To fight America’s opioid epidemic, lawmakers and regulators have clamped down hard on doctors’ prescribing practices.

But one avenue for obtaining prescription opioids appears to have been overlooked, according to a new study.

Millions of tablets

Veterinarians are prescribing large quantities of opioids to pets, raising concern that some people might be using Fido or Snuggles to feed their addiction.

Opioid prescriptions from the University of Pennsylvania’s School of Veterinary Medicine rose 41% between 2007 and 2017, even though the annual number of visits increased by just 13%, researchers found.

Penn Vet handed out 105 million tramadol tablets, 97 500 hydrocodone (Hycodan) tablets, and nearly 39 000 codeine tablets during the study period, results show.

“I think it would come as a surprise to everyone, the quantities,” said senior author Dr Jeanmarie Perrone, director of medical toxicology at the University of Pennsylvania’s Perelman School of Medicine.

Not just for pets

It’s very likely at least some of these drugs wound up being used by humans, said Emily Feinstein, executive vice president of the Center on Addiction.

“There’s a small percentage, I’m sure, of people in this data who are using their pets and an encounter with a veterinarian as a means of getting themselves opioids,” Feinstein said.

The US opioid crisis led to roughly 50 000 overdose deaths in 2017, according to the US Centers for Disease Control and Prevention.

Americans now are more likely to die from an opioid overdose than from a car or motorcycle crash, a fall, drowning or choking on food, a report issued Tuesday by the National Safety Council concluded.

Perrone initiated her study after vet school colleagues complained that they’d been getting a lot of after-hours calls from patients about filling opioid prescriptions for pets. They asked her advice about how to handle these requests.

“Before I went to talk, I asked them to pull all of their opioid prescriptions so I’d have an idea how often they actually prescribed opioids,” Perrone said. “To their shock and our shock, there were about 3 000 prescriptions a month.”

Perrone thought back to when she’d had her own dog spayed, and the vet handed her a bag of supplies to care for her recovering canine. She went looking for that bag.

“I found a bottle of tramadol I was given when my dog got spayed four years ago. It was still in the cabinet with all the dog stuff,” Perrone said.

Following general trends

After looking at Penn Vet’s prescribing practices, Perrone’s team obtained statewide prescription data kept by the US Drug Enforcement Agency for all Pennsylvania veterinarians.

Between 2014 and 2017, Pennsylvania vets doled out 688 340 hydrocodone (Hycodan) tablets, 14 100 codeine tablets, 23 110 fentanyl patches, 171 100 tablets of hydromorphone (Dilaudid) and 7 600 doses of oxycodone (Oxycontin), the federal data showed.

The findings were published in the journal JAMA Network Open.

The opioid epidemic stems from a shift in medical philosophy, in which pain’s role as a symptom to be treated became more prominent and the risks of opioid addiction were not fully appreciated, Feinstein said.

“Veterinarians live in the same society as the rest of us,” she said. “It’s not surprising to see the same trends happening in veterinary medicine as were happening in the rest of medicine. All of medicine was prescribing more opioids and thinking they were safe.”

Beyond the risk of people “vet shopping” for drugs, Feinstein said the numbers suggest pet cabinets across the country might contain opioids ripe for misuse.

Better pain management

“If there is someone with an opioid use problem in your circle, those leftover pills can become a temptation if they’re not safely locked up,” she said.

Dr John de Jong, president of the American Veterinary Medical Association, said he hasn’t seen any data to suggest that what was found in Pennsylvania is occurring elsewhere.

“First, this is a survey of veterinarians at a veterinary teaching hospital to which complex cases are referred and for which more extensive pain management is often needed,” de Jong said. “It is inappropriate to extrapolate results from a practice like that to primary care practices across the country.”

Second, pain management is a rapidly emerging field in veterinary medicine, de Jong said.

“The period of this study overlaps a period of significant growth in understanding pain and its impact on veterinary patients,” he said. “It is reasonable to expect that as knowledge grows, so will efforts to address related concerns. So, it’s very possible that this study doesn’t reflect overprescribing, but instead reflects appropriate prescribing representing better pain management in veterinary patients.”

Better monitoring

At the same time, vets are starting to keep a closer eye on their opioid prescriptions, de Jong added.

“There appear to have been few confirmed cases of owners deliberately injuring their pets to obtain opioids,” he said. “We have heard more veterinarians share that they suspect some pet owners may be using their pet’s medications and asking for refills in advance of when those should be needed, or that they’ve lost or spilled medications, but this is anecdotal.”

These results suggest vets need to be urged as strongly as other doctors to prescribe opioids with care, said Dr Harshal Kirane, director of addiction services at Staten Island University Hospital in New York.

