Meds

The genes that make people susceptible to alcoholism also make them prone to becoming addicted to marijuana, a new study suggests.

Researchers interviewed almost 6,300 men and women aged 24 to 36, including almost 2,800 sets of twins who were part of the Australian Twin Registry, about their use of alcohol and marijuana over their lifetime.

Twins are valuable to researchers in determining the role of genetics in various diseases or conditions because identical twins share 100 percent of their genes, while fraternal twins share 50 percent of their genes, the same as other siblings.

About 60 percent of the likelihood of becoming a heavy drinker, a frequent marijuana user or of becoming dependent on marijuana can be attributed to genes, according to the study, while about half of the likelihood of being an alcoholic can be traced to genetics.

“We know there is a high likelihood of alcohol addiction-related problems among people who smoke marijuana heavily and vice versa,” said study author Carolyn E. Sartor, a research instructor at Washington University School of Medicine in St. Louis. “What we found is that some of the same genetic influences that impact alcohol use and dependent symptoms also impact marijuana use and dependent symptoms.”

Still, that means between 40 percent and 50 percent of the cause of alcohol or marijuana dependence may be due to environmental influences. Despite a genetic tendency, no one is predestined to abuse either substance, Sartor noted.

And even though a common set of genes appear to influence marijuana and alcohol addiction, there are also likely specific genes that influence addiction susceptibility to individual substances, Sartor added.

The study will be published in the upcoming March issue of Alcoholism: Clinical & Experimental Research.

Marijuana is the most commonly used illegal drug, according to the study, citing a 2008 survey that found about 42 percent of high school seniors reported having tried marijuana. About 5 percent said they had used it daily during the previous month.

Though generally believed to be less addictive than nicotine in tobacco products, about 12 percent of marijuana users meet the criteria for dependency, according to the study. Symptoms of marijuana or alcohol dependency include using more heavily or more frequently than intended, giving up important activities to smoke or drink and building a tolerance or needing to use more to get the same effect.

Marijuana’s active ingredient, THC, acts on the brain’s cannabinoid system, which is involved in learning, memory, appetite and pain perception, explained Dr. Christian Hopfer, an associate professor at the University of Colorado School of Medicine. Medical uses for marijuana including alleviating pain and boosting appetite in people with cancer and other serious illnesses.

But marijuana has its downsides. Other research has shown marijuana use increases the risk of developing mental illnesses, Hopfer added.

Far less research has been done about marijuana than on tobacco or alcohol products, Hopfer said. That needs to change. Not only is marijuana use widespread, but THC levels in pot have increased in recent years, making the drug’s effects more potent.

“We are quasi-legalizing it due to medical marijuana, yet we really don’t know that much about it except a lot of people are self-administering it,” Hopfer said. “Marijuana addiction is a subtler addition than with some other drugs, but it can be a big focus of their life and interfere with their functioning.”

In the past, researchers have often studied the addictive properties of drugs such as tobacco, cocaine, marijuana, heroin and alcohol separately, Hopfer said. But studies such as this suggest there can be similar genes underlying a propensity toward many types of substance abuse.

“There is a lot of evidence that if you have trouble with one substance you will have trouble with others,” Hopfer said. “Twin data shows that the genetic effects may be across substances.”

While there are legal drugs available to help treat nicotine and alcohol addiction, there are no drugs to treat marijuana addiction. For marijuana dependency, behavioral modification, family therapy, cognitive behavioral therapy and 12-step programs are among the programs that may help, Hopfer said.

It’s not enough to “sleep it off” after a night of drinking.

According to a study released today, the effects of intoxication last long after the booze is out of the blood, not only leaving a nasty hangover but also slowing reaction times and the ability to concentrate the next morning.

Rhode Island and Massachusetts researchers found that it didn’t matter whether the liquor consumed was clear or dark; the level of brain impairment was the same the next morning.

“People will be impaired the morning after – after the alcohol leaves the system,” Dr. Damaris Rohsenow of the Brown University Center for Alcohol and Addiction Studies in Providence, Rhode Island noted in a telephone interview with Reuters Health.

The findings are based on a study looking at the effects of heavy drinking on 95 young adults between the ages of 21 and 33. The subjects spent two nights at the Boston test facility. One night they were given alcohol (either vodka or bourbon mixed in cola) and the other night they were given a placebo. The researchers determined their blood alcohol levels, sleep patterns and ability to think quickly and over a long period of time.

