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The Blue Planet effect: why marine biology courses are booming

SOURCE:  The Guardian/Helena Pozniak   Jan 12, 2018

Thanks in part to the BBC wildlife series, there has been a sea change in the popularity of marine biology courses and the study of the world’s oceans.

When she was just 12 years old, an impressionable Cathy Lucas, now associate professor in marine biology at the University of Southampton, met Sir David Attenborough. He’d come to talk to students about his 1979 landmark wildlife series Life on Earth. “I thrust him my copy of his book to sign. He inspired me to go on and study zoology.”

Just back from a research trip to Saudi Arabia, she’s since spent years investigating what makes jellyfish tick – programme makers at the BBC’s latest natural history series Blue Planet IIsought her expertise for a segment. Although jellyfish have been around for at least 500m years, they’ve remained the poor relation of marine life, often misrepresented as freakish, alien blobs, says Lucas.

But recent population blooms have piqued scientists’ interest. “Attention is focused on what’s driving this growth in numbers – and the effect this has on the oceans.” Invited to a screening of the Blue Planet II series, she once again heard Attenborough speak and thought: “Here I am, doing this, as my actual job.”

Lucas teaches students on Southampton’s marine biology degrees based at the National Oceanography Centre. Like many universities around the country, Southampton is noticing the “Blue Planet effect” on the numbers of students interested in the field. “Big series such as these are critical in raising awareness of the issues facing marine wildlife,” says Lucas.

Even between the first and second series, there have been dramatic changes in the oceans, says David Duffy, a research fellow at Bangor University. “Most of these changes can be traced back to human activity, which is having a devastating impact.”

Duffy is working with scientists at the Sea Turtle hospital in the Whitney laboratory for marine bioscience at the University of Florida, investigating the huge rise in cases of young turtles suffering cancerous tumours. “Numbers worldwide are skyrocketing and this is almost certainly due to human activity, but we don’t know exactly what activity,” he says.

Drawing on techniques he developed during five years spent researching human cancers, Duffy has been analysing samples from the turtles operated on: “I became convinced that the cutting-edge techniques I was using could be applied more broadly, so I embarked upon a project that brought me back to wildlife and the sea – having studied marine snails as a postgrad.”

From acidification of the oceans to the aggression of hermit crabs, there’s no shortage of research avenues, says Prof Mark Briffa who’s taught students on Plymouth University’s one-year master of research (MRes) in marine biology. As professor of animal behaviour in the School of Biological and Marine Sciences, he’s currently researching how and why sea anemones fight.

“We’re still seeing students coming through who were inspired by the first Blue Planet series,” he says.

Plymouth accepts about 20 students on the year-long course, which kicks off with some taught modules to build research skills. Students then pursue individual research projects, working with university researchers or those based at the nearby Marine Biological Association. They may investigate local shores, go offshore or travel to a research facility in Ischia, Italy.

“The degree gives you a chance to dip your toe into research and see if it’s for you,” says Briffa. Students go on to find work with marine agencies and environmental consultancies, he says.

Briffa hopes the students also leave inspired with a sense of wonder and curiosity: “I can go to a local rocky shore and pick up a single rock and find some major divisions of life – that can’t fail to fascinate anyone.

“It sparks questions of why animals live where they do and how they survived. There’s a whole world down there that people simply aren’t aware of.”

As Britain bans microbeads, lawmakers urge more action on plastic

SOURCE:  Reuters/Varsha Saraogi            Jan 8, 2018

LONDON, Jan 8 (Thomson Reuters Foundation) – A ban on plastic microbeads, used as exfoliants in toothpastes, face washes and shower gels that end up in the oceans, will come into force in Britain on Tuesday, but lawmakers said more needed to be done to tackle plastic pollution.

The tiny plastic beads pollute waterways and oceans, where they can be eaten by marine life and end up in the human food chain. A report by lawmakers in 2016 said the industry’s commitment to phasing them out was inconsistent and recommended a ban.

“Microbeads in cosmetics are an avoidable part of the problem, which is why we called for a ban,” member of parliament Mary Creagh, chair of the Environmental Audit Committee, a cross-party green watchdog, said in a statement. “This is a step in the right direction, but much more needs to be done. Since we called for a ban, my committee has also recommended a deposit return scheme for plastic bottles, a latte levy for plastic-lined coffee cups and reforms to make producers responsible for their packaging.”