“Our national response to the opioid epidemic should leave no stone unturned,” Kirane said. “This work highlights that contemporary veterinary medicine uses a significant volume of opioid medications, yet lacks a systematic framework for safe opioid-prescribing practices. While the apparent scale of opioid medication management in animals is drastically smaller in comparison to humans, it still represents a powerful opportunity for practice improvement.”

In the meantime, pet owners should secure any opioids prescribed for their animals, and dispose of the drugs safely when they’re no longer needed, said Dr Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York.

“I feel like sometimes you don’t even think of it. It may slip your mind that the medication is there in the cabinet,” Krakower said. “Sometimes it’s not clearly marked as a human medication may be.”

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While cigarette smoking has hit an all-time low, another form of tobacco use is rising in popularity – hookah smoking – and researchers are concerned there’s a new epidemic brewing, especially among young adults.

Once seen as an exotic pastime and cultural phenomenon in the Middle East, hookah smoking spread to Europe and North America in recent years.

“When I started this research 20 years ago, I did not think that it would be a global problem. Now, hookah has moved to the US and it’s one of the main tobacco products used by young Americans,” said Dr Wasim Maziak, professor and chair of the Department of Epidemiology at Florida International University in Miami.

An estimated 2.6 million US adults – or 1% – smoked hookah in 2017, nearly double the number seen just several years before, according to data from the Centers for Disease Control and Prevention. It’s most common among 18- and 24-year-olds. And kids are smoking it, too: Despite declining use among US teens in recent years, an estimated 630 000 high school and middle school students smoked hookah in 2017.

Unique features

Hookah, also known as waterpipe smoking, is a unique method of smoking tobacco. It consists of a head (which holds the tobacco), a body, a chamber filled with water, a hose and a mouthpiece. Charcoal briquettes are used to heat the tobacco.

Experts say the unique features of hookah may have aided its popularity among young adults. Unlike cigarette tobacco, hookah tobacco can be sold in candy and fruit flavours, which appeals to younger consumers. They also produce smooth, aromatic smoke that’s easier and more pleasant to inhale than tobacco smoke. Plus, people smoke hookah in chic cafes and lounges, creating the perception that it’s a social activity and less habit-forming.

While research on the health effects of hookah smoking is still emerging, preliminary findings indicate it’s certainly not harmless. “This is probably as deadly as cigarettes. For certain carcinogens and toxicants, you have a much higher exposure with waterpipe smoking than cigarettes,” said Maziak.

A typical hookah session delivers significantly higher levels of smoke, tar and nicotine compared to cigarettes, a 2016 study found. Plus, the charcoal briquettes deliver additional toxins, especially carbon monoxide – possibly as much as nine to 10 times as much as cigarettes, according to a small study presented in November at the American Heart Association’s Scientific Sessions conference.

“The whole waterpipe apparatus acts as a connection between the charcoal to the smoker’s deepest airways,” Maziak said.

Gateway to other tobacco products

While hookah smokers smoke less frequently than cigarette smokers, their sessions are longer. On average, hookah sessions last about 30 minutes to an hour compared to a five-minute cigarette break, prolonging exposure to toxins and harmful chemicals, Maziak said.

Mary Rezk-Hanna, an assistant professor at the UCLA School of Nursing, said there’s not enough information on the long-term health impact of hookah smoking since the practice is still relatively new outside of the Middle East.

“While we know that long-term cigarette smoking damages cardiovascular health and can speculate it will be the same for hookah smoking, it needs to be studied empirically,” she said.

Still, Rezk-Hanna and Maziak are both concerned that hookah smoking could be a gateway to other tobacco products for younger Americans because waterpipe use introduces the hand-to-mouth habit as well as nicotine, one of the most addictive substances.

“There are concerns that hookah smoking could be addicting a new generation of kids, adolescents and young adults who aren’t fully aware of what they are smoking and the relative consequences,” said Rezk-Hanna.

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Regular exercise before and after a cancer diagnosis significantly improves odds of survival, a new study finds.

Among more than 5 800 US patients with a range of early- to late-stage cancers, those who exercised three or four times a week before and after their diagnosis had a 40% lower risk of death than inactive patients, researchers reported.

Much lower risk of death

But survival gains were strong even for patients who began exercising only after their cancer diagnosis.

“Patients who reported never doing any type of exercise until they were faced with a cancer diagnosis cut their risk of death by 25–28% compared to those who remained inactive,” said first author Rikki Cannioto. She’s an assistant professor of oncology at Roswell Park Comprehensive Cancer Center in Buffalo, New York.

Patients who exercised once or twice a week also had a much lower risk of death than inactive patients, suggesting that any amount of regular, weekly activity is better than no activity, according to the researchers.

