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"providing kids and adolescents with after-school activities, from music and the arts to sports like soccer and indoor skating to many other clubs and activities. — setting drinking and smoking ages, banning alcohol and tobacco advertising, enforcing curfews for teenagers, and getting parents more involved in their kids’ schools."

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Iceland may be the world's most progressive country at reducing teenage substance abuse. In the more than 4 decades that I have studied, researched and written about substance misuse, I have not seen a more promising approach.

For three decades, I have been a regular consultant to this spectacularly beautiful and sparsely populated Nordic country (population = 332,000). In the late '90s, it was commonplace on Friday and Saturday nights to observe hordes of drunk teenagers sullying the streets of Reykjavik in mob-like revelry. Today, nearly 20 years later, I am witness to Iceland's unprecedented success in preventing substance misuse and other harmful behaviors among arguably the most volatile demographic on earth -- teenagers.

The enormity of Iceland's progress is evident in the figure below. From 1998 to 2016, the percentage of 15-16 year old Icelandic youth drunk in the past 30 days declined from 42% to 5%; daily cigarette smoking dropped from 23% to 3%; and having used cannabis one or more times, fell from 17% to 5%. These results are truly phenomenal! [1].

SUBSTANCE ABUSE DECREASE AMONG 15-16 YEAR ADOLESCENTS IN ICELAND*

Better than Dope
Promoting alternative recreational activities, strengthening family ties, improving self-efficacy (a person's experience of competence and self-regard), building social competence (comfortably and responsibly relating to others), and broadening cultural experiences are the most effective strategies for delinquency and drug abuse prevention. At-risk youth can turn their lives around when exposed to and engaged in fulfilling alternatives to drugs and crime [2, 3, 4].

Iceland has succeeded at implementing these ideals on a national scale...other countries should urgently consider taking a page from their book!

Across the U.S., there are thousands of "evidence-based" prevention programs designed to interrupt the dangerous trajectory from teenage drug abuse to a panoply of persistent problems across the lifespan. Yet substance abuse among youth in the U.S. remains rampant. According to the most recent data from the U.S. Monitoring the Future Survey (2016), the percentage of 10th, 11th and 12th grade students that participated in binge drinking (5 or more in a row) in the previous 2 weeks was 4.6%, 10.9% and 17.2%, respectively. Daily cigarette smoking in the same grade levels was 1.3%, 3.0%, and 5.5%. Annual use of marijuana/hashish was 11.8%, 25.4% and 34.9% [5].

The Obama administration is trying to weigh-in. For the first time, his administration proposes more funding in FY 2017, for demand reduction efforts than would be focused on supply reduction [7, 8]. Although the federal government now intends to budget $1.5 billion dollars for prevention, throwing more money at teenage drug abuse cannot solve the magnitude of the problem. 4,358 people in the U.S. under age 21 die each year from alcohol-related car crashes, homicides, suicides, alcohol poisoning, and other injuries such as falls, burns, and drowning [9]. Especially in the categories of binge drinking and annual marijuana use (the most widely abused drugs in adolescent culture), we are woefully behind Iceland's gold standard for success.

Where are we missing the mark?
The problems with developing a successful approach to prevention in the U.S. are 4-fold:

1) Federal, State and local governments prioritize law enforcement and treatment over prevention. Most of the funding is allocated to crisis-oriented law enforcement, treatment or punishment for attempted suicide, overdose, burglary, robbery, and assault.

2) Youth service agencies vigorously compete for limited funds provided through federal, state, and local governments, interfering with beneficial inter-agency alliances.

3) There is an absence of consensus among youth advocates and prevention/intervention specialists on "what works" in substance abuse prevention.

4) Communities differ greatly in terms of types of substance abuse problems and kinds of available prevention resources, making it unrealistic to transpose "what works" in one community to another.

Why Iceland is different
Iceland, despite their cataclysmic banking crisis of 2008, has shown sustained and progressive improvement in preventing teenage substance misuse over the past 20 years. In fact, the Youth in Iceland model which is now is being replicated in 14 countries and 32 different municipalities throughout Europe is about to celebrate its 10th anniversary -- Youth in Europe.

