TIME Innovation

Fight Prison Gangs by Breaking Up Big Prisons

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. America’s biggest prisons are factories exporting prison gangs. Break them up.

By David Skarbek and Courtney Michaluk in Politico

2. Find out why demographics and a charismatic leader still aren’t enough to make a majority party.

By Suzy Khimm in the New Republic

3. Denied a seat at the table of global power, the BRICS nations are building their own table.

By Shashi Tharoor in Project Syndicate

4. With an implanted treatment that blocks a narcotic high, one doctor wants to end addiction.

By Sujata Gupta in Mosaic Science

5. Your next insurance inspector could be a drone.

By Cameron Graham in Technology Advice

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Addiction

One in 10 Americans Now Vape but Most Also Use Regular Tobacco Products

New e-cigarette laws
Yui Mok—AP

Three out of four of e-cigarette users are now both vaping and smoking

E-cigarette use may be on the rise but isn’t helping Americans kick tobacco addictions, according to new research

A poll of 5,679 Americans conducted by Reuters found 75% of people who use electronic cigarettes or other vaporizing devices continue to also smoke traditional tobacco products. The poll indicates that this population of “vapers” is now up to roughly 10% of U.S. adults and 15% of U.S. adults under the age of 40. This number represents a significant rise from 2013, when the U.S. government estimated the figure to be about 2.6% of Americans. Almost 70% of this poll’s e-cigarette users claim to have started in the last year.

While about 40% of e-cigarette-using respondents said they were motivated to use e-cigarettes because they could be smoked indoors and are cheaper than most tobacco products, a majority of users also cited vaping as a safe alternative to smoking. In fact, researchers have yet to corroborate this. The FDA has even proposed regulations requiring e-cigarette manufacturers to add health warnings to their labels.

Some 80% of respondents also identified vaping as “a good way to help people quit smoking.”

According to the Center for Disease Control and Prevention, 17.8% of U.S. adults are current tobacco smokers.

Read more at Reuters

TIME opioids

FDA Warned Drugmaker About Pain Pill Injection

Endo Pharmaceuticals Opana Drug Pain Killer
Tripplaar Kristoffer—Sipa/AP A logo sign outside of a facility occupied by Endo Pharmaceuticals in Malvern, Penn. on May 30, 2015.

A new form of pain killer could be driving addicts to inject the drug, hastening the spread of HIV

As officials in Indiana scramble to contain a fast-spreading HIV outbreak, TIME has learned that government officials warned one company that the newest version of a drug it manufactured could be driving behavior that is contributing to the crisis.

In May 2013, federal regulators from the Food and Drug Administration told Endo Pharmaceuticals, the maker of the widely used prescription pain pill Opana, that a new form of the medication could be driving abusers to inject the drug intravenously instead of snorting it.

The HIV outbreak in southern Indiana, which has ballooned from 8 cases in January to 166 as of June, is the result of addicts dissolving and injecting Opana, according to the Centers for Disease Control and Prevention (CDC) and local officials in Scott County, where the outbreak is centered. 96% of those who tested positive for HIV and were interviewed by the CDC said they were injecting Opana, according to an April health alert by the agency.

In 2012, Endo introduced a new version of the drug that it said was designed to be abuse deterrent. Where a previous version of the drug could be easily crushed and snorted or dissolved and injected, the new version had a special coating that supposedly made doing so more difficult. Endo removed the previous version from the market and asked the FDA to rule that it had been unsafe. Such a ruling would have prevented other drug makers from introducing generic versions of the pill.

The FDA denied Endo’s request, rejecting the company’s claims about the new coating’s ability to deter abuse. While the new formulation made it harder to crush and snort the drug, the FDA found, “it may be easier to prepare OPR for injection.” That raised, the FDA said, “the troubling possibility that the reformulation may be shifting a non-trivial amount of Opana ER abuse from snorting to even more dangerous abuse by intravenous or subcutaneous injection.”

