Theresa H M Moore, Stanley Zammit, Anne Lingford-Hughes, Thomas R E Barnes, Peter B Jones, Margaret Burke, Glyn Lewis
Summary
Background – Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.
Methods – We searched Medline, Embase, CINAHL, PsycINFO, ISI Web of Knowledge, ISI Proceedings, ZETOC, BIOSIS, LILACS, and MEDCARIB from their inception to September, 2006, searched reference lists of studies selected for inclusion, and contacted experts. Studies were included if longitudinal and population based. 35 studies from 4804 references were included. Data extraction and quality assessment were done independently and in duplicate.
Findings – There was an increased risk of any psychotic outcome in individuals who had ever used cannabis (pooled adjusted odds ratio=1•41, 95% CI 1•20–1•65). Findings were consistent with a dose-response eff ect, with greater risk in people who used cannabis most frequently (2•09, 1•54–2•84). Results of analyses restricted to studies of more clinically relevant psychotic disorders were similar. Depression, suicidal thoughts, and anxiety outcomes were examined separately.
Findings for these outcomes were less consistent, and fewer attempts were made to address non-causal explanations, than for psychosis. A substantial confounding eff ect was present for both psychotic and aff ective outcomes.
Interpretation The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication eff ects, although evidence for aff ective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now suffi cient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.

Source: The Lancet Vol.370 pp 319-328 July 2007

New research shows that specific variations in the cannabis receptor gene (CB1) may be associated with the development of one or more symptoms of marijuana dependence in adolescents. This is one of the first studies looking specifically at the link between marijuana dependence and CB1 variations.

Background: Marijuana is the most commonly abused illegal substance among adolescents and young adults, and those who begin using at this stage are about twice as likely as adults to become dependent. Genetic variations in the CB1 receptor—the brain target for the psychoactive ingredient in marijuana—is a logical candidate gene to study as a potential contributor to vulnerability to marijuana dependence. Therefore, researchers examined the associations between specific variants in the CB1 gene and the rates of marijuana dependence.

Study Design: The scientists collected DNA from 541 youths aged 17 or older who had used marijuana at least five times recently. After interviews to identify one or more DSM-IV symptoms of dependence, 327 were established as cases; the remaining 214 had no symptoms and served as controls. All subjects were genotyped for four specific DNA sequence variations of the CB1 gene.

What They Found: One CB1 variant (found in 21 percent of the general population) was associated with a lower rate of having one or more marijuana dependence symptoms, while two others (present in 12 percent of the general population) were linked to increased likelihood of developing dependence symptoms.

Comments from the Authors: Identifying gene variants that may afford some protection against marijuana dependence may have important implications for intervention. However, it is likely that multiple genes and their interactions with environmental events influence marijuana and other drug addictions. Therefore, some level of genetic protection may not necessarily protect an adolescent from becoming dependent on drugs or suffering other related health consequences.

What’s Next: Future studies should examine these genetic variants for other drug-related traits, as well as additional DNA sequence variations for possible drug abuse associations.

Publication: The study, led by Dr. Christian J. Hopfer of the University of Colorado, was published in volume 141B, pages 895-901 (2006) of the American Journal of Medical Genetics Part B (Neuropsychiatric Genetics).

Source:NIDA Newscan 27th Aug. 2007

Background: Prevention interventions that focus on the impact of social influences, making healthy choices, and promoting anti-substance abusing norms have proven effective in reducing adolescent drug use. The school-based drug abuse prevention program Life Skills Training (LST) teaches a variety of cognitive-behavioral skills for problem-solving and decisionmaking, resisting media influences, managing stress and anxiety, communicating effectively, developing healthy personal relationships, and asserting one’s rights. Researchers wanted to know if these strategies may also be successfully applied to combat adolescent delinquency, verbal and physical aggression, and fighting.

Study Design: Researchers introduced LST to 2,374 students in 20 New York City public and parochial schools, and established a comparable control group. Sample composition was 39 percent African-American, 33 percent Hispanic, 10 percent White; 55 percent economically disadvantaged; and 30 percent living in mother-only households.

What They Found: After 15 school-based sessions, delinquency and frequent fighting were significantly reduced across the entire intervention group.

Comments from the Authors: This study supports the idea that multiple problem behaviors may have common causes. It further suggests that the development of comprehensive, integrated school-based approaches to prevention may more efficiently target an array of related behaviors, thereby reducing the burden on resources and increasing the likelihood for adoption and implementation.

What’s Next: More research is needed to test the durability of the LST approach. It would also be useful to determine if these strategies can prevent more serious forms of violence, such as assault and homicide.

Publication: The study, led by Dr. Gilbert J. Botvin of the Department of Public Health at Weill Cornell University Medical College, was published in volume 7, pages 403-408 (2006) of Prevention Science.

Source: NIDA 27th Aug.2007

The results of this study suggest that many drug abusers may experience similar changes in the patterns of global gene expression in their brains, irrespective of their drug of choice. Whether longtime drug abusers favor cocaine, marijuana, or PCP, their autopsied brains showed a number of common gene changes consistent with diminished brain plasticity— i.e., the ability to learn from new experiences and adapt to new situations. Therefore, brain functions may be similarly impaired as the result of chronically abusing different drugs.

Background: Chronic drug abuse can change the structure and function of several brain regions. Recent advances in genomic technologies allow us to monitor the expression level of thousands of genes simultaneously in specific parts of the brain, including the anterior prefrontal cortex (aPFC), a region that plays an important role in decision making. A dysfunctional aPFC appears to be a characteristic feature of the brains of drug abusers. Researchers wanted to know if different drugs of abuse can compromise the normal patterns of gene expression that converge in common pathways, resulting in similar changes in the brains of drug abusers.

Study Design: NIDA scientists compiled clinical case histories and toxicology reports to establish the primary drug of abuse of 42 deceased drug abusers. The drugs examined included cocaine, marijuana, and PCP. The researchers then measured the level of expression of more than 9000 individual genes in small brain tissue samples obtained from the aPFC.

What They Found: Although many effects were specific to each drug, the scientists also found that nearly 80 percent of the drug abuse cases displayed similar alterations in genetic output compared to the controls. For example, genes involved in calcium signaling were turned down, while genes involved in lipid- and cholesterol-related pathways were turned up.

Comments from the Authors: The aPFC is characterized by a particularly dense and complex network of neural connections. Our results show that cocaine, marijuana, and PCP can alter the function of this critical brain area in similar ways, which could threaten the drug abuser’s ability to make sound decisions.

What’s Next: Many of the gene families identified here point to common downstream pathways that should be studied further in order to understand their specific contributions to the long-term effects of abused drugs on the human brain.

Source: The study, led by Dr. Elin Lehrmann of the Cellular Neurobiology Research Branch in NIDA’s Intramural Research Program in Baltimore, was published in the open access journal PLoS ONE on December 27, 2006 (PLoS ONE 1:e114).

Nicotine addiction relies on brain receptors that have been difficult to fully study and characterize. Scientists at the University of Colorado in Boulder have demonstrated that an immunolabeling technique can effectively analyze receptor subunits.

Background: Nicotine’s effects on the brain are triggered upon its binding to nicotinic acetylcholine receptors, each of which consists of five subunits: two alphas, one beta, one delta and one gamma. Different combinations of these subunits produce different receptor subtypes, which may vary in their pharmacology, biophysical properties, and distribution. To more fully understand how to interfere with nicotine’s effects in the brain, scientists must first understand where these different receptors are and how they work. Two of the most important subunits, a4 and b2, have been hard to study because current study methods can only locate the fully assembled receptor unit. Researchers wanted to know if an alternative strategy of immunolabeling (i.e., using antibodies to tag individual proteins), which has been fraught with technical challenges, would be able to identify, map, and quantify separate subunits.

Study Design: Scientists at the University of Colorado worked with brain sections of mice genetically engineered to express particular a4 and b2 subunit combinations. Using a sensitive immunolabeling technique, they explored the expression of the a4 and b2 subunits at both the gene and protein levels. Additional mice strains, missing the subunits under study, were used as controls.