The tide began to turn in 1997 when substance abuse among Icelandic youth was approaching epidemic proportions; for example, 17% of 15 year olds had already tried hashish and wanton binge drinking was becoming the norm. Despite a concerted approach to provide school-based education about the negative effects of drugs, alcohol and drug abuse appeared to be spiraling out of control.

As Professor Inga Dóra Sigfúsdóttir (Director of Research at the Icelandic Centre for Social Research and Analysis - ICSRA) explained at the April 19, 2016, United Nations General Assembly Special Session (UNGLASS) on the World Drug Problem:

A visionary group of policy makers, researchers and practitioners - decided to gather their strengths, try out a new approach, and see whether it might be possible to reverse this negative, upward trend in substance use among young people.

We wanted to change what looked like this: research, policy and practice {as} three separate aspects with scientists publishing their findings, not knowing, and often not caring much whether they would come to any use in society.

We wanted to change from this:

To this:

This interdisciplinary group initiated an intersectoral collaboration (i.e., uniting multiple sectors of society) ** among a broad network of stakeholders in adolescent well-being, i.e., parent groups, schools, research scientists, politicians, media, sports organizations, and corporations. A highly-publicized annual "Prevention Day" was launched in 2007 by the President of Iceland, the goals of which were to:
* Increase time spent together by adolescents and their families
* Postpone the onset of alcohol use until 18 years of age and over
* Increase adolescent participation in structured and organized youth activities supervised by adults

The Icelandic Model
The Icelandic model is predicated upon three pillars of success: 1) Evidence-based practice; 2) Using a community-based approach; and 3) Creating a dialogue among research, policy and practice.

The high value placed on political support for evidence-based drug prevention is epitomized by the policies of Dagur Eggertsson, Mayor of Reykjavik:

My vision is that politics should be in a much closer dialogue and discussion with academia and researchers, and that good monitoring of policies are instrumental to having good results.

Every year, nationwide, Icelandic children and teenagers 10-16 years of age take part in a comprehensive survey of "Life and Living Conditions of Youth" (85-87% response rate). Youth are promised anonymity and instructed to mark answers to multiple choice questions about risk and protective factors including: self-esteem; patterns of alcohol or other drug use; family living conditions; neighborhood characteristics; attitudes about school, leisure time activities; religious affiliations; quality of parental supervision; love and guidance; support from peers; neighborhood support; anxiety, depression, and suicide; etc.

Analysis of these surveys shows that affiliations with family, peer group effects and types of recreational activities available are the strongest predictors of the paths taken by adolescents. -Inga Dóra Sigfúsdóttir

Jón Sigfússon (ICSRA Director of Youth in Iceland and Youth in Europe) explains the essence of the Icelandic model:

Well it's not magic. It's simply organized, structured work. We collect data in Iceland in February among the 10-16 year olds and within a period of about two months we have processed this data and made the report. They know from this data the situation in their municipalities approximately two months after the actual data collection.

Today we have contact persons within all these municipalities and we regularly communicate with them. We tell them what's up next in the research field and in the data collection. When they get their reports, or even before that, they have set up meetings and someone from our research institution comes and we go through the data...with them.

They gather people working in the field... teachers, politicians, people from the health care center, the church, the sports club. They gather parents of course. We go through the situation and just talk about how the situation is. This is how your children are feeling, this is what they want and here there is a rise, here is a decline. We follow this up so that the information gets into action as soon as possible.

Where do we go from here? In her closing remarks at the UN Special Session Professor Sigfúsdóttir presented her view on how to move forward:

In a world where there are practically no cultural or national boundaries anymore - AND cyberspace is without limits - teenagers are mobile in more than one sense of the word.

In this kind of world, we know that it is only through joining forces, by learning from each other and basing our work on trustworthy research, by which we will succeed in fighting substance use. It is not an easy task. But - based on research - we know it can be done - with guardianship, community attachment and informal social control. We will not change anything by single project solutions. Prevention needs to be consistent and comprehensive - not one campaign, but a quiet revolution!