Officials in Scott County say abusers discovered they could cook down the abuse deterrent version of the pill, dissolving it and preparing it for injection. Officials say addicts prefer the drug to heroin, even though it is more expensive, and the high doesn’t last as long. Addicts in Scott County have transmitted HIV to each other by sharing needles as they shoot up, sometimes as often as 20 times a day.

Endo, a Pennsylvania-based company that specializes in pain medications, earned $1.16 billion in revenue from Opana from 2008-2012. The company has denied Opana is at the heart of the outbreak and has suggested generic versions of its drug that didn’t have the “abuse deterrent” coating might be at fault, as discussed in the current cover story of TIME on opioid abuse in America:

In April, Endo held a conference call with public-health officials in Scott County. The Endo officials “thought it was a mistake,” says [Scott County public health nurse, Brittany] Combs, who was on the call. Around the same time, [Scott County Sheriff Dan] McClain says an Endo security official called him and offered to help investigate the source of the pills. The Endo official told him the drug being abused couldn’t be Opana because it had been reformulated to be “abuse deterrent.” McClain was skeptical. “I’ve got an evidence room full of Opana over there right now, and I don’t have any generic forms of that pill that are being purchased off the street,” McClain says.

Endo officials declined repeated requests to be interviewed for this article. In response to questions emailed to the company regarding its marketing of Opana and its response to the crisis in Scott County, Keri Mattox, senior vice president for investor relations, said, “Patient safety is a top priority for Endo,” and the company has “an ongoing, active and productive dialogue” with the FDA regarding Opana’s “technology designed to deter abuse.” Mattox says the company supports “a broad range of programs that provide awareness and education around the appropriate use of pain medications” and has reached out to the CDC, Indiana state officials and Scott County health and law enforcement officials, among others.

 

 

 

TIME Addiction

Alcohol Problems Affect About 33 Million U.S. Adults

Many do not get treated

About 14% of U.S. adults have alcohol-related problems, according to new data on Americans’ drinking behaviors.

The new study, published in the journal JAMA Psychiatry, looked at the prevalence of drinking issues based on a new definition for alcohol use disorders in the DSM-5 handbook. The new definition classifies problem drinkers as those who have two of 11 symptoms including continuing to drink even if it harms relationships, drinking harming performance at work of school, or inability to quit. The severity of the problem is classified by the number of symptoms a person has.

In the new research, the study authors interviewed more than 36,000 adults about their lifetime drinking behaviors. The report shows that 30% of those interviewed had been a problem drinker at some point in their lives and 14% currently had problems. Many of the people had never been treated.

Overall, men were more likely than women to have trouble with alcohol, and the issue was particularly noticeable among 18- to 29-year-olds, with about 7% showing symptoms of the most severe form of drinking problem, the study found. The researchers say that is in line with increasingly higher rates heavy of drinking among the age group.

“Most importantly, this study highlighted the urgency of educating the public and policy makers about alcohol use disorder and its treatments, destigmatizing the disorder, and encouraging among those who cannot reduce their alcohol consumption on their own, despite substantial harm to themselves and others, to seek treatment,” the study authors concluded.

TIME portfolio

On the Fringe of Society with Christopher Occhicone

Christopher Occhicone was the recipient of the TIME award at the 2014 Eddie Adams Workshop

Photographer Christopher Occhicone spent months following a group of addicts who live on the outskirts of Lakewood, N.J., in a tent city in the forest. The result is his long-term project titled Fringe. “They live outside the boundaries of social norms,” he writes in his introduction to the series. “Their food and clothing needs are satisfied through donations. Their drug and alcohol needs are met by cash gotten from odd jobs, petty crime, sympathetic relatives, and social security and disability payments.”

Today, the camp is gone. Promoters acquired the land it used to sit on, buying out its former occupants. But, in 2013, when a group of 15 to 20 people still lived in tents and makeshift home, Occhicone documented their everyday lives.