What They Found: The two predominant nicotinic receptor subtypes (a4 and b2) were reliably detected using immunolabeling. Expression of the a4 subunit protein was almost universally dependent on b2, whereas most, but not all, b2 subunit protein expression was a4-dependent.

Comments from the Authors: Immunolabeling using specific antibodies offers a powerful approach for mapping the distribution of nicotine receptor subunits and can produce reliable quantitative results.

What’s Next: Similar studies can be designed to locate other nicotine receptor subtypes. In many cases, the antibody recognition sites are inside the cell membrane. It will likely take alternative biochemical approaches to uncover these less accessible sites. A better understanding of receptor composition and function may eventually have important implications for developing interventions at the receptor level.

Source: The study, led by Dr. Paul Whiteaker of the Institute for Behavioral Genetics at the University of Colorado, Boulder, with Dr. Jon Lindstrom of the University of Pennsylvania, was published in volume 499, number 6, pages 1016-1038 (2006) of the Journal of Comparative Neurology.

An analysis that compared the DNA of drug abusers with that of non-abusing controls has identified 89 genes that are likely to contain variants that contribute to addiction vulnerability.

Background: Vulnerability to addiction is a complex trait with strong genetic influences. Since the mid-1990s, scientists have been developing methods and tools to identify and evaluate the functional role of genes and their variants. The impact of such efforts has been greatly enhanced by the Human Genome and International HapMap Projects. By 2001, the first low-resolution genome-wide association studies from the NIDA-IRP’s Molecular Neurobiology Branch were published. Genetic research technology is now able to reliably scan the genome of individuals for genetic variants linked to specific functions.

Study Design: From 1990 to 2005, thousands of people participated in studies at NIDA-IRP’s Molecular Neurobiology Branch, providing self-reports and DSM Diagnostic Interview Schedule scores. From among this pool, researchers identified 980 African-American and European-American “drug abusers” (heavy lifetime use of illegal substances) and 740 controls (no significant history of addictive substances, no abuse, no dependence). Pooled DNA samples, prepared from blood extracted from each group were used to examine a panel of close to 640,000 genetic variations.

What They Found: Using strong statistical models that focused on the overlaps between the samples, this screen identified 89 genes that display clusters of genetic variants that are likely involved in addiction vulnerability. Most of these genes are expressed in the brain. Twenty-one of these genes influence cell adhesion, and nearly all of those are expressed in brain regions implicated in memory processes.

Comments from the Authors: The nature of the addiction-associated genes identified in this study, especially those involved in cell adhesion, suggest the critical role played by dysfunctional nerve cell connections in the addicted brain.

What’s Next: Other genes that emerged from the analysis are being tested in the context of where they are located in the brain and their likely functions: enzymes, transporters, receptors, protein processing, and transcriptional regulation. Results like these highlight characteristics that are common to human addiction and may facilitate efforts to develop targeted prevention and treatment strategies.

Source:The study, led by Drs. George Uhl and Qing-Rong Liu of the Molecular Neurobiology Branch at the National Institutes of Health Intramural Research Program at NIDA in Baltimore, was published in volume 141B, pages 1-8 (2006) of the American Journal of Medical Genetics Part B (Neuropsychiatric Genetics).

Marijuana and its main psychoactive component, THC, exert a plethora of behavioral and autonomic effects on humans and animals.
Some of these effects are the cause of the widespread illicit use of marijuana, while others might be involved in the potential therapeutic use of this drug for the treatment of several neuronal disorders. The great majority of these effects of THC are mediated by cannabinoid receptor type 1 (CB1), which is abundantly expressed in the central nervous system. The exact anatomical and neuronal substrates of each action, however, were previously unknown. Using an advanced genetic approach, Krisztina Monory and colleagues at the Johannes Gutenberg University Mainz discovered that specific neuronal subpopulations mediate the distinct effects of THC. Their work is published online this week in the open-access journal PLoS Biology.
In their study, the researchers generated mutant mice lacking CB1 expression in defined neuronal subpopulations but not in others. These mice were treated with THC, and typical effects of the drug on motor behavior, pain, and thermal sensation were scored. Their discovery of the neural substrates underlying specific effects of THC could lead to a refined interpretation of the pharmacological actions of cannabinoids. Moreover, these data might provide the rationale for the development of drugs capable of selectively activating CB1 in specific neuronal subpopulations, thereby better exploiting cannabinoids’ potential therapeutic properties. http://www.plos.org/

Source: News-Medical.net Oct. 2007

Oct 8, 2007 in alcohol, hospital
Tags: risky drinking, teenage binge drinking
The Telegraph:
One in seven people taken to hospital for drinking too much in the past year was under 14 years old, according to new figures.
A total of 2,239 under-14s were given treatment in A&E suffering from the effects of alcohol over the past 12 months, a study found – one in seven of the total under 59 admitted.
The revelations about the scale of underage drinking led to renewed calls for a clampdown on alcohol advertising seemingly targeted at children.
The last time The Telegraph looked at this issue (February 2007) they found there were 7,596 admissions involving 16- to 19-year-olds. The Guardian in June this year were reporting “that last year 5,280 children younger than 16 were admitted because of their drinking – of whom 59% were girls”. Previously (November 2006) the BBC had said they had found out there were “20 cases a day of under-18s diagnosed with conditions like alcohol poisoning.”

Source: Daily Dose 13th Oct.2007

Beshay M, Kaiser H, Niedhart D, Reymond MA, Schmid RA.
Division of General Thoracic Surgery, University Hospital Berne, Switzerland.

Background: We observed a remarkable increase in the number of young patients who presented with lung emphysema and secondary spontaneous pneumothorax (SSP) at our institution for over a period of 30 months; most of them have a common history of marijuana abuse. Study design: Retrospective case series. Methods: Seventeen young patients presented with spontaneous pneumothorax with bullous lung emphysema were systematically evaluated over a period of 30 months. All were regular marijuana smokers. Clinical history, chest X-ray, CT-scan, lung function test, and laboratory and histological examinations were assessed. We compared the findings of this group (group I) with the findings of non-marijuana smoking patients (group II) in the same period. The findings of this series were also compared with the findings of 75 patients presented with pneumothorax in a previous period from January 2000 till March 2002 (group III). Results: In group I, there were 17 patients: the median age of the patients was 27 years (range 19-43 years), 16 males and 1 female. All were living in Switzerland. All but one smoked marijuana daily for a mean of 8.8 years and tobacco for 11.8 years. CT-scan showed multiple bullae at the apex or significant bullous emphysema with predominance in the upper lobes only in two patients. Only two patients had reduced forced first second expiratory volume (FEV1) and one reduced vital capacity (VC) below the predicted 50%. This correlated with the subjectively asymptomatic condition of the patients. All but two patients were treated by video-assisted thoracoscopic surgery (VATS) for prevention of relapsing pneumothorax. Histology showed severe lung emphysema, inflammation, and heavily pigmented macrophages. In group II, there were 85 patients: there were 78 males, the median age was 24 years (range 17-40 years), 74 patients smoked tobacco for 13.4 years but no marijuana. CT-scan in 72 patients showed only small bullae at the apex but no significant emphysema; other clinical, laboratory, and histopathological findings showed no significant difference in group I. In group III, there were 75 patients: there were 71 males and 4 females. Mean age was 25 years (range 16-46 years). Six smoked marijuana daily for a mean of 3.2 years, and 62 smoked tobacco for 14 years. CT-scan done in 59 patients showed few small bullae at the apex but no significant lung emphysema. The presence of lung emphysema on CT-scan in group I was significantly different than in groups II and III (p=0.14). No significant difference was found among all groups in the form of clinical, laboratory, and histopathological findings. Conclusions: In case of emphysema in young individuals, marijuana abuse has to be considered in the differential diagnosis. The period of marijuana smoking seems to play an important role in the development of lung emphysema. This obviously quite frequent condition in young and so far asymptomatic patients will have medical, financial, and ethical impact, as some of these patients may be severely handicapped or even become lung transplant candidates in the future.