If you want to replicate what happened in Iceland, here is what I recommend you to do:
* Minimize unsupervised adolescent time periods
* Create more activity, frequently and in structured ways
* Delay 'first drink' onset
* Base your efforts at a community level - where things can get done, practically and quickly
* Get your Presidents and elected leadership to campaign for this venture

__________________________________________________
* On April 19, 2016 The Icelandic Model: Evidence Based Primary Prevention - 20 Years of Successful Primary Prevention Work was featured at the Special Session of the United Nations General Assembly on the World Drug Problem. https://www.unodc.org/ungass2016/en/side_events1.html

**Intersectoral action refers to actions affecting health outcomes undertaken by sectors outside the health sector, possibly, but not necessarily, in collaboration with the health sector - World Health Organization: http://www.who.int/kobe_centre/interventions/intersectorial_action/en/

FURTHER READING
1. Kristjansson, AL., Sigfusdottir, ID., Thorlindsson, T., Mann, MJ., Sigfusson, J., Allegrante, JP. (2016). Population trends in smoking, alcohol use, and primary prevention variables among adolescents in Iceland, 1997-2014. Addiction, 111, 645-652.

2. Catalano, R.F., Fagan, A.A., Gavin, L.E., Greenberg, M.T., Irwin, C.E., Ross, D.A., Shek, D.T.L., "Worldwide Application of Prevention Science in Adolescent Health," The Lancet, Vol 379, April 28, 2012, 1653-1664.

3. Griffin, K.W. and Botvin, G.J. (2010). Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child Adolesc Psychiatr Clin N Am. 2010 Jul; 19(3): 505-526. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916744/

4. Milkman, H. and Wanberg, K. (2012) Pathways to Self-Discovery and Change: Criminal Conduct and Substance Abuse Treatment for Adolescents - Provider's Guide and Participant's Workbook, Sage Publications, Inc.; Milkman, H., "Better than Dope," (March, 2001). Psychology Today; Milkman, H., Wanberg, K., Robinson, C. (1996). Project Self-Discovery, Journal of Community Psychology Monograph, John Wiley and Sons.

5. Johnston, L. D., O'Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan.

6. http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2015.pdf

7. http://www.drugwarfacts.org/cms/Economics#sthash.NiUs4hiO.dpbs (2016 allocation of Federal funding for drug, prevention, intervention, treatment, and interdiction).

8. https://www.whitehouse.gov/sites/default/files/ondcp/press-releases/fy_2017_budget_highlights.pdf (National Drug Control Budget FY 2017 funding highlights).

9. http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/underage-drinking
____________________________
Harvey B. Milkman, Ph.D. received his baccalaureate degree from City College of New York and his doctorate from Michigan State University. He is currently Scholar in Residence at the Department of Psychology, Metropolitan State University of Denver and clinical psychologist, licensed by the Colorado State Board of Psychologist Examiners.

CONTACT US:
Inga Dóra Sigfúsdóttir (ICSRA Research Director, Reykjavik University) - ingadora@ru.is

Jón Sigfússon - (ICSRA Director, Reykjavik University) jon@rannsoknir.is

Álfgeir Logi Kristjánsson (ICSRA Data Analyst, Reykjavik University) - alkristjansson@hsc.wvu.edu

John Allegrante (Faculty of Social Sciences, University of Iceland and Mailman School of Public Health, Columbia University, New York)- jpa1@columbia.edu

Harvey Milkman (Scholar in Residence, Metropolitan State University of Denver and Visiting Professor ICSRA, Reykjavik University) milkmanh@msudenver.edu

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Iceland Succeeds at Reversing Teenage Substance Abuse The U.S. Should Follow Suit

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Iceland may be the world's most progressive country at reducing teenage substance abuse. In the more than 4 decades that I have studied, researched and written about substance misuse, I have not seen a more promising approach. For three decades, I have been a regular consultant to this spectacularly beautiful and sparsely populated Nordic country (population = 332,000).

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how much use does it take for someone to be considered addicted to a drug?

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how much use does it take for someone to be considered addicted to a drug?