“It took time to get the access,” he says. “In the eight months I spent there, I really shot a lot for four months. The first two months, I was just hanging around, talking to people and not taking any pictures. I wanted to get to know the guys.” That also meant eating and drinking with them. “They invite you to eat, you eat. They offer you a beer, you have a beer,” he says. “Obviously, there are certain lines you don’t cross, certain things you get offered that you don’t accept.”

Quickly, two main characters appeared in Occhicone’s work: Chris and Eve. The married couple, featured in many of the New Jersey-based photographer’s work, had a turbulent relationship. “She was a 30-year-old alcoholic, and he was only 19,” he says. “And it felt like he thought he was in a summer camp. I don’t think he realized what he was doing. They would call the cops on each other all the time.”

Now, with the camp dismantled, Occhicone’s work is done. “I think I said what I wanted to say,” he tells TIME.

Christopher Occhicone is a New Jersey-based freelance photographer.

TIME Addiction

Your Fingerprint Can Reveal Cocaine Use

A new way to accurately test for drugs may be through your fingerprint

Scientists can already tell from people’s fingerprints if they’ve touched cocaine, but a new study goes one step further, showing that fingerprints can now also reveal whether a person has ingested the drug. The study, published in Analyst, may pave the way for simpler drug testing that doesn’t require urine or blood.

In a small study, a team of researchers analyzed the fingerprints of a handful of patients in drug treatment centers using a process called mass spectrometry. Someone who uses cocaine excretes components of metabolized cocaine called benzoylecgonine and methylecgonine. The study authors showed they were able to detect the cocaine components in the residue left by the patients’ fingerprints on glass through the mass spectormetry chemical analysis technique.

“These results provide exciting opportunities for the use of fingerprints as a new sampling medium for secure, non-invasive drug detection,” the researchers write in their study. “The mass spectrometry techniques used here offer a high level of selectivity and consume only a small area of a single fingerprint, allowing repeat and high throughput analyses of a single sample.”

If such a technique could be made portable, the researchers believe it could possibly provide a simpler and less invasive alternative to current drug testing.

TIME Addiction

Health Experts Angry FDA Still Doesn’t Regulate E-Cigarettes

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

Prominent medical groups are asking the government to hurry up

A year has passed since the U.S. Food and Drug Administration (FDA) proposed new regulations for e-cigarettes, cigars and waterpipe tobacco, to prevent them from being sold to minors and to require manufacturers to add health warnings to labels—but the new rules still haven’t gone into effect.

Now, public health experts are urging action, arguing it’s unacceptable that it’s taken so long given data shows use of these products among minors has spiked.

Earlier this week, 31 health and medical groups including the American Academy of Pediatrics, the American Academy of Family Physicians and the American Heart Association wrote a letter to President Obama asking for the federal government to finalize the “long-overdue” regulation. The medical groups say cigar and e-cigarette brands are using marketing tactics that they feel appeal directly to young people, like promoting candy and fruit-flavored products, and they want regulations to put an end to it.

“It’s no wonder use of e-cigarettes by youth has skyrocketed,” the letter reads. “This process has already taken far too long. We cannot afford more delays that allow tobacco companies to target our kids with a new generation of tobacco products.”

Health experts are concerned over a recent U.S. Centers of Disease Control and Prevention (CDC) report that showed e-cigarette use among middle school and high school students tripled between 2013 to 2014 and hookah use doubled. The report showed that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014, which is a rise from approximately 660,000 students to 2 million.

“My concern is always the first-time users,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “It’s bad it took so long to make a dent in [conventional] tobacco users, and we are now starting something else, and we are just waiting and waiting and waiting. We don’t have the data that e-cigarettes are a gateway [to other tobacco products], so we just wait. It should not be like that.”