Source: Pubmed. Eur J Cardiothorac Surg. 2007 Oct 9;

By Randy Dotinga, Contributing Writer
Health Behavior News Service

Adding to the evidence that maternal drug use can have lasting effects, a new study finds that young schoolchildren of cocaine-using moms scored more poorly on attention tests.

Researchers looked at test scores of 415 African-American children who took tests at age 5 or 7 (now 14 to 16 years old). The mothers of 219 of the children had taken cocaine while pregnant, and the mothers of the other 196 had not. All of the mothers were poor and living in the Miami inner city.

Children born to cocaine-addicted moms showed signs of having more trouble paying attention than the other kids. They were more likely to make errors of omission and had slower reaction times on tasks.

“This study provides further evidence of a subtle but consistent effect on attention through early school-aged years,” said lead author Veronica Accornero, assistant professor of clinical pediatrics at the University of Miami.

However, the effects are minor, and one pediatric specialist suggested they pale next to the problems caused when mothers use alcohol and tobacco. In general, children born to cocaine-using mothers “are doing much better than anyone predicted, especially considering their background,” said Tamara Warner, research assistant professor at the University of Florida who is familiar with the study findings.

The study appears in the June issue of the Journal of Developmental and Behavioral Pediatrics.

During and after the crack epidemic of the 1980s, so-called “crack babies” were the subject of media coverage and concern about their futures. Researchers found, however, that the effects in general “appear to be more subtle and specific than initially believed,” Accornero said.

She said the children do not appear to have a hard time with “intellectual functioning,” although they might have difficulties with language, attention and behavior.

The future effects on these children is unclear. “Certainly, attention and the ability to maintain attention is an important skill that supports the development of other skills like language and behavior,” Accornero said. “It’s possible that because of subtle deficits we may see an effect on academic performance. We just don’t know yet.”

Source: J Developmental & Behavioural Pediatrics 28(3), June 2007

What do suffering a traumatic brain injury and using club drugs have in common? University of Florida researchers say both may trigger a similar chemical chain reaction in the brain, leading to cell death, memory loss and potentially
irreversible brain damage.

A series of studies at UF over the past five years has shown using the
popular club drug Ecstasy, also called MDMA, and other forms of
methamphetamine lead to the same type of brain changes, cell loss and
protein fluctuations in the brain that occur after a person endures a
sharp blow to the head, according to recent findings.

“Using methamphetamine is like inflicting a traumatic brain injury on
yourself,” said Firas Kobeissy, a postdoctoral associate in the College
of Medicine department of psychiatry. “We found that a lot of brain
cells are being injured by these drugs. That’s alarming to society now.
People don’t seem to take club drugs as seriously as drugs such as
heroin or cocaine.”

Working with UF researchers Dr. Mark Gold, chief of the division of
addiction medicine at UF’s McKnight Brain Institute and one of the
country’s leading experts on addiction medicine, and Kevin Wang,
director of the UF Center for Neuroproteomics and Biomarkers Research,
Kobeissy compared what happened in the brains of rats given large doses
of methamphetamine with what happened to those that had suffered a
traumatic brain injury.

The group’s research has already shown how traumatic brain injury
affects brain cells in rats. They found similar damage in the rats
exposed to methamphetamine. In the brain, club drugs set off a chain of
events that injures brain cells. The drugs seem to damage certain
proteins in the brain, which causes protein levels to fluctuate. When
proteins are damaged, brain cells could die. In addition, as some
proteins change under the influence of methamphetamine, they also begin
to cause inflammation in the brain, which can be deadly, Kobeissy said.

Kobeissy and other researchers in Gold’s lab are using novel protein
analysis methods to understand how drug abuse alters the brain. Looking
specifically at proteins in the rat cortex, UF researchers discovered
that about 12 percent of the proteins in this region of the brain showed
the same kinds of changes after either methamphetamine use or traumatic
brain injury. There are about 30,000 proteins in the brain so such a
significant parallel indicates that a similar mechanism is at work after
both traumatic brain injury and methamphetamine abuse, Kobeissy said.

“Sometimes people go to the clubs and take three tablets of Ecstasy or
speed,” Kobeissy said. “That may be a toxic dose for them. Toxic effects
can be seen for methamphetamine, Ecstasy and traumatic injury in
different areas of the brain.”

About 1.3 million people over the age of 12 reported using
methamphetamine in the previous month, according to the 2006 National
Survey on Drug Use and Health. In 2004, more than 12 million Americans
reported having tried the drug, the survey’s findings show.

People often think the effects of drugs of abuse wear off in the body
the same way common medications do, but that may not be the case, Gold
said.

“These data and the previous four years of data suggest some drugs,
especially methamphetamine, cause changes that are not readily
reversible,” Gold said. “Future research is necessary for us to
determine when or if methamphetamine-related brain changes reverse
themselves.”

Gold and Dennis Steindler, director of UF’s McKnight Brain Institute and
an expert on stem cells, are planning studies to find out if stem cells
can be applied to repair drug-related brain damage.

UF researchers are also trying to uncover all the various ways drugs
damage and kill brain cells. During their protein analysis, researchers
discovered that oxidation was damaging some proteins, throwing the
molecules chemically off balance.

“When proteins are oxidized they are not functional,” Kobeissy said.
“When proteins are not working, the cell cannot function.”

Neurologist Dr. Jean Lud Cadet, chief of the molecular neuropsychiatry
branch of the National Institute on Drug Abuse, said analyzing proteins
is important to understanding how drugs such as methamphetamine affect
the brain.

“I think saying the results of methamphetamine abuse are comparable to
the results of a traumatic brain injury is a new idea,” Cadet said. “I
agree with (the findings). Our own work shows that methamphetamine is
pretty toxic to the brains of animals. In humans, imaging studies of
patients who use methamphetamine chronically show abnormalities in the
brain.

“Abuse of methamphetamine is very dangerous.”

This research was presented at a Society for Neuroscience conference
held recently in San Diego.

Source: Science Daily (Nov. 29, 2007)

Cannabis use has been found to co-exist with a range of mental health symptoms and disorders (a concurrence referred to hereafter as co-morbidity). Large-scale epidemiological surveys have found higher rates of psychotic, affective, anxiety, and behavioural disorders among individuals with substance use disorders than in the general population (Degenhardt, Hall & Lynskey, 2001; Farrell et al., 2001; Merikangas et al., 1998). The majority of individuals seen at publically-funded mental health services have psychosis (including schizophrenia), bipolar disorder, or severe personality disorder, especially borderline personality disorder. Though there has been a dearth of studies on the latter, there have been several attempts to develop treatments for cannabis use for the former conditions (Edwards et al., 2006; Barrowclough et al., 2001; Baker et al, 2006; Kavanagh et al., 2002). Recent Australian studies have found cannabis use in individuals with psychosis to be significantly greater than have comparable international studies (Wade et al., 2006; Wade et al., 2007; Hinton, Edwards & Elkins, 2008) in a similar population of patients with recent-onset psychosis.
Source: www.npic.au 2009 Management of Cannabis and Related Disorders

Research Summary
Ecstasy is a stimulant like various classes of amphetamines, but the popular club drug is more likely to kill young and otherwise healthy users, Reuters reported Jan. 29.
U.K. researchers who studied ecstasy and amphetamine related deaths found that ecstasy-related deaths were more common among “victims who were young, healthy, and less likely to be known as drug users.”
Study author Fabrizio Schifano of the University of Hertfordshire said that ecstasy seemed to have a higher “intrinsic toxicity,” particularly among users ages 16-24. Schifano speculated that the deaths could be related to the fact that adolescents’ brains are still developing.

Source: www.jointogether.org Feb 3 2010 published in Neuropsychobiology.