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Hospital funding is tied to pain reduction, so doctors are prescribing more pain killers

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Hospital funding is tied to pain reduction, so doctors are prescribing more pain killers

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The questions about pain seem harmless:

During this hospital stay, did you need medicine for pain?

How often was your pain well-controlled?

How often did the hospital staff do everything they could to help you with your pain?

Part of a survey routinely given to patients on Medicare or Medicaid, the answers to these questions are used to determine how much medical facilities are reimbursed by the federal government.

Doctors across the country point to the survey as just one example of how emphasizing pain treatment puts pressure on them to overprescribe painkillers.

They feel that pressure from the patients who expect a pill for every ailment and from some patients who may be addicts.

They feel it from the pharmaceutical companies that used deceptive advertising about the safety of opioids.

They feel it from their bosses who are under pressure to get high scores on patient satisfaction surveys.

"Doctors have been caught in the middle of this," said Dr. Nancy H. Nielsen, former president of the American Medical Association.

At a recent medical conference, she spoke of these pressures on physicians.

"People universally were nodding," said Nielsen, who is also senior associate dean for Health Policy at the University at Buffalo School of Medicine. "That is the perception."

Centers for Disease Control has declared "an opioids overdose epidemic" in the United States, as record numbers of people are abusing pain killers and turning to the cheaper alternative of heroin.

At the same time, doctors, addiction experts and families of people who died from overdoses are demanding changes in policies about treating pain. They also are calling for changes in attitudes about how pain should be treated.

That is starting to happen.

This summer, the Centers for Medicare & Medicaid Services announced a proposal to stop using the answers related to pain treatment as part of its funding formula for reimbursing hospitals. The agency said it would keep the questions in place while it explored alternatives. More than 2,800 comments were submitted online following the proposal, and a ruling on how to proceed is expected to be announced around Nov. 1.
One doctor's experience
Dr. Jose G. Perez-Brache, a local emergency room physician who has been personally touched by the opioids epidemic, shared an experience he said he had three years ago.

A woman came into the emergency room at Kenmore Mercy Hospital, saying she had fallen in the bathtub and that her back hurt, he said

Perez-Brache gave her a thorough physical exam, he recounted. Sensing there was something other than a back issue involved, he ordered a urine test and a CT scan. The CT scan showed no signs of any injury but the urine test came back positive for opiates, the doctor said.

Perez-Brache told the patient about the test results and she immediately walked out of the ER. The doctor surmised that the woman was "doctor shopping" for someone to write her a prescription for an opiate.

Some time later, the patient filed a complaint against Perez-Brache, saying he wouldn't treat her pain and he was asked by the hospital to write a letter detailing what happened.

The doctor ran into an administrator at the hospital and asked about the response letter he had written.

The administrator told him, according to Perez-Brache: "I don't care. Make them happy. I don't want any more complaints."

Perez-Brache said he was stunned.

"It really took me back," he said.

In response to Perez-Brache's allegation, Catholic Health officials said Catholic Health never would ask a doctor to give any kind of medical care that is not medically necessary.

"In Catholic Health, we take patient complaints seriously and investigate matters of concern," said Dr. Brian J. D'Arcy, Senior Vice President of Medical Affairs and Chief Medical Officer of Catholic Health.

"We expect doctors working in our hospitals to treat patients with compassion and respect, however, we would never request a physician administer medical care, including pain medications, that is not clinically necessary."
A personal reason to come forward
Perez-Brache acknowledged that the complaint from the woman claiming back pain wasn't the first time a patient has complained about him. He said he has received complaints for lecturing patients who are obese about making better lifestyle choices to help control their weight and from smokers he has urged to quit cigarettes.

At the time of the incident with the back injury patient, Perez-Brache was splitting his work between Kenmore Mercy and Mount St. Mary's Hospital in Lewiston. A few months later, he left Kenmore Mercy to work full time at Mount St. Mary's Hospital in Lewiston.

Perez-Brache decided to tell The Buffalo News about the experience he had in 2013 to illustrate what doctors and hospitals are facing and also because of a personal tragedy. Two years ago, his girlfriend's daughter, Marlee DeFazio, died of an opioid overdose in their house in Hamburg. She was 23.