To approximate the effects of drinking on an empty stomach, Rohsenow and colleagues gave test subjects a standardized meal three hours before the test liquids were given until subjects reached a minimum blood alcohol level of 0.09 grams percent. (In all 50 states, 0.08 grams percent is considered legally drunk.)

Previous research shows that symptoms of a hangover (headache, nausea, sleepiness) usually lift within a few hours of waking. While this study did not measure how long impairment lasted, Rohsenow told Reuters Health: “It’s likely that the performance effects probably lift within a few hours,” too.

Vodka and bourbon appear on each extreme of alcohol purity: vodka is the most free of impurities while bourbon has the highest level – all other alcohols are somewhere in between.

Previous research shows that the higher the impurities the lousier a drinker is likely to feel the next day, but this study showed that impairment was the same.

“Bourbon versus vodka didn’t make a difference; the biggest thing was the alcohol itself,” Rohsenow said.

Subjects given alcohol the night before “thought their ability to drive a car was as good as or better” than those who were administered placebo, Rohsenow said.

It “might be a good rule of thumb (to) wait until they don’t feel so lousy the next morning before doing any activities that might involve operating dangerous equipment,” Rohsenow said.

The researchers chose to study young adults because there are more heavy drinkers among this age group, it’s safer, and they have more time to devote to the overnight stays required by the study. As a result, the findings can only be applied to people between the ages of 21 and 33.

Surgical patients whose incisions become infected with antibiotic-resistant bacteria are at greatly increased risk for hospital readmission and death, claims a new study that found that treating this type of infection can cost as much as $60,000 per patient.

Duke University Medical Center researchers examined the 90-day postoperative outcomes of 659 patients. Some had surgical site infections caused by methicillin-resistant Staphylococcus aureus (MRSA), some were infected with methicillin-susceptible Staphylococcus aureus (MSSA), and others had no infection.

“We found that patients with surgical site infections due to MRSA were 35 times more likely to be readmitted and seven times more likely to die within 90 days compared to uninfected surgical patients,” lead author Dr. Deverick J. Anderson, an infectious diseases specialist, said in a news release. “These patients also required more than three weeks of additional hospitalization and accrued more than $60,000 in additional charges.”

The study also found that patients with MRSA averaged six more days of hospitalization and $24,000 more in additional hospital charges than those with MSSA. However, the researchers were surprised that those infected with MRSA didn’t have a higher risk of death than those with MSSA.

“For the seven hospitals we looked at, the total estimated cost resulting from surgical site infections due to MRSA was more than $19 million. That’s a staggering amount, which demonstrates an area of cost-saving potential for these institutions and other community hospitals,” Anderson said.

According to a new recommendation from the U.S. Preventive Services Task Force, there is insufficient evidence to assess the balance of benefits and harms of screening infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy. Hyperbilirubinemia is a condition marked by a high level of bilirubin in the blood, which is often apparent as yellow-colored skin and eyes (jaundice). This recommendation and the accompanying summary of evidence will appear in the October issue of Pediatrics.

About 60 percent of all infants have jaundice, and it generally clears up without any medical treatment. Some infants are more likely to have severe jaundice and higher bilirubin levels than others. In some infants, hyperbilirubinemia may lead to chronic bilirubin encephalopathy, a rare but devastating neurological condition. The brain damage associated with chronic bilirubin encephalopathy, or kernicterus, may result in cerebral palsy, auditory processing problems, gaze and vision abnormalities, and cognitive problems. The number of children who develop chronic bilirubin encephalopathy is unknown and difficult to determine.

“There is inadequate evidence that screening all full-term and near-term infants for elevated bilirubin leads to improved health outcomes,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. “More research is necessary to understand how often chronic bilirubin encephalopathy occurs, its risk factors, and whether screening is associated with a reduction in chronic bilirubin encephalopathy.”

There is evidence that screening using risk factor assessment or bilirubin level measurement can identify infants at risk of developing hyperbilirubinemia, but there is no known screening test that will reliably identify all infants at risk of developing chronic bilirubin encephalopathy. Not all infants with chronic bilirubin encephalopathy have a history of hyperbilirubinemia, and not all infants who have extremely high levels of bilirubin develop chronic bilirubin encephalopathy.

