The problem with prescription painkillers

Wynne Armand, MD
Wynne Armand, MD, Contributing Editor

Opioids are effective pain relievers. But sometimes people can develop a tolerance to these drugs, requiring increasingly higher doses of medication to achieve the same pain relief. And physical dependence — withdrawal symptoms when the drug is stopped — is also common. The increased availability of these drugs has put many people at risk for addiction, overdose, and even death.

Low-nicotine cigarettes may help determined smokers cut back

Mallika Marshall, MD
Mallika Marshall, MD, Contributing Editor

A study examining the effects of low-nicotine cigarettes on smoking behavior yielded surprising results. The study volunteers who smoked the low-nicotine cigarettes actually smoked less and had fewer cigarette cravings than those who smoked cigarettes with a higher level of nicotine. Although more research is needed before we can draw any conclusions, it’s possible that very-low-nicotine cigarettes might be a way to mitigate the health dangers of smoking for people determined not to quit.

Edible marijuana — a half-baked idea?

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Marijuana-laced brownies have long been a way to get high. Now a new generation of “food companies” is taking the concept of edible marijuana in a somewhat scary new direction: marijuana-laced foods that mimic popular candies. These sweets could pose a danger to children, warns a Perspective article in today’s New England Journal of Medicine. From a marketing perspective, it’s a cute concept to sell Buddahfingers that look like Butterfingers, Rasta Reese’s that mimic Reese’s Peanut Butter Cups, or Pot Tarts that resemble Pop-Tarts. But the availability of edible marijuana products has led to an increase in emergency visits to hospitals because of kids accidentally eating edible marijuana products and in marijuana-related calls to poison and drug hotlines.

Report highlights the dangers of opioid painkillers

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.

Heavy drinkers aren’t necessarily alcoholics, but may be “almost alcoholics”

Patrick J. Skerrett, Former Executive Editor, Harvard Health

Nearly one-third of American adults are “excessive” drinkers, but only 10% of them have alcohol use disorder (alcoholism). Those numbers, published yesterday in a national survey, challenge the popular idea that most people who drink too much are alcoholics. The new study, done by researchers with the CDC and the Substance Abuse and Mental Health Service Administration, found that about 70% of all American adults drink alcohol at least now and then, about 30% report excessive drinking, and 3.5% have alcohol use disorder. It is higher among heavy drinkers (10%) and binge drinkers, ranging from 4% among those who report binge drinking once or twice a month to 30% among those who binge drink 10 times or more in a month. The knowledge that only 10% of heavy drinkers are alcoholic may be reassuring, but that doesn’t mean the other 90% aren’t have problems with drinking. Some are what Drs. Robert Doyle and Joseph Nowinski call “almost alcoholics.”

New strategies help smokers quit when nicotine replacement alone doesn’t work

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

Breaking a smoking habit can be hard. Nicotine is so addictive that smoking, or using tobacco in other forms, may be the toughest unhealthy habit to break. But it’s possible to quit. Nicotine replacement, in the form of nicotine patches, gum, sprays, inhalers, and lozenges, can help overcome the physical addiction. Medications such as varenicline (Chantix) and bupropion (Zyban) can also help. They can help reduce the cravings for a cigarette, and may also make smoking less pleasurable. Two new studies show that adding one or both of these medications to nicotine replacement can help improve quit rates. This research doesn’t suggest that smokers take varenicline and bupropion as a first step in smoking cessation. But when nicotine replacement alone hasn’t helped, adding varenicline with or without bupropion may lead to success.

Heavy drinking in middle age linked to memory loss in men

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

For some people, like those with an addiction, any amount of alcohol is too much. For others, drinking alcohol is something of a balancing act — a little may be healthful, while more than a little may be harmful. A new report in the journal Neurology highlights the dual effects of alcohol in men. As part of the Whitehall II study in Britain, researchers assessed the drinking habits of middle-aged men and women three times over a 10-year period. The study participants also took a mental skills test three times over the next 10 years. Compared with men who didn’t drink or who drank moderately, mental decline began to appear one to six years earlier in men who averaged more than 2.5 drinks a day. (There weren’t enough heavy drinkers among women to show any clear differences.) How does a person know if he or she is drinking too much? The CAGE and AUDIT tests can help.

Surgeon General’s 1964 report: making smoking history

Anthony Komaroff, M.D.
Anthony Komaroff, M.D., Executive Editor, Harvard Health Letter

On a Saturday morning 50 years ago tomorrow, then Surgeon General Luther Terry made a bold announcement to a roomful of reporters: cigarette smoking causes lung cancer and probably heart disease, and the government should do something about it. Terry, himself a longtime smoker, spoke at a press conference unveiling Smoking and Health: Report of the Advisory Committee of the Surgeon General of the Public Health Service. That press conference was held on a Saturday in part to minimize the report’s effect on the stock market. The 1964 Surgeon General’s report, and others that followed, have had a profoundly positive effect on the health of Americans, despite the tobacco industry’s concerted and continuing efforts to promote smoking. By one new estimate, the decline in smoking triggered by the 1964 report and others that followed prevented more than 8 million premature deaths, half of them among people under age 65. But we still have a long way to go. Some 42 million Americans still smoke, and tobacco use accounts for millions of deaths each year around the world.

Join the Great American Smokeout

Patrick J. Skerrett, Former Executive Editor, Harvard Health

If you smoke, you’ve probably heard that quitting is beneficial at any age. It’s good for your health, can make you feel and look better, and saves you money. But you also know, from personal experience or the experiences of friends, that quitting is hard. Take heart. Today, there are more ex-smokers than smokers in the United States. There are also more and better tools to help people quit. Each year on the third Thursday of November, the American Cancer Society sponsors the Great American Smokeout. It aims to make smokers and their loved ones more aware of the benefits of quitting and the tools available for achieving that goal. In support of the Great American Smokeout, Harvard Health Publications is giving away free electronic copies of the Harvard Medical School Guide: How to Quit Smoking. This offer ends at midnight tonight (Nov. 21, 2013).

Nighttime overeating can throw weight and health out of sync

Michael Craig Miller, M.D.
Michael Craig Miller, M.D., Senior Editor, Mental Health Publishing, Harvard Health Publications

For many people, a late-night “snack” is a daily habit. There are two types of nighttime eating disorders. Sleep-related eating disorder is a highly-publicized though uncommon malady. People with this problem eat while sleepwalking or while in a twilight state between sleep and wakefulness. A better-documented problem is night eating syndrome, in which people do the majority of their eating late at night. It may affect 1 or 2 out of 100 people in the general population. Sleeping and eating are almost certainly connected, given the link between lack of sleep and weight gain. So getting plenty of sleep may be a helpful substitute for nighttime trips to the refrigerator. Being mindful of the problem and trying to identify its triggers, or stress-reduction techniques, may help avert trips to the refrigerator. Some people benefit from talk therapy.