In a statement sent to TIME, the FDA said it “remains concerned about the significant increase in e-cigarette and hookah usage among youth.” The agency wrote:

These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health. Rulemaking is a complex process, and this particular proposed rule resulted in more than 135,000 public comments for the agency to review and consider. FDA is committed to moving forward expeditiously to finalize the rule that will extend its authority to additional tobacco products such as e-cigarettes, cigars, pipe tobacco, and other currently unregulated tobacco products.

Stanton Glantz, a professor of medicine at the University of California, San Francisco Center for Tobacco Control Research & Education, said he hopes that when the regulation is finalized there are no loopholes. “Given that the White House has blocked eliminating menthol from cigarettes for years despite strong evidence—including from the FDA’s own analysis that doing so would protect public health—I am not holding my breath,” he said.

Several states and local governments have regulated items like e-cigarettes on their own. Data shows at least 42 states and 1 territory currently prohibit the sale of e-cigarettes or vaping/alternative tobacco products to minors.

“I just hope that the final FDA rule does not do anything to make that process more difficult,” said Glantz.

The medical groups concluded in their letter that “further delay will only serve the interests of the tobacco companies, which have a long history of using product design and marketing tactics to attract children to harmful and addictive products.”

When asked for a comment about the letter, the White House’s Office of Management and Budget referred TIME to the FDA.

TIME Addiction

Habitual Gamblers See Patterns Where There Are None, Study Says

Las Vegas Sands deceived a Nevada court in an attempt to stall a lawsuit by the former head of its Macau operations, a state judge ruled on Friday, fining the casino operator and abridging its right to object in a fight over key evidence. REUTERS/Tyrone Siu (CHINA - Tags: BUSINESS CRIME LAW SOCIETY) - RTR386IJ
Siu Chiu—Reuters A croupier sits in front of a gaming table inside a casino on the opening day of Sheraton Macao hotel at Sands Cotai Central in Macau September 20, 2012

"Gamblers are more willing to bet impulsively on perceived illusory patterns," researcher says

Researchers have found gamblers are more prone to find non-existent patterns in completely random sequences — and are more likely to bet on those erroneous perceptions — adding to a large amount of research that suggests pathological gambling is the result of cognitive distortions.

The study, published Wednesday in Springer’s Journal of Gambling Studies, says that all humans fall victim to illusory patterns — if a roulette ball lands on black five turns in a row, for example, it is normal to think that it must surely land on red next. But compulsive gamblers see more such imaginary patterns and are different to recreational gamblers by their increased likelihood to bet on the false trends.

“Our results suggest that gamblers are more willing to bet impulsively on perceived illusory patterns,” stated co-lead author Wolgang Gaissmaier in a press release.

In a laboratory, the team compared the betting habits of 91 habitual gamblers versus 70 people who were not. Participants were shown pictures of two slot machines and had to predict the winner, but the catch was one had a 67% chance of producing a win while the other machine produced a win only 33% of the time. Participants were not explicitly told of the probability difference but the study said it “could be learned from experience via feedback.”

The results showed that gamblers were more likely than non-gamblers to use ‘probability matching’ — or making predictions based on past results.

“They are overly prone to accept random series of events as, in fact, non-random — and non-random enough to be worth betting on,” said Gaissmaier.

TIME Addiction

Hawaii Set to Become First State to Raise Smoking Age to 21

TIME.com stock photos E-Cig Electronic Cigarette Smoke
Elizabeth Renstrom for TIME

The bill covers both cigarette and e-cigarette use

Hawaii is set to become the first state to pass a law banning the sale, use and possession of cigarettes and e-cigarettes to people under the age of 21.

If a bill approved by Hawaii lawmakers on Friday is signed into law by Governor David Ige, adolescents will be prohibited from smoking, buying and possessing both conventional cigarettes and e-cigarettes. First-time offenders will be fined $10, and after that they can be charged a $50 fine or be required to complete community service, the Associated Press reports.

Some local governments have raised the smoking age to 21 in certain counties and cities — New York City among them — but if the bill becomes law, Hawaii will be the first state to do so.