Perez-Brache and his girlfriend knew DeFazio was abusing pain pills. She received outpatient counseling and had moved in with Perez-Brache and his girlfriend.

Then on March 31, his girlfriend came home and asked, "Where's Marlee?"

She found her daughter dead on the second floor.

The police came and showed Perez-Brache six pills. He recognized them right away. Oxycodone.

"You can see why I'm so passionate about it," he said. "It's affected me. It's affected my family tremendously."
The fifth vital sign
Nearly everyone touched by the opioids crisis believes that attitudes about pain have played a key role in the explosion of painkiller use and abuse.

It goes back to the 1990s, when there was a call for pain to be treated as "the fifth vital sign," said Dr.Timothy Gabryel, president of the Medical Society of Erie County and medical director of Mercy Hospital.

"That set an expectation that there should be a pill for every problem and there should be no discomfort at all," Gabryel said.

Two highly influential papers were published that argued that opioids that had been developed to treat cancer pain could be used safely to treat more kinds of pain and weren't addictive, according to a 2013 New Yorker article "Who is responsible for the pain-pill epidemic?"

The opioids were greenlighted for treatment of non-cancer pain, and soon drugs like oxycodone and hydrocodone were routinely prescribed, often 30, 60 and even 90 days worth at a time. Between 1999 and 2014, sales of prescription opioids quadrupled, according to the CDC.

Patients came to expect their pain to not only be addressed, but eradicated. It's no wonder.

Walk into any ER or doctor's office these days, and one of the first questions you are likely to be asked is about pain. You might be asked to rate your pain on a scale of zero to 10 or point to one of a series of cartoon faces on a chart, ranging from a smiley face to a bright red face with tears streaming down.

With the skyrocketing addiction problem and overdoses, medical providers are taking a step back and re-examining prescription protocols.

"I think now, as the scene has changed and we've seen more negative outcomes ... everybody is backing away and saying: Wait a minute. You should only prescribe for seven days,'" Gabryel said.
Patient satisfaction
A national coalition of medical and addiction professionals called Physicians for Responsible Opioid Prescribing identified earlier this year two sources of pressure on doctors: the patient survey used by Centers for Medicare and Medicaid Services and the "Pain Management Standards" of the Joint Commission on Accreditation of Healthcare Organizations, one of the major accrediting organizations in the country.

That national coalition, which includes Anne Constantino, president and CEO of Horizon Health Services in Buffalo, and Avi Israel, president of Buffalo-based Save the Michaels of the World, asked the federal agency to remove the questions altogether.

"Hospitals are financially incentivized by [the Centers for Medicare and Medicaid Services] to obtain high scores on HCAHPS Survey questions," the group wrote in a letter. "The questions on the Survey pertaining to treatment of pain have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge."

The letter pointed to a study that found that doctors prescribe opioids in more than half of nonsurgical hospital admissions.

"While there is no empirical evidence" that pain questions "unduly influence prescribing practices," the Medical and Medicaid agency said in a news release in announcing proposed changes to how the survey is used, "we propose to remove the pain management dimension from the Hospital Value-Based purchasing program to eliminate any potential financial pressure clinicians may feel to overprescribe pain medications."

The same agency acknowledged that it had heard concerns about the pain questions and that some hospitals were using the survey results to incentivize individual doctor, nurses and hospital staff. The survey, the agency said, "was never intended to be used in these ways."

The agency said that it was exploring new questions to more appropriately address pain and conducting research on the clinicians' concerns and to "determine if there are any unintended consequences that link the Pain Management dimension questions to opioid prescribing practices.

The proposed changes and recognition about the role that putting too much emphasis on pain can have are important first steps, Nielsen said.

"This can't happen soon enough," Nielsen said. "But it doesn't go far enough."

She would like to see the pain questions removed completely.
The Joint Commission
The national physicians coalition also wrote to the Joint Commission, saying its policies on pain promote the routine pain assessment of all patients, even when it doesn't make sense.