A deposit return scheme involves consumers paying a small deposit that is refunded when they return empty plastic bottles and is common in many parts of the world including Denmark, Germany and Australia.

In Britain, the idea of a deposit return scheme for bottles has won the backing of two supermarkets, Iceland and the Co-op, the first major retailers to support the policy to promote recycling and tackle ocean plastic pollution.

A spokesman for the Department for Environment, Food and Rural Affairs (DEFRA) said last month the government “will be working with industry to explore how we can reduce the amount of single-use plastic waste.”

Eight million tonnes of plastic – bottles, packaging and other waste – are dumped into the ocean every year, killing marine life and entering the human food chain, says the United Nations Environment Programme (UNEP).

If current pollution rates continue, there will be more plastic in the sea than fish by 2050.

In December, all l93 countries that are members of the United Nations signed a U.N. resolution to eliminate plastic pollution in the sea, a move some delegates hoped would pave the way to a legally binding treaty. (Editing by Ros Russell )

Soils reveal a hidden cost of farming, and fertilizers

SOURCE:  Environmental Health News/Douglas Fischer   Dec 15, 2017

In one Montana ag basin, drinking wells test at twice the federal health standard for nitrate pollution. That’s a problem on many levels. Montana State researchers are working with farmers to solve it.

For every ton of fertilizer farmers apply to fields in the United States, almost 1,200 pounds is wasted due to inefficiency, with almost 400 pounds of that waste flushing into streams and aquifers.

That’s a lot of nitrogen – farmers apply 22 million tons of fertilizer a year in the United States alone, according to the U.S. Department of Agriculture. Nitrogen runoff is responsible for a lot of polluted drinking water sources and compromised aquatic ecosystems across the globe — a problem only getting worse in regions with growing population and development.

New research out of Montana State University finds that, in one agricultural basin in the upper Missouri River watershed, groundwater and streams mirrored soil chemistry. For the environment, you are what’s in your dirt. Now scientists are working with farmers who manage the land to make the findings relevant to those with power to make a difference.

In the Judith River basin, where farmers fertilize crops of wheat and barley – and then pray for timely rain, researchers found mean nitrate levels in drinking wells more than twice federal standards. Those concentrations exceeded the 75th percentile for Montana’s statewide agricultural well network and landed in the 95th percentile for a 2011 survey nitrate pollution in U.S. wells.

Loss of nitrogen from soil triggers problems on many levels, says Montana State University Water Quality Associate Specialist and graduate student Adam Sigler, the lead author of the study, published this fall in the Journal of Hydrology. Infants are particularly vulnerable to nitrate pollution, which can lead to a condition known as “blue baby” syndrome.

Farmers suffer, too, as nutrients they’re paying for – fertilizer is a $58 billion industry in the U.S., according to the Fertilizer Institute – get flushed into the environment rather than boosting yield and protein in crops.

And excess nitrogen triggers a host of problems in the environment, from algae blooms in water to impaired plant growth on land and the increase of greenhouse gases in the atmosphere.

The Montana researchers found some silver linings. Planting a cover crop – rather than leaving the land fallow – helps. “Simply growing a crop every year mitigates the environmental implications,” Sigler said. And getting farmers engaged can trigger change.

That dialog, researchers concluded, “allowed agricultural producers to evaluate their role in landscape-scale water quality issues and to help identify management strategies that would be practical and effective.”

Listen to Adam Sigler explain the research.

And read about what some California farm towns are doing to fight nitrate pollution, in this report published in September in Resilience.

Where Are the Sharks? Scientists Use DNA Sampling to Find Out

SOURCE:  PEW Charitable Trusts/Rebecca Goldburg        Dec 7, 2017

Scientists are estimating the relative abundance and diversity of shark species across vast stretches of the ocean with little more than a few plastic bottles filled with seawater.

By analyzing environmental DNA (or eDNA), a relatively inexpensive and non-invasive technique, researchers can determine if a species is—or has recently been—in the area. The work, led by Professor Stefano Mariani and researcher Judith Bakker from the University of Salford, UK, is detailed in a study published Dec. 4 in Scientific Reports.