Though the rates of high-school-age smokers have dropped in recent years, some 2.3 million children and young adults started smoking in 2012. In addition, a recent report from the U.S. Centers for Disease Control and Prevention revealed that e-cigarette use among middle-school and high school students tripled in one year.

If the Hawaii bill passes, it will go into effect Jan. 1, 2016.

[AP]

TIME Addiction

Health Officials Worry as HIV Cases in Indiana Grow

TIME.com stock photos Health Syringe Needle
Elizabeth Renstrom for TIME

Health officials say families are using drugs together

The number of new HIV infections in Scott County, Indiana, has risen to 142, prompting local and state officials to call it a public-health emergency.

A new report released by the federal and state health officials on Friday reveals disturbing trends in injection drug use in a county of only 4,200 people. Scott County has historically reported less than five new cases of HIV each year, making the new tally of 142 all the more alarming. Health experts say the recent outbreak is reflective of a growing drug epidemic nationwide.

“There are children, and parents and grandparents who live in the same house who are injecting drugs together sort of as a community activity,” said Dr. Joan Duwve, the chief medical consultant for the Indiana State Department of Health, at a press briefing. “This community, like many rural communities, especially those along the Ohio River and Kentucky and West Virginia, has really seen a lot of prescription opioids flooding the market. With few resources [and] not a lot to do, the use and abuse has been occurring for at least a decade and probably longer.”

Health officials note that like many other rural counties in the U.S., Scott County has high unemployment, high rates of adults who have not completed high school and a large proportion of residents living in poverty with limited health care access. The report underlines the fact that the county consistently ranks among the lowest in Indiana for health and life expectancy.

“The outbreak highlights the vulnerability of many rural, resource-poor populations to drug use, misuse and addiction,” said Duwve.

The ages of the men and women diagnosed with HIV in Scott County range between ages 18 and 57. The health officials report that no infants have tested positive, though a small number of pregnant women have. Ten women in the cluster were identified to be sex workers. Around 84% of the patients have also been infected with hepatitis C. Eighty percent of the patients with HIV have reported injection drug use and among those people, all of them have reported dissolving and injecting tablets of oxymorphone. Some also reported using methamphetamine and heroin.

Dr. Jonathan Mermin, who runs the CDC’s National Center for HIV/AIDS, reminded reporters that the United States is facing an epidemic of prescription opioid abuse. “An estimated two million people are dependent on or abuse prescription opioids nationally. So while opioid pain relievers can play an important role in the management of some types of pain, the overprescribing of these powerful drugs has created a national epidemic of drug abuse and overdose,” he said.

The CDC estimates that nationwide about 3,900 new HIV infections each year are attributable to injection-drug use, which is down nearly 90% from a peak of about 35,000 in the late 1980s, says Mermin. He adds that opioid poisoning deaths in the United States have nearly quadrupled from 1999 to 2011. This epidemic has already played a major role in a growing epidemic of viral hepatitis among people who inject drugs with a 150% increase in reports of acute hepatitis C nationwide between 2010 and 2013.

State health officials and the CDC are working together to control the outbreaks of HIV and hepatitis C. The state has launched a public health campaign to notify residents of the support available to them: lab testing and treatment, referrals to addiction services and employment, and help with insurance registration. The state initially declared a 30-day public health emergency for Scott County on March 26, but expanded the executive order another 30 days. “I want to assure everyone [that] the state of Indiana will not abandon this community once the executive order is over,” said Dr. Jerome M. Adams, the Indiana State Health Commissioner.

The CDC also released a health advisory on Friday, and is asking states to look closely at their most recent data on HIV and hepatitis C diagnoses, overdose deaths, admissions for drug treatments, and drug arrests in order to help identify communities that could be at high risk for unrecognized clusters of the infections.

“We must act now to reverse this trend and to prevent this from undoing progress in HIV prevention to date,” said Mermin.

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