"The Pain Management Standards foster dangerous pain control practices," the physicians group wrote in a letter in April, "the endpoint of which is often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families and communities."

The Joint Commission has adamantly refuted the notion that its policies have led to over-prescription of opioids and published a five-point statement earlier this year to counter "common myths about the Joint Commission pain standards."

The Joint Commission argued that it "never endorsed pain as a vital sign," has amended its requirements for pain assessment of all patients, does not require hospitals to reduce pain to zero, doesn't mention the use of opioids and noted the rise in opioid prescriptions preceded the release in their standards in 2001.

However, the Joint Commission has been criticized for its relationship to pharmaceutical companies that make opioids, particularly Purdue Pharmaceutical, which produces OxyContin. A 2003 report by the U.S. General Accounting Office that found that Purdue was "one of two drug companies that provided funding for JCAHO's pain management educational programs."

It also said that "under an agreement with JCAHO, Purdue was the only drug company allowed to distribute certain educational videos."

The report to Congress said: "Purdue's participation in these activities with JCAHO may have facilitated its access to hospitals to promote OxyContin."

In 2007, criminal charges against OxyContin's makers led to more than $600 million in fines. A holding company affiliated with Purdue Pharma pleaded guilty to a felony charge that it had fraudulently claimed OxyContin would cause less abuse and addiction than competing short-acting narcotics, according to a New York Times article.
The perception
While some dispute any direct cause and effect between between making patients happy with over prescription of opioids, Nielsen said, there's a strong perception that there's pressure to prescribe opioids.

"Perception is everything,"she said.

And if the perception is that it is making doctors feel they need to prescribe opioids, even against their better judgment, she said, then measures need to be taken.

But others argue that treating pain is an essential part of good medical care and that the vast majority of people given prescription pain killers are not abusing them and are not becoming addicts.
Changing attitudes about pain
The pendulum has swung back to being more cautious about painkillers, and that has led to situations where doctors are now discharging patients who they believe are misusing pain medication.

The Medical Society has fielded complaints from patients who complain they were dumped by their doctors.

Christine C. Ignaszak Nadolny, executive director of the Medical Society, shared a not uncommon patient complaint: "The doctor won't give me any more scrips.

The patients, fearful of pain and of withdrawal symptoms, will even threaten doctors with going to the streets to buy heroin, she said.

It's up to the doctors to make the best recommendations for their patients, said Gabryel, medical director of Mercy Hospital, and that's not always easy.

"Physicians have to say no and we do say no, and sometimes that makes us less popular with our patients. That, unfortunately, is reflected in surveys."

Nielsen said the challenge is to change people's attitudes about pain.

"We have to make sure that patients understand that some discomfort is often part of the healing process," she said.

For too long, people have embraced "better living through chemistry," she said. "That is a problem. So we have to adjust patient expectations while trying our best to let patients suffer."

Doctors also need to figure out how to safely treat chronic pain.

"We need more research on that," Nielsen said.

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Doctors say funding formula for hospitals encourages overprescribing of pain meds

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The questions about pain seem harmless: During this hospital stay, did you need medicine for pain? How often was your pain well-controlled? How often did the hospital staff do everything they could to help you with your pain?

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Unfortunately, the rates of opioid abuse and overdose deaths have skyrocketed in recent years, leading healthcare providers and patients alike to be cautious about the use of opioids. And now it turns out that there is another reason to avoid opioids: they may not be the most effective treatment for acute pain after all.

Do opioids work better than other drugs?

A recent study in the Journal of the American Medical Association throws into question how well opioid drugs actually treat acute pain.

In the study, researchers assigned 416 emergency room patients with moderate-to-severe pain to one of four treatment groups. Three of the treatment groups received a combination of a common opioid painkiller (either oxycodone, hydrocodone, or codeine) plus 300 mg of acetaminophen, a common non-opioid pain medication often sold over the counter as Tylenol. The fourth group received 400 mg of ibuprofen, a non-opioid painkiller, plus 1,000 mg of acetaminophen.