Perhaps unsurprisingly, the study found that areas experiencing less human impact and greater shark protections appear to support more shark species. These more pristine areas also may support greater abundances of several shark species, although the study addressed only the abundance of the species relative to one another.

Scientists used a method called eDNA metabarcoding to isolate DNA directly from seawater samples (the technique is also used on land, for example in analyzing soil). Unlike traditional animal monitoring approaches, eDNA does not require researchers to see the organisms of interest, or catch and tag them.

In recent years, eDNA has been used to detect rare or invasive species, particularly in rivers and lakes, where water is relatively contained compared to the ocean. The new study shows that this technique can also be used to monitor large, elusive species, even including highly mobile ones like sharks. Assessing geographical patterns of diversity and, potentially, abundance in shark populations can help inform conservation strategies, such as the creation and monitoring of marine protected areas.

In the Field

Developing management strategies for sharks is a challenge due to the high cost and effort associated with large-scale monitoring of shark species. In this study, scientists estimated shark diversity and relative abundance in the Caribbean Sea and the Coral Sea. From February to November 2015, researchers collected water samples from four Caribbean locations—Jamaica, the Bahamas, Belize, and Turks & Caicos Islands; and three locations in the Coral Sea—Noumea, New Caledonia North, and the Chesterfield atolls. These areas represented various levels of human impacts and known shark protections.

The researchers genetically identified 22 shark species—12 in the Caribbean and 16 in the Coral Sea (nine species appeared in both regions).

They also found a greater diversity and relative abundance of sharks in the Coral Sea than the Caribbean. Within the Caribbean, the study found the most shark species (11) in the Bahamas, where shark fishing is banned, and fewer in areas with greater human impacts, including Jamaica (two species) and Belize (one species). Similarly, in the Coral Sea shark diversity was greater in remote locations such as New Caledonia North (14 species) and Chesterfield atolls (11 species), while waters near the densely populated city of Noumea supported only five species.

Next Steps

While eDNA research is still new, scientists are already making rapid improvements with it, including the ability to distinguish closely related species from one another. Still, the technique has limitations: In some cases, eDNA can specify only the genus for closely related species. And scientists still need to compare this new method to established approaches used to estimate the relative abundance of individual species. Also, much more research is required to determine whether estimates of actual population abundance can be obtained using the technique.

“This technique has the potential to become a powerful conservation tool in the near future,” says Mariani. “Conservation and management of highly mobile species like sharks requires rapid and extensive monitoring across large ocean areas and at numerous times a year. A streamlined water-collection program may be the only approach able to provide this level of coverage.”

Stress Test: New Study Finds Seals are Stressed-Out by Sharks

SOURCE:  RSMAS/University of Miami    Dec 5, 2017

MIAMI—While a little added stress may be helpful to flee a dangerous situation, or to meet an approaching deadline, it’s no secret that prolonged exposure to the stress hormone cortisol is linked to health problems. So, what effects does stress have on animals in the wild that need to navigate the same waters as the ocean’s top predator— great white sharks?

Predators are known to impact the population abundances of their prey by killing and consuming them. But can predators in the wild also exert control over their prey from the stress associated with living in high-risk waters?

University of Miami (UM) Rosenstiel School of Marine and Atmospheric Science-led research team found just the right situation—fur seals living among one of the densest populations of great white shark off South Africa’s Western Cape—to test this predation-stress hypothesis in the wild.

In the three-year study, the scientists focused their investigation on six islands in the region where Cape fur seals (Arctocephalus pusillus) colonies have varied seasonal exposure to hunting great white sharks (Carcharodon carcharias). To evaluate the seals’ stress levels in relationship to hunting sharks, the team collected hundreds of seal fecal samples and measured them for glucocorticoid metabolite concentrations (fGCM), a cortisol stress hormone.

The team compared stress hormone levels in seal fecal samples with residency patterns of great white sharks at the different seal colonies based on satellite tagging data. The team also compared seal fecal cortisol concentrations with measured shark attack rates on seals at one the sites. The researchers found that seals exhibited high stress levels when the risk of great white shark attack was high, at locations where and when the seals were under risk of unpredictable and lethal attack from great whites as the seals they left the safety of an island’s inner perimeter and passed through a gauntlet of white sharks hunting to reach offshore feeding grounds.