Research Summary
Human brain cells can be altered and damaged by low doses of ecstasy, leading to reduced blood flow to the brain, researchers say.
Bloomberg News reported Nov. 27 that a new study finds that even first-time users of ecstasy experience a decrease in verbal memory, and that taking just a few doses of the drug causes brain changes that can be seen 18 months after first use.
“We don’t know if it’s reversible or permanent,” said researcher Maartje de Win of the University of Amsterdam, who presented the findings at a meeting of the Radiological Society of North America this week. “People should know there might be some consequences for them even after incidental use.”
The study included brain scans of 188 young adults considered at risk of ecstasy use; initial scans were taken before any of the group had used the drug. When follow-up scans were taken 18 months later, 64 members of the group had tried ecstasy; 59 of these were reexamined by researchers, as well as 56 members of the group who had not used the drug.
Source: www.jointogether.org Nov.2006

Fred M. Jacobs, M.D., J.D., Commissioner,
New Jersey Department of Health and Senior Services
August 2007

Dear Dr. Jacobs,

Re: Establishment of Needle and Syringe Programs

I understand that the state of New Jersey is considering a needle and syringe “exchange” program. I am also advised that New Jersey is a liberal democratic society whose members for the most part believe in freedom of the individual to pursue “life, liberty and happiness”. This of course is wonderful! And also provides a useful opportunity to note that no drug addict enjoys real freedom while their will, their lives, their relationships and their resources are largely dedicated to the service and slavery of their chemical addiction. This would make your lovely part of the world an excellent place in which to pursue those liberties which should be the birthright of every human being.

To introduce myself I am a family physician in Australia, and have pursued a special interest in the treatment of addiction especially for heroin, but also other drugs of addiction for the last ten years. Health department figures indicated last year that in the years 2001-2006 I single handedly registered 11,000 of the 14,000 registrations for opiate detoxification in the state of Queensland. I have also attained one of the three largest numbers of naltrexone based rapid opiate detoxifications in the country of Australia with over 1,800 procedures performed including 600 naltrexone implants. This was done with only two overnight hospital admissions which is a world safety record. I have also submitted evidence to several Government committees and leaders on the subject of drug policy.

As the so-called “needle “exchange” programmes” make little effort to exchange syringes, and as actual exchange makes little difference to the operation or mission of the programs, it is probably more accurate to refer to them as needle and syringe distribution programs, or NSP’s. It is important that your community appreciate this because syringe disposal is a real problem with these facilities. It has been so in this country. Our lovely and world famous Bondi beach in Sydney is now said to be one of the best places in the country to get a needle stick injury, due to the many syringes hidden in the sand. Clean up patrols have operated in King’s Cross twice daily for years to clean up the extreme public nuisance of hundreds of used syringes left dangerously in the streets and side walks, to protect the public . This is a well recognized problem with NSP’s which is generally covered up while such programs are in the planning phase.

Epidemiological Evidence

Since the NSP experts readily resort to discussion of “evidence based treatments”, and since the community decision to fully implement this program has such far reaching implications both in terms of needle disposal bins in all public toilets and for the time and direction of public health policy in the management of addiction, it is very appropriate that careful consideration be given to the quality of evidence which is typically cited in support of NSP’s. In particular the evidence based literature waxes lyrical about “levels of [reliability of] evidence.”

Self-report data is widely used in the addiction literature but it has been shown many times to be highly flawed and unreliable, and to fails to correlate with more objective and hard signs of HIV rates. As was pointed out to you by Dr. Fred Payne’s letter, and as was noted in the Institute of Medicine Report on this subject, it is well recognized that most of the literature on the subject of needle exchange is based on self report. This would clearly make it the least reliable form of evidence by their own criteria. Actually one would have to wonder if the evidence based gurus would accept such data at all.

Secondly we are aware of the “ecological” studies where they repeatedly report many cities with and without NSP’s. The work of Dr. Kirsten Kall’s group from the University of Linkoping shows clearly that in such an epidemic the rate of rise of the epidemic is related to the population at risk. Epidemics it is argued have a natural life history with a rise, fall and usually stabilization levels. Depending where in the natural history of the epidemic one takes one’s samples one will get a different picture of the efficacy of the NSP’s. It is for this reason that showing either a rise or a fall in HIV incidence or prevalence after NSP introduction is irrelevant if one is not informed of the natural history of the epidemic, and unless one can adduce by other means the likely outcome in its absence. This is a severe criticism, and one which effectively invalidates the whole of this genre of studies. I am also assured by epidemiologists familiar with such matters, that such studies are given no weight in epidemiological circles for this reason. That they have been foisted upon the rest of the world and even mentioned in major UN reports shows the degree to which such sloppy unscientific methods have been adopted within such agencies.

Indeed Dr. Alex Wodak, understood to be one of the primary authors of the relevant section of the 2006 UNAIDS report which eulogized NSP’s and the harm minimization addiction management paradigm, unequivocally stated in 1995 that formal proof of the methods of harm minimization would be impossible as it would not be possible to control in real life the many confounding factors which would be acting, and thereby prove that any particular intervention alone had been salient in controlling the target disorder .

Furthermore there is a clear conflict of interest by some of the leading proponents of NSP’s . Dr. Alex Wodak was for many years the President of the International Drug Law Reform Foundation and is the current president of the Australian Drug Reform Foundation which lobbies unceasingly for drug decriminalization. Dr. Don Jaralais in the USA is also understood to be of a similar ideology, and his advocacy for NSP’s is well known. I am of the understanding that such parallels could be made repeatedly for many of the most ardent advocates of NSP’s.

Dr. Payne’s letter mentions the very high rates of HIV in Vancouver at present despite the operation of an NSP, having risen from 1% to 35%. It was also shown long ago in Montréal that the HIV rate amongst NSP attendees was 2.5 times that amongst non-attendees (3.1 Vs. 7.9%) .

In terms of its control of other virus transmission NSP’s seem to substantially lack power. They failed to control Hepatitis B in Amsterdam , or Hepatitis C in Australia where rates of HCV carriage amongst IVDU who have been involved in the lifestyle for longer than six months exceed 80%.

Special Situations

Some situations are special and require special consideration. We are well aware that the apparent success of harm minimization techniques in this country is frequently cited overseas and in international fora as proof of principal of the efficacy of harm minimization epidemic management techniques. What is repeatedly overlooked in such discussions is our record rates of other infections such as Hepatitis B and C, and the venereally transmitted agents Herpes, Warts and Chlamydia. Indeed recently released data shows 30-100% growth in the last five years in Queensland in Gonorrhea, Hepatitis C, Chlamydia and Syphilis . Indeed it has been estimated that the Australian health care system has now to plan for over 100,000 liver transplants required for Hepatitis C alone in the next 20 years. One also notes that the outcome after transplantation for Hepatitis C is inferior to that for other infections due to the universal early graft re-infection which invariably occurs in the first few post-operative days, and the clash between anti-rejection immunosuppressive therapy and the anti-viral needs of fighting an aggressive viral infection in the context of the immuno-suppression and likely immuno-senescence induced by drug addiction, which is reversed to an unknown extent by abstinence.

In Australia our HIV rate amongst IVDU who do not share other risk factors is very low by international standards of the order of 1%. New cases of HIV nationally in all groups have risen from about 100 in 1991 to around 300 in 2005 . There appears to be significant variation in the estimates for the number of syringes distributed to addicts in this country with estimates varying from 20,000,000 to 200,000,000 – a level of inexactitude which in itself should give us pause. The former number was more than our total population at the time, and the latter number is substantially greater than the number of sheep here (which says a lot for a nation which for a long time was said to ride on the sheep’s back!) One important feature then facing the advocates of any NSP program is exactly how many syringes do they want to distribute? One for every man woman and child in the state?

However in the case of Australia we would do well to heed Wodak’s warnings about the inability to control for other confounders. From a modeling point of view the epidemic began in certain well known high risk groups. Its spread would then have been related to the population at risk, the activity of the various risk taking behaviours, and the intersection of these behaviors with the wider general community. Still today over half of all HIV infections in this country occur amongst men who have sex with men. It should also be added that the rate of IVDU in this group is 10-20 times higher than it is in the general community. Clearly then the spread of the disease into the wider community is related to the behaviour of this reservoir of infected people. One of the obvious confounding factors which has never been studied or quantified is what might be termed the homosexualization of the Australian culture with many laws, many bureaucracies, and schools of public health completely subsumed by the new ideology accompanying the public health impetus of the HIV epidemic. In that this likely instilled major good will in the primary target community, and is likely to have very positively influenced the relevant risk taking behaviours, it is clearly an intimate confound which confuses and likely dilutes any effects which might be attributable strictly to NSP’s.

