judge who might be the most vulnerable to becoming addicted and get them into the appropriate interventions, he said.

Minozzi noted the fact that her review found a "deficiency of good-quality" studies on this subject, "seems to stand in contrast to the widespread concern of doctors and authorities relating to the prescription of opioids for pain."

Myhealthnewsdaily.com

The number of babies born exposed to addictive drugs while in the womb is increasing, a new study suggests.

Between 2000 and 2009, the incidence of neonatal abstinence syndrome — a disorder that occurs in babies exposed to illegal or prescription drugs during pregnancy — increased nearly threefold in the United States, the study found.

The rate of mothers using opiates such as heroin, morphine, codeine and Oxycontin at the time of delivery increased fivefold over that same period.

Neonatal abstinence syndrome most commonly occurs in newborns exposed to opiates while in the womb. The condition can bring increased irritability, tremors, seizures and respiratory distress.

During the study period, the average cost of treating babies with neonatal abstinence syndrome (NAS) increased 35 percent, and the length of time these babies stayed at the hospital remained about the same (16 days, on average).

"The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce" exposure to opiates before birth, the researchers write, in a paper published online today (April 30) in the Journal of the American Medical Association.

In addition, standardizing the care these babies receive, and developing new treatments for the condition may better treat babies with NAS symptoms and reduce the length of their hospital stays, the researchers said.

Researchers from the University of Michigan Health System analyzed information from two national databases — one for children and one for adults — each containing information from about 7 million people released from the hospital.

Between 2000 and 2009, the rate of newborns diagnosed yearly with NAS increased from 1.20 per 1,000 births to 3.39 per 1,000 births. Also over this period, the number of mothers using or dependent on opiates increased from 1.19 per 1,000 births to 5.63 per 1,000 hospital births per year.

Average hospital charges for newborns diagnosed with NAS increased from $39,400 to $53,400, the researchers said.

In 2009, about 13,500 infants were diagnosed with NAS, an estimate that equates to about one infant born per hour with the condition.

Treating mothers who use opiates with a drug called buprenorphine may have advantages over the traditional treatment, which involves use of methadone, the researchers noted, pointing to a 2010 study that showed that newborns whose mothers were treated with buprenorphine required 89 percent less morphine, and spent 43 percent less time in the hospital.

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