“Our findings showed that seals exhibited high stress in the places and at the times when great whites were hunting and the seals had no way of anticipating or effectively preventing a predation attempt from any shark that decided to attack,” said the study’s lead author Neil Hammerschlag, a research assistant professor at the UM Rosenstiel School and UM Abess Center for Ecosystem Science and Policy.

“Comparable stress responses were not detected in places and times where sharks were not hunting. Interestingly, stress responses were also not detected at one island where seals could reduce their risk of attack by using kelp beds and reef as underwater refuges, despite the presence of hunting great whites,” said study co-author Scott Creel, a Professor at Montana State University.

In one location, called Seal Island in False Bay, the seals’ fecal stress levels were highly correlated with weekly shark attack rates. However, seals did not show comparable signs of stress at another location known as Geyser Rock in Gansbaii, which contains kelp beds and reefs that the seals use as natural safe passageways from sharks as the move about the island.

Based on the findings, the authors suggest that predation risk will produce physiological costs in the form of a stress response when risk cannot be adequately predicted or controlled by behavioral responses.

“These results underline the ecological importance of apex predators,” said Hammerschlag. “Any resulting loss in health or survival of prey due to predator-induced stress could have cascading effects on the entire ecosystem and food web.”

The study, titled “Physiological stress responses to natural variation in predation risk: evidence from white sharks and seals,” was published on December 1 in the journal Ecology, DOI: 10.1002/ecy.2049

The study’s authors include: Michael Meÿer, Simon Mduduzi Seakamela and Steve Kirkman from the Republic of South Africa’s Department of Environmental Affairs, Chris Fallows of Apex Shark Expeditions, and Scott Creel from Montana State University. Funding for the study for provided in part by Canon USA and the Herbert W. Hoover Foundation.

Photo Caption:  A great white shark launches an attack in pursuit of a Cape fur seal.
Photo: Chris Fallows/ Apex Shark Expeditions

How opioids started killing Americans at the corner pharmacy

SOURCE: Bloomberg/Natasha Rausch    Nov 28, 2017

A huge study of the epidemic’s acceleration shows most deaths began with a prescription.

It’s been conventional wisdom for some time now that America’s opioid epidemic began at the pharmacy. Now there are numbers to put any doubt to rest.

More than half of all people who succumbed to an overdose between 2001 to 2007 were chronic pain sufferers who filled an opioid prescription and sometimes even saw a doctor in the month before they died. Only 4 percent were ever diagnosed as having an abuse problem, said Mark Olfson, one of five researchers who conducted a massive study of the crisis and its causes for Columbia University Medical Center.

The findings of the new study, published Tuesday in the American Journal of Psychiatry, split the epidemic into two groups: those who were diagnosed with chronic pain and those who weren’t. In the year before they died, about two-thirds of those studied were diagnosed with chronic pain and prescribed an opioid. (Many would also get a prescription for anti-anxiety drugs called benzodiazepines, which can make for a deadly combination.) The other third among those who died had no diagnosed chronic pain but became addicted to opioids in another way.

“Those are different populations,” Olfson said in a telephone interview. “Understanding those things puts us in a better position to combat the epidemic.”

According to the National Institute on Drug Abuse, more than 33,000 Americans died from opioid overdoses in 2015. Most of those deaths were linked to prescription pain pills, though the use of heroin was already growing rapidly, accounting for almost 13,000 fatalities that year. The scourge has continued to inundate America’s health care infrastructure. An analysis published this week by OM1 Inc., a company that uses artificial intelligence to improve health outcomes, found that in the second quarter of 2017, one out of every six emergency room visits in the U.S. was opioid-related.

And while opioid prescriptions have become harder to come by, the drugs are still too easy to obtain, U.S. health officials have said. The amount of opioid painkillers prescribed in the U.S. peaked in 2010 and declined each year through 2015, according to the Centers for Disease Control. Nevertheless, the drugs are prescribed about three times as much as they were in 1999, the CDC said in July.

In the Columbia study, researchers analyzed clinical diagnoses and prescriptions for more than 13,000 adults in the Medicaid program in 45 states who died of an overdose from 2001 to 2007. According to the study, people with disorders such as depression, anxiety or alcohol abuse were at higher risk of opioid-related death.