Another important confounding factor was that Australia made treatment for HIV free to all patients who would have benefited from it from the outset of the epidemic. Assuming that the most at risk individuals were infected near the beginning of the epidemic, then those that survived their infection might reasonably be expected to have had a lower viral load for most of this time making them les infectious. This can be expected to have significantly slowed the rate of progression of the epidemic in this country.

Sweden is an important case in point which must be mentioned in any intelligent discussion of the NSP movement. Sweden has very limited methadone treatment availability, until recently no NSP activity, and no legal “shooting galleries” and a very low rate of HIV in IVDU. Hence the methods of harm minimization cannot strictly be said to be required for HIV control. Clearly HIV control can occur in a very effective manner in the absence of the model harm minimalist strategies.

The situation in prisons, or penitentiaries, is a special one and well worth at least some specific consideration. I was privileged to give evidence to the Inquiry into the Impact of Illicit Drug Use on Families before the Federal House of Representatives of the Australian Parliament on 3rd April 2007 . During that interview I stated that “my blood ran cold at the thought of 500 inmates all sharing the same syringe barrel” as was recounted to me by one of my HIV positive patients. However typical harm minimalist solutions such as methadone, syringe distribution and bleach use have been found to be impractical in the prison environment, and in this country have triggered strikes and industrial disputes by the prison warders due to the creation of unsafe workplaces. Since making those comments to the committee I have considered what might best be done about this appalling situation. One approach follows below (see “Other Treatment Modalities”).

In essence it is my belief that where the crime for which a person is committed is referable to opiate drugs, the standard of care will become naltrexone implant insertion on admission to the jail (after appropriate detoxification procedures), naltrexone implant maintenance during incarceration, and naltrexone implant prior to discharge to prevent the overdose which so often accompanies discharge (and the ritualistic “get a whack, get a woman” routine which is invariably followed). Indeed in Perth patients discharged from the prison are taken by volunteer escort from the prison gates to the clinic for implantation before the whole destructive cycle can re-commence. This seems the most sensible, responsible and compassionate management of this problem.

Other Treatment Modalities

Naltrexone was fist synthesized in the USA 1963 at Endo laboratory by Matossian acting under Blumberg’s instruction . Naltrexone implants and depot preparations have recently received a lot of attention from the international addiction management literature, and have been commercially introduced in the USA. American developed depot injections typically last 3-4 weeks. A preparation recently developed in this country lasts typically 4-6 months. The results of the first formal clinical trial conducted in Perth will soon be announced, probably in a leading medical journal such as JAMA or New England Medical Journal. They have been extensively used in this clinic where we have inserted over 600 USA (Wedgewood) and Australian (Perth “Go Medical”) implants. I was asked by the Preventative and Community Medicine Committee of the Queensland Faculty of the Royal Australian College of General Practitioners to evaluate naltrexone medicine including the Perth naltrexone program in 1998, and since 2001 I have been involved with the development in Perth of their naltrexone implant.

Unofficially the abstinence rate in terms of not returning to dependent heroin use at five months was well in excess of 50% in a study which set new standards international medical literature for patient follow-up. Only 11% of the 70- patients were lost to follow-up compared to over 90% in a similar (larger) study conducted in leading centres in the USA reported by Hollister in 1977 for NIDA at the NIH . Naltrexone is also a widely recognized and used technique for reducing problem drinking in alcoholics. It has also been used for gambling addiction, with positive results on some occasions. Moreover other results reported from the Perth clinic indicate that naltrexone is likely to have a controlling effect on other chemical addiction such as benzodiazepines, cannabis and stimulants such as amphetamines.

It is my personal view that they are excellent and will soon revolutionize the treatment of opiate addiction. Opiate dependence of course is the most addictive and refractory of all drug addictions, and the possibility of gaining control of such patients in a drug free context, as opposed to the usual medical model involving the indefinite maintenance of addiction, must be one of the most exciting opportunities ever to be offered to physicians in addiction medicine.

Another medical agent which has shown enormous promise in the control of multiple addictions is the cannabinoid antagonist rimonabant (“Accomplia”; SR141716A) which has been used with success against opiate, tobacco, alcohol, amphetamine food and cocaine addictions. This drug has attracted attention from NIDA and is undergoing further testing. I am not sure what its regulatory status is in the USA. It was available in eight European nations when I enquired with the pharmaceutical company (Sanofi-Synthelabo) about four months ago. The drug is still under patent, so this impedes its being re-formulated into an implant or depot preparation.

The combination of naltrexone and rimonabant has yet to be tested but would appear to show obvious promise, and it would be a priority in a rational testing program to investigate this further.

Future Research Directions

Many studies show increased evidence of drug use in young people.

All senior authorities in the world agree that there is far too little resources put towards investigating the toxicological effects of addictive drugs in general, and in adolescents in particular.

If we are ever going to do more than shut the door after the horse has bolted, clearly the issue of the true toxicity of addiction must be much better investigated, and the results of such studies broadcast far and wide to our young people, to de-glamourize the dreadfully seductive marketing program to which the rock music and popular culture misleadingly subjects them. If we are ever going to contain the monster of rampant destructive drug use in our younger people, then their dangers must be better emphasized.

Given the obvious multi-system damage of long term chemical addiction which is immediately apparently to even the untrained observer, one can only conclude which a Science which espouses the relative benignity of addiction must be grossly and egregariously deficient.

I have formulated a detailed plan by which such a strategy can be put in place, based around the accumulated ageing changes evident in the skin, teeth, hair, blood vessels, bones, immune system, stem cells and brains of addicts. It invites international collaboration and multi-system multilevel cooperation and the application of state of the art techniques to classical clinical problems. That however, is another story.

CONCLUSION

In summary NSP’s incur great social cost and are clearly part of the problem rather than part of the solution. Their scientific literature is remarkable for its lack of compelling evidence and methodological rigor, not to mention the prominence of adverse findings, when properly adjudicated. Rather the global penetration of NSP’s is an indicator of the strength of the marketing strategy of the ideology they enshrine. They are in any case about to be phased out like old dinosaurs by the cutting edge technologies which are moving ever closer to being a real market alternative, particularly the revolutionary long lasting Australian naltrexone implant.

I have been advised that now methadone is worth $150/week to dispensing hospitals in Federal hospital subsidies. As some of the most famous institutions in the USA have 10,000 – 20,000 patients enrolled on it, this income source forms a major stream of hospital funding. As such it is not likely to be disrupted. What the management of the Australian HIV epidemic does teach us is that it is best to get on and treat the HIV infection as soon as medically appropriate. In addiction medicine we have up until now largely done the reverse, for there we have deliberately continued indefinitely maintenance treatment designed to not to confront the addicted physiology, but rather to postpone indefinitely the definitive redress of that medical condition. The Australian success with HIV management tends to rather emphasize the reverse approach. This is the therapeutic route suggested by naltrexone implant maintenance. In all the discussion we would appear to have forgotten that in the early 1960’s New York was in urgent need of a treatment for addicted GI’s returning home from Vietnam. Methadone as the only medical solution then available was adopted and quickly came to command tremendous official support to the point where it became in time, the established industry. We have now a far more exciting opportunity to launch naltrexone implants and other new treatments in a similar and innovative manner. In would be my sincere hope that nations can move speedily to deliver proven and safe medical treatments to vulnerable populations without incurring undue, unnecessary and officious regulatory obstruction.

This would appear to be the visionary, drug free and health enhancing approach. As these concepts are more widely understood it is hoped that regulators and administrators will cooperate to mobilize international best medical practice on behalf of those with whose care they have been entrusted. I would invite the legislators of New Jersey to work with us on these issues of major cultural importance.

Yours Sincerely,

A. Stuart Reece, MBBS (Hons.), FRCS (Ed.), FRCS (Glas.), MD, FRACGP.
Family Physician, Highgate Hill Brisbane,
Senior Lecturer, Medical School, University of Queensland,
Fellow, Drug Watch International,
Fellow, Drug Free Australia,
Member, Society for Neuroscience,
Member, International Cannabinoid Research Society,
Attendee, College of the Problems of Drug Dependence Conferences 2002-2006.
Awardee, National Institute of Drug Abuse, International, 2003, 2004, 2006.