The result? All four groups experienced the same levels of pain relief. While opioid drugs did help to reduce pain, they were no more effective than a combination of non-opioid painkillers.
What are other options for pain treatment?
While opioids are usually given for acute pain, some of the following options also work well for chronic pain, or pain that lasts longer than six months.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
, , and are known as nonsteroidal anti-inflammatory drugs ( ). They control pain, lower fevers, and reduce inflammation. NSAIDs are often considered to be the first line of defense for acute pain , especially pain that doesn't respond to non-drug treatments.

One word of caution: long-term use of NSAIDs can lead to stomach distress or bleeding in your gastrointestinal tract, and the that non-aspirin NSAIDs may increase the risk of heart disease and stroke.
Acetaminophen
Acetaminophen is used on its own as a painkiller and is also an active ingredient in many combination medicines for pain and colds. It is a popular over-the-counter option, sold under brand names like . Acetaminophen is especially helpful in addressing acute pain for conditions like headache, arthritis, and cancer pain.

Acetaminophen does not cause the gastrointestinal or cardiovascular side effects of NSAIDs, but taking amounts in excess of the recommended dosage may lead to liver damage or even liver failure. Because acetaminophen is present in so many medications, check whether other medications you're taking contain acetaminophen as well.
Antidepressants Anti-epileptic medications
Anti-epileptics can be taken to address chronic nerve pain and chronic pain from conditions like diabetes, shingles, chemotherapy, herniated disks, and fibromyalgia. Research on how well anti-epileptic medications work for pain is unclear. Some people may receive significant benefits while others may not receive any pain relief at all.
Corticosteriods
Corticosteriods , commonly referred to as just steroids, decrease inflammation and reduce the activity of the immune system. They can reduce swelling and pain for conditions like cancer, back injuries, arthritis, joint pain, and nerve pain. Steroids can be helpful for short-term treatment of acute pain and are also used for the management of some chronic pain conditions. , Common steroids used for pain relief are dexamethasone ( ), prednisone ( ), and prednisolone ( ).

Steroids can be taken orally, applied as a cream, injected, or inhaled. Steroids do come with side effects such as weight gain, high blood pressure, and weakened immune system. Taking low doses of steroids for short periods can minimize those side effects. Injecting steroids directly into an area of pain also reduces side effects and promotes targeted treatment of the affected area.
Non-drug treatments
Non-drug treatments like exercise, physical therapy, yoga, acupuncture, cognitive behavioral therapy, biofeedback, chiropractic, and relaxation training can provide pain relief, especially for chronic pain., In fact, organizations as diverse as the American College of Physicians, the U.S. Department of Veterans Affairs, and the Centers for Disease Control and Prevention recommend non-drug treatments as the first course of action for chronic pain. Although side effects for non-drug treatments tend to be minimal, be sure to consult with a healthcare provider before beginning any new treatment activities.

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6 Alternatives to Opioids for Pain - The GoodRx Prescription Savings Blog

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Unfortunately, the rates of opioid abuse and overdose deaths have skyrocketed in recent years, leading healthcare providers and patients alike to be cautious about the use of opioids. And now it turns out that there is another reason to avoid opioids: they may not be the most effective treatment for acute pain after all.

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What are the long term impacts of addiction once the addict recovers?

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What are the long term impacts of addiction once the addict recovers?

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What if you're born addicted to opiates? Can you recover or will you always feel the need to take them? 

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What if you're born addicted to opiates? Can you recover or will you always feel the need to take them? 

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Given the location - steps from the Novartis Institutes for Biomedical Research and not far from M.I.T. and Kendall Square - a number of passers-by worked in science or medicine. Many happily volunteered, eager to help the passed-out dummy, try the lockbox and see if they could administer the Narcan, which came in a simple-to-use nasal spray.

They adapted easily to the role playing. After they had secured the Narcan from the lockbox, many would run back to the dummy, as if the dummy's life depended on it. One volunteer, Shirley Poyau, a doctoral student, jumped into the experiment so enthusiastically that her baby daughter, strapped to her chest, almost fell out. When Ms. Poyau quickly, expertly administered the Narcan - and held onto her daughter - the police and the doctors all burst into applause.