Study participants had blood or head and neck cancers, as well as breast, prostate, lung, colon, kidney, oesophageal, bladder, ovarian, endometrial, pancreatic, liver or stomach cancers. Others had sarcoma or cervical, thyroid, testicular, brain or skin cancers.

Encouraging finding

The strongest link between exercise and reduced risk of death was seen with eight types: breast, colon, prostate, ovarian, bladder, endometrial, oesophageal and skin cancer, the research team said.

The results “solidify the importance of the message that when it comes to exercise, some weekly activity is better than inactivity,” Cannioto said in a Roswell news release.

The finding that low-to-moderate weekly exercise is associated with improved survival is particularly encouraging, Cannioto said, given that cancer patients and survivors can be overwhelmed by the current recommendations of at least 30 minutes of daily moderate-to-intense physical activity.

The study was published recently in the journal Cancer Causes & Control.

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We know that early learning can set up a child for success.

A study done by researchers at Penn State University found out just how early that learning should start – by age two.

For this study, parents filled out surveys about how many words their 2-year-olds knew, and then the researchers checked in with them three years later when their children were in kindergarten.

The toddlers with a large vocabulary were more likely to start kindergarten ready to read and learn maths.

Reading to babies

It turned out that they also paid more attention in class and were better behaved. This may also be why some kids do better than others in school.

Building that vocabulary stems from very early and frequent interactions with mom and dad. It takes only simple things to engage baby, such as talking and reading. In fact, it’s hard to over-stress the importance of reading to babies.

A separate study done at the University of Iowa found that babies respond more to reading than to even toy- or puppet-play and, in turn, learn more from it.

A love for books

A very young baby may only babble in response to hearing your voice as you read, but when you respond back by repeating or expanding on his or her sound or offering a word with that sound, this back-and-forth interaction helps with language development.

Another important difference maker for a child’s early development is to read books with bright pictures and simple sentences rather than single words.

Be engaged as you to read so that baby will develop not only a great vocabulary, but also a love for books that will serve him or her well throughout life.

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It happens every January. Gyms fill with people who’ve committed to New Year’s resolutions involving health and fitness. While making a resolution is an important first step, developing new habits is the key to long-term success, said Erik Minaya, who has maintained significant weight loss for several years.

Minaya started to put on the kilo during his first year year in college. His body mass index continued to creep up throughout his college years and beyond, as he began working at a stressful job with a one-hour commute each way. By age 24, he tipped the scale at nearly 120kg.

“The bad habits compounded over the years,” said the 30-year-old from Michigan.

Sugary drinks and fast food were his biggest vices. Drive-in dinners were easier and cheaper than healthy options, and the jolt of sugar and fat temporarily alleviated some of the stress after working at a job he didn’t enjoy. By 14:00 nearly every afternoon, Minaya would crash.

“I wasn’t motivated to do much,” he said. “And good luck getting me to go out and do anything physical.”

Minaya’s family has a history of elevated blood pressure and cholesterol, and diabetes. Worried that he was headed down the same path, Minaya made drastic lifestyle changes in 2013.

He cut out fast food, replacing it with lower-carb offerings that he prepared himself. He swapped regular soda for diet; a few months later, he switched to water.

“It wasn’t a crash diet,” Minaya said. “I was trying to make actual life changes.”

People should limit their intake of added sugars to no more than half of their daily “discretionary calories,” suggests the American Heart Association. For most men, that figure is 150 calories per day; for most women, it’s 100 calories. But one 350ml can of most sugary sodas will typically contain about 150 calories, and some have even more.

The changes Minaya made had an almost immediate impact.

He lost just under 7kg during the first year. And after accepting a new job with a shorter commute and an onsite gym, he lost nearly 7kg more. Since then, he has continued to lose weight more slowly – nearly 23 kg total so far. He has more energy and focus.

“I have an almost heightened sense of awareness,” he said.

Minaya recently finished a 5km in less than 30 minutes “which is slow for me,” he said. He also lifts weights and plays golf, tennis and soccer. He persuaded his company, Delta Dental of Michigan, to put up a basketball hoop in the parking lot.

“It’s good to have a goal and go for it,” Minaya said. “I like being driven to achieve something.”

Minaya is not shy about sharing his experience. He recently encouraged a friend to adopt the same diet, which led the friend to lose nearly 14kg. He also told his story at an event hosted by Delta Dental, the AHA and the Grand Rapids Children’s Museum as a part of the Rethink Your Drink campaign.

With a newborn at home, Minaya said he has succumbed to old temptations and put on a few pounds, but he is determined to get back on track, not only for his sake but also for the sake of his daughter, Elsie.

“My wife, Jamie, and I want to make better choices for her sake,” he said. “I’ll never have six-pack abs, but what I care about is good health.”