MINNESOTA COUNTY ATTORNEYS ASSOCIATION

POLICY POSITION

OPPOSING THE MEDICAL USE OF MARIJUANA IN MINNESOTA

Adopted February 16, 2007

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The Minnesota County Attorneys Association (hereafter MCAA) strongly opposes any efforts to use marijuana for medical purposes within the State of Minnesota currently under consideration in the Minnesota Legislature in Senate File No. 345 and House File No. 655 (hereafter S.F. 345). Prosecutors are not alone in our opposition to this proposal. Legalizing marijuana for medicinal uses is also opposed by the Minnesota Sheriff’s Association, the Minnesota Chiefs of Police Association, the National District Attorneys Association, and the U.S. Drug Enforcement Administration. The reasons for the strong opposition to this proposal by these law enforcement organizations are many and are set forth in outline form below.

I. Marijuana is an Addictive Drug That Poses Significant Health Consequences, Even to a Person Using it for “Medical Reasons.”

• Marijuana is an addictive drug that poses significant health consequences to its users, including those who may be using it for medical purposes.
- Marijuana has been proven to be a psychologically addictive drug. Scientists at the National Institute of Drug Abuse have demonstrated that laboratory animals will self administer THC in doses equivalent to those used by humans who smoke marijuana.
- Persons using marijuana, even for medicinal purposes, suffer withdrawal symptoms when use is stopped, such as restlessness, loss of appetite, trouble with sleeping, weight loss and shaky hands.
• The short-term effects of marijuana use include: memory loss, distorted perception, trouble with thinking and problem solving, loss of motor skills, decrease in muscle strength, increased heart rate, and anxiety.
• Long-term use of marijuana may increase the risks of chronic cough, bronchitis, and emphysema, as well as cancer of the head, neck, and lungs.
• Studies have shown smoking marijuana causes a variety of health problems, including cancer, respiratory problems, loss of motor skills, and increased heart rate. It damages the immune system by impairing the ability of T-cells to fight off infections, demonstrating that marijuana can do more harm than good in people with already compromised immune systems.
- Marijuana is a significant health hazard which contains 50-70 percent more carcinogenic hydrocarbons than does tobacco smoke. Using marijuana may promote cancer of the respiratory tract and disrupt the immune system.
- Marijuana contains more than 400 chemicals, including the harmful substances found in tobacco smoke. Smoking one marijuana cigarette deposits almost four times more tar into the lungs than a filtered tobacco cigarette.
- According to the National Institute of Health, studies show that someone who smokes five joints per week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.
- Smoked marijuana has also been associated with an increased risk of the same respiratory symptoms as tobacco, including coughing, phlegm production, chronic bronchitis, shortness of breath and wheezing. Because cannabis plants are contaminated with a range of fungal spores, smoking marijuana may also increase the risk of respiratory exposure by infectious organisms (i.e., molds and fungi).
- In a 2003 study, researchers in England found that smoking marijuana for even less than six years causes a marked deterioration in lung function. The study suggests that marijuana use may rob the body of antioxidants that protect cells against damage that can lead to heart disease and cancer.
- Smoking marijuana also weakens the immune system and raises the risk of lung infections. A Columbia University study found that a control group smoking a single marijuana cigarette every other day for a year had a white-blood-cell count that was 39 percent lower than normal, thus damaging the immune system and making the user far more susceptible to infection and sickness.
• Harvard University researchers report that the risk of a heart attack is five times higher than usual in the hour after smoking marijuana.
- Marijuana can cause the heart rate, normally 70 to 80 beats per minute, to increase by 20 to 50 beats per minute or, in some cases, even to double.
• According to two studies, marijuana use narrows arteries in the brain, “similar to patients with high blood pressure and dementia,” and may explain why memory tests are difficult for marijuana users. In addition, “chronic consumers of cannabis lose molecules called CB1 receptors in the brain’s arteries,” leading to blood flow problems in the brain which can cause memory loss, attention deficits, and impaired learning ability.
• The British Medical Journal recently reported: “Cannabis use is associated with an increased risk of developing schizophrenia, consistent with a causal relation. This association is not explained by use of other psychoactive drugs or personality traits relating to social integration.”
- Dr Andrew Campbell, a member of the New South Wales (Australia) Mental Health Review Tribunal, published a study in 2005 which revealed that four out of five individuals with schizophrenia were regular cannabis users when they were teenagers. Between 75-80 percent of the patients involved in the study used cannabis habitually between the ages of 12 and 21.
- A laboratory-controlled study by Yale University scientists, published in 2004, found that THC “transiently induced a range of schizophrenia-like effects in healthy people.
• According to several recent studies, marijuana use has been linked with depression and suicidal thoughts, in addition to schizophrenia. These studies report that weekly marijuana use among teens doubles the risk of developing depression and triples the incidence of suicidal thoughts.
- Marijuana users have more suicidal thoughts and are four times more likely to report symptoms of depression than people who never used the drug.
• Carleton University researchers published a study in 2005 showing that current marijuana users who smoke at least five “joints” per week did significantly worse than non-users when tested on neurocognition tests such as processing speed, memory, and overall IQ.
• Mentions of marijuana use in emergency room visits in this country have risen 176 percent since 1994, surpassing those of heroin. In 2001, marijuana was a contributing factor in more than 110,000 emergency department visits in the United States.
• Users can become dependent on marijuana to the point they must seek treatment to stop abusing it. In 1999, more than 200,000 Americans entered substance abuse treatment primarily for marijuana abuse and dependence.

II. Marijuana Does Not Have Any Proven Medical Value and it is Not Supported for Medicinal Use by Many Prominent National Health Organizations.

Before considering the enactment of this proposed statute, the Legislature is urged to look closely at the medical facts behind this issue. These include:

• Scientific research has not demonstrated that smoked marijuana is helpful as medicine.
• Major medical and health organizations, as well as the clear majority of nationally recognized experts in the fields of medicine, science and scientific research, have concluded that smoking marijuana is not a safe and effective medicine. These organizations include: The American Medical Association, the American Cancer Society, the National Sclerosis Association, the American Glaucoma Association, the American Academy of Ophthalmology, the National Eye Institute, and the National Cancer Institute.
• The American Medical Association (AMA) has rejected pleas to endorse marijuana as a medicine, and instead has urged that marijuana remain a prohibited, Schedule I controlled substance (although it does support further studies, especially those aimed at delivering a “smoke-free inhaled delivery system for marijuana or . . . (THC) to reduce the health hazards associated with the combustion and inhalation of marijuana.”)
• The American Cancer Society “does not advocate inhaling smoke, nor the legalization of marijuana” (although the organization does support carefully controlled clinical studies for alternative delivery methods, specifically a THC skin patch) .
• The American Academy of Pediatrics (AAP) opposes the legalization of marijuana because it believes that “[a]ny change in the legal status of marijuana, even if limited to adults,” [which would include its use for medical purposes] “could affect the prevalence of use among adolescents.” (Similar to the AMA, the AAP supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana.)