Olfson said he hoped the study would alert lawmakers and health care providers to those at highest risk, as well as the dangers of prescribing opioids and benzodiazepines simultaneously.

Each piece of data, he said, helps give people a sense of the “crisis we’re in the midst of.”

–Bloomberg contributor: Jared S Hopkins

Gulf of Mexico’s Deep-Sea Corals: Ancient Jewels Worth Protecting

SOURCE:  Pew Charitable Trusts/Holly Binns  October 25, 2017

Some of the deep-sea corals in the Gulf of Mexico started growing when Rome still ruled an empire and Native Americans were constructing civilizations in the vast forests that would—centuries later—become the U.S. Southeast.

For countless generations, these structure-forming animals have thrived in the cold, dark depths, serving as homes to starfish, squat lobsters, crabs, sharks, and many species of fish, including grouper and snapper. But modern-day threats loom for these fragile and slow-growing jewels, which may take centuries to recover from damage, if they recover at all. Of primary concern is fishing gear, such as trawls, traps, longlines, and anchors, which can break coral. Fortunately, fisheries managers can do something about this.

While energy development and changing ocean conditions also pose threats to corals, fisheries managers have jurisdiction over preventing damage from fishing gear. The Gulf of Mexico Fishery Management Council, which sets fishing policy in the Gulf’s federal waters, prohibits anchoring or the use of certain types of deep-fishing gear near some coral communities. The council is considering extending similar protections to additional areas where scientists have identified dense communities of corals.

The council is taking public comment here and will host public hearings early next year. Protecting corals is an important part of conserving the Gulf’s marine ecosystem.

You can see Gulf of Mexico deep-sea corals in this video and learn more about them here.

Up to 1 in 5 Fish Sold Is Caught Illegally—and Other Surprising Illegal Fishing Facts

SOURCE:  The Pew Charitable Trusts/Julie Janovsky    Nov 13, 2017

Our ocean is under assault from a battery of threats that are damaging ecosystems, depleting fish stocks, and changing the marine environment. One of those threats gets relatively little attention but is both serious and solvable: large-scale illegal fishing.

Here are seven facts about this crime, including what is being done to address it.

1. Illegal fishing accounts for up to $23.5 billion worth of seafood every year.

That’s up to 1 in 5 fish taken from the ocean. At the top end of that estimate, that’s 26 million tons of fish annually—or 1,800 pounds of fish stolen every second.

2. Up to 32 percent of seafood imported into the U.S. is caught illegally.

While illegal fishers tend to target the waters of countries with few enforcement resources, which means the bad actors face less risk of being caught, they are less discriminating about where they sell their ill-gotten catch.

2014 study published in the journal Marine Policy found that up to 32 percent of seafood imported into the U.S. is caught illegally. This is because once fish get past a port, it is very difficult to determine where, how, and by whom they were caught.

3. Illegal fishing is linked to a host of other crimes.

The activities connected to illegal fishing include arms and wildlife smuggling, drug trafficking, and human rights abuses. In some cases, crew members on illegal vessels have been sold into slavery and work for years at sea in horrific conditions for little or no pay.

4. Some governments make it easy to fish illegally.

Some states provide flags of registration to nefarious vessel owners and conceal the whereabouts of these vessels and their activities. Tightening policies—though regional fisheries management organizations, international treaties, and stronger control of seafood imports at the national level—can help increase accountability for such countries. For example, the European Union, with its red-yellow-green card system, has forced numerous countries to ensure that the seafood they import to the EU as caught legally.

5. Marine reserve status doesn’t make an area safe from poaching.

Although defined boundaries on a map might convey a sense that all marine life within those lines is safe from human threats, protected-area designations are almost meaningless unless they are backed up by effective surveillance and enforcement. In fact, illegal fishers intentionally target reserves because they know that fish are more abundant within those areas.

6. Illegal fishers historically have had a remarkably easy time evading detection, capture, and punishment.

This is due to a combination of factors, including patchwork fisheries policies around the world, lax enforcement at many ports, and the difficulty of policing the open ocean.

7. Ending illegal fishing requires action on numerous fronts—and that’s happening.

The Port State Measures Agreement has led to stronger controls in dozens of countries to stop illegally caught fish from coming ashore. More fisheries management bodies are requiring that boats have International Maritime Organization numbers to boost accountability.