In assessing the potential benefits and harms of screening infants for hyperbilirubinemia, the Task Force looked for evidence that screening reduced the number of new cases of chronic bilirubin encephalopathy. No studies have directly addressed whether screening, either risk-factor assessment or bilirubin testing, reduced the number of new cases of chronic bilirubin encephalopathy. The current evidence on screening has evaluated the effectiveness of screening to identify infants for treatment intended to reduce high levels of bilirubin.

The Task Force found that the evidence is currently insufficient regarding whether treating infants with high levels of bilirubin results in fewer children developing chronic bilirubin encephalopathy. There is a critical gap in the evidence regarding the relationship between screening infants without symptoms of hyperbilirubinemia and the desired outcome of reducing cases of chronic bilirubin encephalopathy. When the Task Force finds insufficient evidence to make a recommendation, it does not mean a clinician shouldn’t provide a service but that the evidence is lacking, and if a service is offered, patients should understand the uncertainty about the balance of benefits and harms. The Task Force recognizes that clinical or policy decisions involve more consideration than their recommendations alone, and clinicians and policy makers should understand the evidence but individualize decision-making to the specific patient or situation.

Efforts have been made by clinicians to eliminate this rare disorder by applying measures to screen for and aggressively manage high bilirubin levels. Universal screening for jaundice is widespread in the United States, and clinicians and parents should continue to work together to decide whether to screen in the face of insufficient evidence. Clinicians must remain aware that screening and resulting treatment of hyperbilirubinemia have potential harms such as weight loss, gastrointestinal problems, and disruption of the mother-infant bonding.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality (AHRQ), conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services.

The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspshyperb.htm.

People with sleep apnea who are also obese may triple the chances of eliminating their sleep problems by losing weight, a new study suggests.

Losing about 10 percent of their body weight was enough to bring on total or near-total remission, said Gary Foster, head of the Center for Obesity Research and Education at Temple University in Philadelphia, and lead author of the study.

“It’s been clear that obesity increases the risk of sleep apnea but less clear that if obese people or people with type 2 diabetes lost weight, it would result in significant improvements in their sleep apnea — and it did,” said Foster.

People who are overweight or obese are much more likely to have obstructive sleep apnea, a condition in which a person’s breathing stops or becomes very shallow, sometimes several hundred times a night and sometimes for as long as a minute, according to the American Sleep Apnea Association.

“The soft palate in the back of mouth falls down and blocks the airway,” said Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City. “When you get to people with serious levels of obesity, it’s virtually impossible to find those without [this type of] sleep apnea.”

The condition can lead to cardiovascular problems, including stroke, and can raise the risk for dying prematurely.

“It really has tremendous detrimental effects on the cardiovascular system,” Roslin said.

The study involved 264 obese men and women who also had type 2 diabetes and obstructive sleep apnea. They were randomly assigned to an intensive behavioral program intended to encourage weight loss or to a less intensive set of group sessions that mainly addressed the issue of diabetes management.

After a year, those in the intensive program had lost an average of about 24 pounds, compared with slightly more than a one-pound average weight loss for the others.

Those who lost the weight also saw a substantial reduction in the number of sleep apnea episodes they experienced, with more than three times as many people in the intensive group experiencing complete remission (13.6 percent versus 3.5 percent).

“The greatest benefit was seen in men and those with severe apnea,” Foster said.

Any amount of weight loss brought on an improvement, but those who lost about 10 percent of their original body weight saw the greatest effect. “Any weight loss is good,” Foster said.

Most experts recommend 10 percent as the weight loss needed to improve sleep apnea.

However, the study also found that people whose weight remained stable experienced a worsening in their sleep apnea. Just why that occurred remains unclear.

“This is one of the first and certainly the largest study ever conducted so we’re at the point in the field, unfortunately, where we’re just describing the effect,” Foster said.

The study, published Sept. 28 in the Archives of Internal Medicine, does seem to confirm what common sense and experience have shown.

“We’ve seen that when patients gain five to 10 pounds, their sleep apnea is much worse. If they lose five to 10 pounds, the sleep apnea is much better,” said Dr. Hormoz Ashtyani, director of pulmonary critical care and sleep medicine at Hackensack University Medical Center in New Jersey. “It’s usually not a resolution, but it’s a significant improvement.”