- The AAP asserted that with regard to marijuana use, “from a public health perspective, even a small increase in use, whether attributable to increased availability or decreased perception of risk, would have significant ramifications.”
• The National Multiple Sclerosis Society (NMSS) states that studies done “have not provided convincing evidence that marijuana benefits people with MS,” and thus marijuana is not a recommended treatment. Furthermore, the NMSS warns that the “long-term use of marijuana may be associated with significant serious side effects.”
• A recent study by the Mayo Clinic, showed THC to be less effective than standard treatments in helping cancer patients regain lost appetites.
• The British Medical Association (BMA) has also voiced extreme concern that down-grading the criminal status of marijuana would “mislead” the public into believing that the drug is safe. [The same holds true in reference to legalizing the use of marijuana for medical purposes.]
- The BMA maintains that marijuana “has been linked to greater risk of heart disease, lung cancer, bronchitis and emphysema.” The 2004 Deputy Chairman of the BMA’s Board of Science said that “[t]he public must be made aware of the harmful effects we know result from smoking this drug.”
• Even the 1999 landmark study of The Institute of Medicine (IOM) which reviewed the supposed medical properties of marijuana (a study often cited by “medical” marijuana advocates) clearly discounts the notion that smoked marijuana is or can become “medicine.” A close review of the IOM study reveals the following:
- While the principal investigators in the IOM study found that the active compounds in marijuana may have medicinal potential for some ailments (the IOM found “… potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation.” ) They pointed out that “[t]he effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications [than smoked marijuana].”
- The IOM study concluded that, at best, there in only anecdotal information on the medical benefits of smoked marijuana for some ailments, such as muscle spasticity. For other ailments, such as epilepsy and glaucoma, the study found no evidence of medical value and did not endorse further research.
- The principal investigators of the IOM study explicitly stated that using smoked marijuana in clinical trials “should not be designed to develop it as a licensed drug, but should be a stepping stone to the development of new, safe delivery systems of cannabinoids.”
- The IOM study explained that “smoked marijuana . . . is a crude THC delivery system that also delivers harmful substances.” In addition, “plants contain a variable mixture of biologically active compounds and cannot be expected to provide a precisely defined drug effect.” Therefore, the study concluded that “there is little future in smoked marijuana as a medically approved medication.”

• The Food and Drug Administration and the U.S. Public Health Service have rejected smoking crude marijuana as a medicine. (It is important to note that the Food and Drug Administration (FDA) has never approved medications that are smoked.) This is because not only is it difficult if not impossible to administer safe and regulated dosages of medicine in a smoked form, the harmful chemicals and carcinogens that are by-products of smoking create an entirely new set of health problems.

III. There Already Exists a Legalized Form of “Medical Marijuana” in our Country – It’s Called Marinol (and other approved drugs exist as well to treat these diseases).

• Marinol is an approved pharmaceutical product that is widely available through a doctor’s prescription. It comes in the form of a pill (which can accurately regulate the dose of THC delivered, unlike smoked marijuana), and it is also being studied by researchers for suitability by other delivery methods, such as an inhaler or a patch. The active ingredient of Marinol is synthetic THC, which is the main active chemical found within marijuana. However, unlike marijuana which also contains more than 400 different chemicals (including most of the cancer-causing chemicals found in tobacco smoke), Marinol delivers therapeutic doses of THC in a manner that has been studied and approved by the medical community and the Food and Drug Administration.
• There is, therefore, no medical need to substitute a dangerous and addictive drug like marijuana for an approved prescriptive drug like Marinol that can provide a synthetic form of THC treatment with safe and controlled amounts to assist patients suffering from nausea, vomiting associated with chemo therapy and the loss of appetite associated with AIDS, two of the recognized and approved uses of Marinol.
• Numerous other approved drugs exist to treat the medical problems for which medical use of marijuana would be authorized under S.F. 345. A list of over 20 such medications is set forth in footnote 51 of this document.

IV. Marijuana’s Use As A Medicine Is Contrary to Federal Law as Upheld by Federal Court Decisions (including the U.S. Supreme Court).

• The Federal Controlled Substance Act (CSA) was enacted in 1970 as part of the Comprehensive Drug Abuse Prevention and Control Act. The CSA classifies drugs under five categories (Schedule I–V) based upon their level of danger and acceptance for medical use (among other criteria).
• Schedule I consists of the most restricted drugs under federal law – drugs which have a high potential for abuse, a lack of any accepted medical use, and an absence of any accepted safety criteria for use in medically supervised treatment.
• Marijuana is classified as a Schedule I drug, the manufacture, distribution or possession of which is a federal crime. Manufacture, distribution or possession of marijuana is also a state crime in Minnesota (except possession of small quantities of less than 1.5 oz., which is classified as a petty misdemeanor) .
• States have no authority to change the federal classifications of controlled substances under the CSA (including marijuana) under the Supremacy Clause of the United States Constitution.
• Federal Courts have consistently upheld the classification of marijuana as a Schedule I controlled substance and the fact that marijuana is a dangerous drug with no accepted medical use.
- In 1994, a U.S. Court of Appeals upheld a decision of the Administrator of the Drug Enforcement Administration, who declined to reschedule marijuana from Schedule I to Schedule II of the Controlled Substance Act, finding that marijuana was a drug with “high potential for abuse” which has “no currently accepted medical use in treatment in the United States” and that “there is a lack of accepted safety for use of the drug . . . under medical supervision.”
- The U.S. Court of Appeals found that the DEA Administrator properly relied upon “the testimony of numerous experts that marijuana’s medicinal value has never been proven in sound scientific studies,” noting that physicians supporting use of marijuana for medical purposes (in testimony before an Administrative Hearing Officer) were basing their opinions on “anecdotal evidence, on stories . . . heard from patients, and on . . . impressions about the drug.”
• The most recent and important federal court case on this topic is a 2005 decision of the United States Supreme Court in Gonzales v. Angel, et al., which upheld the authority of federal authorities to enforce federal laws prohibiting the use of marijuana in California for medical purposes as authorized under California law.
- In this decision, the U.S. Supreme Court affirmed that Congress has the authority to regulate controlled substances and “to prohibit entirely the possession or use of substances listed in Schedule I” (including marijuana), except as part of a strictly controlled research project.
• Congress has done just that through passage of the CSA under which marijuana has been designated as a Schedule I drug. In other words, marijuana has been deemed by federal regulation to be an extremely dangerous drug with no general acceptance for medical use.
• If S.F. 345 is passed, it will be in direct conflict with federal law and the U.S. Supreme Court has clearly indicated in Gonzales v. Angel, et al., that federal law takes precedence under the Supremacy Clause of the United States Constitution.
- Consequently, those granted authority to lawfully produce and use marijuana for medical purposes under state law (if S.F. 345 is enacted) will still be committing a federal crime.
• Also, as pointed out by the U.S. Supreme Court in Gonzales v. Angel, et al., legalizing marijuana use for medicinal purposes will clearly lead to increases in the marijuana supply, greater use of marijuana by non-patients and more criminal activity under state law. (See Section VII below for a more specific discussion of this issue.)
• The Minnesota Legislature should not substitute its judgment for that of Congress and the Administrators of the U.S. Drug Enforcement Administration (hereafter DEA) and the Federal Drug Administration (hereafter FDA) as to the fact that marijuana has no general acceptance for medical use and as to defining what is the appropriate way to deliver safe medications to our citizens.
• It is not sound public policy to enact state laws which encourage law abiding citizens to commit federal crimes.

V. Marijuana is a Dangerous Drug that is Associated with Crime and Violence.

• Research shows a link between frequent marijuana use and increased violent behavior.
- Young people who use marijuana weekly are nearly four times more likely than nonusers to engage in violence.
• A large percentage of those arrested for crimes test positive for marijuana. Nationwide, 40 percent of adult males tested positive for marijuana at the time of their arrest.
- Of adult males arrested in the United States for all crimes, 40 percent tested positive for marijuana at the time of their arrest, according to the Director of the U.S. Drug Enforcement Administration.

• In 2003, 3.1 million Americans aged 12 or older used marijuana daily or almost daily in the past year. Of those daily marijuana users, nearly two-thirds “used at least one other illicit drug in the past 12 months.”
- More than half (53.3 percent) of daily marijuana users were also dependent on or abused alcohol or another illicit drug compared to those who were nonusers or used marijuana less than daily.
• There is a strong correlation between drug use and crime. Drug use affects the user’s behavior. In 1997, illicit drug users were:
- approximately 16 times more likely than nonusers to report being arrested for larceny or theft;
- more than 14 times more likely to be arrested for driving under the influence, drunkenness, or liquor law violations; and
- more than 9 times more likely to be arrested on assault charges.

VI. Marijuana is Far More Powerful Today Than it Was 30 Years Ago and it Serves as a Gateway to the Use of Other Illegal Drugs.