Not surprisingly, this self-selected group had an easy time of it. The only concern they raised was that they needed three hands: one to hold their phones to follow instructions from the dispatcher, one to hold the dummy's head back and a third to squirt the Narcan in the dummy's nose.

While everyone involved in the experiment seemed pleased, I wandered up Massachusetts Avenue in search of other views. Some merchants told me they had sent employees to a recent informational session on Narcan and thought the lockboxes might be useful. But others were wary, especially restaurant workers, who worried that the boxes would be bad for business and invite liability issues.

What surprised me was the near-universal misperception that Narcan is addictive or somehow desirable and that drug users, craving it, would break into the boxes to steal it. "The boxes themselves will be a cookie jar for junkies," Gary Mello, a former candidate for City Council, who keeps a keen eye on the Cambridge city government, told me. "Crowbarred same day they're installed."

Narcan is actually quite safe and not addictive, and most drug users hate it because it sends them into withdrawal.

I thought about what Dr. Dan Dworkis, one of the emergency doctors in the experiment, had told me: "Everyone wants to be able to help," he said. "No one wants to leave their fellow human lying on the street."

But talking with people not involved in the experiment showed me just how much education remains to be done about Narcan, even in a city in the grip of an opioid crisis. I hope Dr. Dworkis was right.

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Would You Step In to Help a Stranger Who's Had an Opioid Overdose?

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Given the location - steps from the Novartis Institutes for Biomedical Research and not far from M.I.T. and Kendall Square - a number of passers-by worked in science or medicine. Many happily volunteered, eager to help the passed-out dummy, try the lockbox and see if they could administer the Narcan, which came in a simple-to-use nasal spray.

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buprenorphine - a prescription for heroin addicts, controversial 

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buprenorphine - a prescription for heroin addicts, controversial 

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Gloucester police working to assist addicts togo to rehab rather than arresting

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Gloucester police working to assist addicts togo to rehab rather than arresting

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Date: Sunday, April 15 Location: Breakaway​,​ 221 Newbury St​,​ Route 1, Danvers Time: Doors open at 5:30 p.m., Event ends at 9:30 p.m. Once again, we are pleased to have one of Boston's best comedian​​ Dave Russo and ​friends for a comedy night to help raise funds in memory of Stephenie Jesi. This year the [...]

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PAARI - The Police Assisted Addiction and Recovery Initiative

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Date: Sunday, April 15 Location: Breakaway​,​ 221 Newbury St​,​ Route 1, Danvers Time: Doors open at 5:30 p.m., Event ends at 9:30 p.m. Once again, we are pleased to have one of Boston's best comedian​​ Dave Russo and ​friends for a comedy night to help raise funds in memory of Stephenie Jesi.

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- stress can lead to addictions
- realizing you have an issue is a big step in getting help
- different ways to dealing with your stress will help make you feel better and wean yourself off the drugs
WAYS TO HELP
- Avoiding friends who use it
- avoid clubs or bars
- Seek medical treatment and be honest when doing so about your history

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Make addiction treatment easier to access than opiates.

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https://www.samhsa.gov/find-help/national-helpline
- people can call when struggling to stop addiction
- call when realized they have issues
- "In 2016, the Helpline call volume has increased to an average of over 65,000 per month."
- information kept confidential

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-Cognitive behavioral therapy
-Motivational therapies
-Family and interpersonal therapy
-Peer support

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In 2015 276,000 Adolescents(12-17) were non-medical users of pain relievers. Within that group 122,000 of them were addicted to the prescription pain relievers.

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Over 7 million Americans in 2014 battled a drug use disorder, per NSDUH.

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Over 7 million Americans in 2014 battled a drug use disorder, per NSDUH.

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When one first starts using drugs, they can control the problem but after a while, it is no longer in their control

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According to the National Survey on Drug Use and Health (NSDUH), 21.5 million American adults (aged 12 and older) battled a substance use disorder in 2014.

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According to the National Survey on Drug Use and Health (NSDUH), 21.5 million American adults (aged 12 and older) battled a substance use disorder in 2014.

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Many people are addicted to opiates