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Jane Carlisle Maxwell , PhD Pages 127-140 | Accepted author version posted online: 24 Jun 2015, Published online: 24 Jun 2015

Abstract
Aims: The abuse of prescription pain relievers and/or heroin is a significant public health concern. This article identifies the changes in this epidemic and estimates the extent of the gap between treatment availability and need. Method: This article uses the national data on opioid and heroin abuse to identify at-risk groups. Result: Findings include shifting from narcotic analgesics to heroin and demographic changes as well as changes in supply and new medication-assisted therapies. Conclusions: The number of persons dependent on pain relievers or heroin and new initiates is more than three times greater than the current capacity to deliver treatment.

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Abstract
Whilst disturbances of female reproductive hormones and function are commonplace in opioid dependence, their pathophysiological interrelationships are not well understood. Hormonal levels in females were compared in 77 opioid dependent patients (ODP) and 148 medical controls (MC) including 205 and 364 repeat studies. Significant changes in FSH, LH, oestradiol, testosterone and SBG were noted including power functions with age. The FSH/LH was lower in ODP (P = 0.0150) and the ratio inversion point occurred at 28.06 ± 9.36 v. 46.26 ± 4.76 years, implying a 58% reduction in fertility duration.

FSH has been shown to induce ovarian failure and GnRH (controlling LH and FSH) has been shown to regulate longevity systemically. This implies that, far from being benign, these findings explicate the adverse experience of female compared to male ODP, exacerbate opioid-dependent aging amongst females, and informs the care of opioid dependent women, particularly relating to the choice, dose and duration of agonist or antagonist therapy

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Conclusions and Relevance  Colorado RPC cases for pediatric marijuana increased significantly and at a higher rate than the rest of the United States. The number of children’s hospital visits and RPC case rates for marijuana exposures increased between the 2 years prior to and the 2 years after legalization. Almost half of the patients seen in the children’s hospital in the 2 years after legalization had exposures from recreational marijuana, suggesting that legalization did affect the incidence of exposures.

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