Interpol, under Project Scale, coordinates efforts to fight illegal fishing among its 192 member countries and has caught many illicit actors. And Oversea Ocean Monitor, a satellite-based platform developed by The Pew Charitable Trusts and the U.K.-based firm Satellite Applications Catapult, is proving to be a highly effective tool for spotting suspect activity across large spans of the ocean, even the most remote places.

Taking A Page From Pharma’s Playbook To Fight The Opioid Crisis

SOURCE:  California Healthline/Pauline Bartolone     Nov 8, 2017

Dr. Mary Meengs remembers the days, a couple of decades ago, when pharmaceutical salespeople would drop into her family practice in Chicago, eager to catch a moment between patients so they could pitch her a new drug.

Now living in Humboldt County, Calif., Meengs is taking a page from the pharmaceutical industry’s playbook with an opposite goal in mind: to reduce the use of prescription painkillers.

Meengs, medical director at the Humboldt Independent Practice Association, is one of 10 California doctors and pharmacists funded by Obama-era federal grants to persuade medical colleagues in Northern California to help curb opioid addiction by altering their prescribing habits.

She committed this past summer to a two-year project consisting of occasional visits to medical providers in California’s most rural areas, where opioid deaths and prescribing rates are high.

“I view it as peer education,” Meengs said. “They don’t have to attend a lecture half an hour away. I’m doing it at [their] convenience.”

This one-on-one, personalized medical education is called “academic detailing” — lifted from the term “pharmaceutical detailing” used by industry salespeople.

Detailing is “like fighting fire with fire,” said Dr. Jerry Avorn, a Harvard Medical School professor who helped develop the concept 38 years ago. “There is some poetic justice in the fact that these programs are using the same kind of marketing approach to disseminate helpful evidence-based information as some [drug] companies were using … to disseminate less helpful and occasionally distorted information.”

Recent lawsuits have alleged that drug companies pushed painkillers too aggressively, laying the groundwork for widespread opioid addiction.

Avorn noted that detailing has also been used to persuade doctors to cut back on unnecessary antibiotics and to discourage the use of expensive Alzheimer’s disease medications that have side effects.

Kaiser Permanente, a large medical system that operates in California, as well as seven other states and Washington, D.C., has used the approach to change the opioid-prescribing methods of its doctors since at least 2013. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In California, detailing is just one of the ways in which state health officials are attempting to curtail opioid addiction. The state is also expanding access to medication-assisted addiction treatment under a different, $90 million grantthrough the federal 21st Century Cures Act.

The total budget for the detailing project in California is less than $2 million. The state’s Department of Public Health oversees it, but the money comes from the federal Centers for Disease Control and Prevention through a program called “Prevention for States,” which provides funding for 29 states to help combat prescription drug overdoses.

The California doctors and pharmacists who conduct the detailing conversations are focusing on their peers in the three counties hardest hit by opioid addiction: Lake, Shasta and Humboldt.

They arrive armed with binders full of facts and figures from the CDC to help inform their fellow providers about easing patients off prescription painkillers, treating addiction with medication and writing more prescriptions for naloxone, a drug that reverses the toxic effects of an overdose.

“Academic detailing is a sales pitch, an evidence-based … sales pitch,” said Dr. Phillip Coffin, director of substance-use research at San Francisco’s Department of Public Health — the agency hired by the state to train the detailers.

In an earlier effort, Coffin said, his department conducted detailing sessions with 40 San Francisco doctors, who have since increased their prescriptions of naloxone elevenfold.

“One-on-one time with the providers, even if it was just three or four minutes, was hugely beneficial,” Coffin said. He noted that the discussions usually focused on specific patients, which is “way more helpful” than talking generally about prescription practices.

Meengs and her fellow detailers hope to make a dent in the magnitude of addiction in sparsely populated Humboldt County, where the opioid death rate was the second-highest in California last year — almost five times the statewide average. Thirty-three people died of opioid overdoses in Humboldt last year.

One recent afternoon, Meengs paid a visit during the lunch hour to Fortuna Family Medical Group in Fortuna, a town of about 12,000 people in Humboldt County.

“Anybody here ever known somebody, a patient, who passed away from an overdose?” Meengs asked the group — a physician, two nurses and a physician’s assistant — who gathered around her in the waiting room, which they had temporarily closed to patients.

“I think we all do,” replied the physician, Dr. Ruben Brinckhaus.

Brinckhaus said about half the patients at the practice have a prescription for an opioid, anti-anxiety drug or other controlled substance. Some of them had been introduced to the drugs years ago by other prescribers.

Dr. Ruben Brinckhaus says his small family practice in Fortuna, Calif., has been trying to wean patients off opiates. (Pauline Bartolone/California Healthline)

Meengs’ main goal was to discuss ways in which the Fortuna group could wean its patients off opioids. But she was not there to scold or lecture them. She asked the providers what their challenges were, so she could help them overcome them.

Meengs will keep making office calls until August 2019 in the hope that changes in the prescribing behavior of doctors will eventually help tame the addiction crisis.

“It’s a big ship to turn around,” said Meengs. “It takes time.”

One short letter’s huge impact on the opioid epidemic

By Nadia Kounang, CNN

Updated 11:16 PM ET, Thu June 1, 2017

(CNN) Every day, 91 Americans die from an opioid overdose. Drug overdoses overall — most of them from opioid painkillers and heroin — are the leading cause of accidental death in the US, killing more people than guns or car accidents. In fact, while Americans represent only about 5% of the global population, they consume about 80% of the world’s opioid painkillers. But how did we get to this point?

Many public health experts point to a simple five-sentence letter to the editor published in a 1980 edition of the New England Journal of Medicine. The 101-word letter, titled “Addiction Rare in Patients Treated with Narcotics,” was signed by Jane Porter and Dr. Hershel Jick of Boston University, who said that of their 11,000-plus patients treated with narcotics, there were only four cases of addiction. And although this letter provided no further evidence and was not a peer-reviewed study, it has often been cited as proof of the safety of prescribing long-term narcotics for chronic pain.

This week, the journal published yet another letter to the editor, this one an analysis from researchers at theInstitute for Clinical Evaluative Sciences of how frequently Porter and Jick’s letter has been cited by other researchers and physicians in studies and journalssince its publication. The analysis found 608 citations of the initial letter as of May 30, 72% of them pointing to it as proof that addiction was rare among long-term narcotic users. Dr. David Juurlink, one of the researchers involved in the analysis, wrote in an email that the “5-sentence letter to the editor in medicine’s most prestigious journal was leveraged as proof that opioids could be used safely over the long term, even though it offered no evidence to support that claim. It’s clear that many of the authors who cited it hadn’t actually read it.

Jick is quick to point out that his letter has been misrepresented. He told CNN last year that it was never meant to speak about the general population, but rather referred only to patients who were closely monitored in a hospital setting. Yet, according to the new analysis, 80% of the articles that referenced the letter make no mention of the fact that these were hospitalized patients.

In addition, most of the citations weren’t critical at all of the letter or the notion that these drugs could be dangerous to prescribe long-term. In fact, references to the letter in studies jumped after the 1995 introduction of OxyContin, the long-acting formulation of oxycodone.

And although positive references to the letter have decreased in recent years, they still remained as of 2016. So far this year, the researchers found no positive references to the letter. To help stem the wave of opioid overdoses across the country, public health experts, legislators and law enforcement have come together in an all-hands-on-deck effort.

Among the most recent efforts, Ohio Attorney General Mike DeWine this week filed suit against five pharmaceutical companies: Purdue Pharma, the maker of OxyContin; as well as Teva Pharmaceuticals; Allergan; Endo Health Solutions and Janssen, a subsidiary of Johnson & Johnson.

In a statement, DeWine said, “These drug manufacturers led prescribers to believe that opioids were not addictive, that addiction was an easy thing to overcome, or that addiction could actually be treated by taking even more opioids.”

Ohio joins a growing list of states and municipalities, such as Mississippi and the city of Chicago, alleging that pharmaceuticals recklessly pushed the prescribing of addictive narcotics while knowing the risks. On Wednesday, the Heroin and Opioid Prevention Effort and Treatment Act went into effect in Maryland, effectively making naloxone, a medication that can reverse opioid overdose, available over the counter. There is similar legislation allowing broad access to naloxone in Alabama, West Virginia and Pennsylvania.

Original article available here.  

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