• Marijuana is much stronger now than it was decades ago. According to data from the Potency Monitoring Project at the University of Mississippi, the tetrahydrocannabinol (THC) content of commercial-grade marijuana rose from an average of 3.71 percent in 1985 to an average of 5.57 percent in 1998. The average THC content of U.S. produced sinsemilla increased 3.2 percent in 1977 to 12.8 percent in 1997.
- The average THC levels in marijuana in the past two decades has increased form 6 percent to more than 13 percent, with some samples containing THC levels of up to 33 percent (which is far higher than the 1 percent potency levels in marijuana used in the mid-1970’s).
• Marijuana is a gateway drug to the use of other illegal drugs like methamphetamine, heroin and cocaine. Long-term studies of students who use drugs show that very few young people use other illegal drugs without first trying marijuana. The use of marijuana often lowers inhibitions about drug use and exposes users to a culture that encourages the use of other drugs.

• Studies show that of the people who have ever used marijuana, those who started early are more likely to have other problems later on. For example, adults who were early marijuana users were found to be:
- 8 times more likely to have used cocaine.
- 15 times more likely to have used heroin,
- 5 times more likely to develop a need for treatment of abuse or dependence on any drug.
• The Journal of the American Medical Association reported a study of more than 300 sets of same-sex twins. The study found that marijuana-using twins were four times more likely than their siblings to use cocaine and crack cocaine, and five times more likely to use hallucinogens such as LSD.
• The study by Columbia University’s National Center on Addiction and Substance Abuse offers further support for the fact that teens who use marijuana at least once a month are 13 times more likely than other teens to use another drug like cocaine, heroin, or methamphetamine and are almost 26 times more likely than those teens who have never used marijuana to use another illegal drug.
- Other studies show that twelve to seventeen year olds who smoke marijuana are 85 times more likely to use cocaine than those who do not. Sixty percent of adolescents who use marijuana before age 15 will later use cocaine. These correlations are many times higher than the initial relationships found between smoking and lung cancer in the 1964 Surgeon General’s report (nine to ten times higher).
• Health care workers, legal counsel, police and judges indicate that marijuana is a typical precursor to methamphetamine use. For example, Nancy Kneeland, a substance abuse counselor in Idaho, pointed out that “In almost all cases meth users began with alcohol and pot.”

VII. Legalizing Marijuana for Medical Purposes Will Lead to Increased Use of Marijuana By Other Persons, Increased Crime and the Perception that Marijuana is Harmless.
• It is foolish to think that there will be no additional use of marijuana occurring as a result of legalizing its use for medicinal purposes under S.F. 345. First of all there will be no practical way to enforce the law to ensure that marijuana obtained from medical purposes is not used by other persons, including children. Anecdotal information received from prosecutors in other states where similar legislation has been enacted indicates that this is exactly what will occur.
• Under S.F. 345, no person would be subject to arrest or prosecution “for constructive possession, conspiracy, aiding and abetting, being an accessory, or any other criminal offense for being in the presence or vicinity of the medical use.” Consequently, there will be no way to ensure that those who obtain marijuana for a medical purpose will not share it with other persons.
• If this legislation is enacted, it will authorize persons to lawfully grow and sell marijuana. Because marijuana is a widely used illegal substance, incentives will exist for some unscrupulous persons involved in the sale or distribution of “legal marijuana” to steal and distribute the substance for illegal uses.
• Institutions, which are lawfully producing marijuana if this legislation is enacted, would also become easy targets for thieves looking to break in and steal “legally produced” marijuana for illegal distribution purposes.
• It is important to note that the U.S. Supreme Court in its 2005 decision in Gonzales v. Angel, et al., specifically acknowledged that adverse impacts of increasing crime and illegal marijuana use will result from the passage of state laws similar to S.F. 345. In Gonzales, the majority of the U.S. Supreme Court made the following conclusions:
- “The exemption for cultivation by patients and caregivers can only increase the supply of marijuana in the [state] market.”
- “The likelihood that all such production will promptly terminate when patients’ medical needs during their convalescence seems remote, whereas the danger that excesses will satisfy some of the admittedly enormous demand for recreational use seems obvious.”
- “[T]he [fact that the] national and international narcotics trade has thrived in the face of vigorous criminal enforcement efforts suggests that no small number of unscrupulous people will make use of the . . . [state] exemptions to serve their commercial ends whenever it is feasible to do so.”
• Legalizing marijuana for medical purposes will lead many to conclude that the drug is in fact safe.
- In states where the issue of legalizing marijuana for medical purposes has been put on the ballot for voters to decide, well-financed and organized campaigns spearheaded by pro-marijuana legalization groups have contributed to the misperception that marijuana is harmless.
- According to the Office of National Drug Policy, these campaigns are led not by medical professionals or patients-rights groups, but by pro-drug donors and organizations in a cynical attempt to exploit the suffering of sick people.
- This misperception that marijuana is harmless is perhaps most prevalent among teens where it has led to a 140 percent increase in marijuana use among high school seniors from 1994-95.
- The mortal danger of thinking that marijuana is “medicine” was graphically illustrated by a story from California. In the spring of 2004, Irma Perez was “in the thrills of her first experience with the drug ecstasy” when, after taking one ecstasy tablet, she became ill and told friends that she felt like she was “going to die.” Two teenage acquaintances did not seek medical care and instead tried to get Perez to smoke marijuana. When it failed due to her seizures, the friends tried to force feed marijuana leaves to her, “apparently because [they] knew that drug is sometimes used to treat cancer patients.” Irma Perez lost consciousness and died a few days later when she was taken off life support. She was 14 years old.
• Legalizing marijuana for medical purposes will lead to the perception that marijuana is harmless, will result in increased use of it for illegal purposes, and will result in more crime (see Section IV above), endangering our youth and the safety of all citizens in our state.

VIII. Legalizing the Use of Marijuana for Medicinal Purposes Will Increase Dangers Associated With Impaired Driving.

Driving under the influence of marijuana can dramatically impact the safety of citizens within our state as indicated by the following:
• Smoking marijuana impairs the judgment of the smoker and increases the risk of accidents. Many car accidents are caused by drivers using marijuana. In fact, some say just as many as those caused by drivers under the influence of alcohol.
• Marijuana affects many skills required for safe driving: alertness, the ability to concentrate, coordination, and reaction time. These effects can last up to 24 hours after smoking marijuana. Marijuana use can also make it difficult to judge distances and react to signals and signs on the road.
• A roadside study of reckless drivers in Tennessee found that 33 percent of all subjects who were not under the influence of alcohol and who were tested for drugs at the scene of their arrest tested positive for marijuana.
• In a 2003 Canadian study, one in five students admitted to driving within an hour of using marijuana.
• In a 1990 report, the National Transportation Safety Board studied 182 fatal truck accidents and found that just as many of the accidents were caused by drivers using marijuana as were caused by alcohol – 12.5 percent in each case.

Some of the documented consequences of marijuana impaired driving across America include the following:
- The driver of a charter bus, whose 1999 accident resulted in the death of 22 people, had been fired from bus companies in 1989 and 1996 because he tested positive for marijuana four times. A federal investigator confirmed a report that the driver “tested positive for marijuana when he was hospitalized Sunday after the bus veered off a highway and plunged into an embankment.”
- In April 2002, four children and the driver of a van died when the van hit a concrete bridge abutment after veering off the freeway. Investigators reported that the children nicknamed the driver “Smokey” because he regularly smoked marijuana. The driver was found at the crash scene with marijuana in his pocket.
- A former nurse’s aide was convicted in 2003 of murder and sentenced to 50 years in prison for hitting a homeless man with her car and driving home with his mangled body “lodged in the windshield.” The incident happened after a night of drinking and taking drugs, including marijuana. After arriving home, the woman parked her car, with the man still ledged in the windshield, and left him there until he died.
- In April 2005, an eight year old boy was killed when he was run over by an unlicensed 16 year old driver who police believed had been smoking marijuana just before the accident.
- In 2001, George Lynard was convicted of driving with marijuana in his bloodstream, causing a head-on collision that killed a 73 year old man and a 69 year old woman. Lynard appealed this conviction because he allegedly had a “valid prescription” for marijuana. A Nevada judge agreed with Lynard and granted him a new trial. The case has been appealed to the Nevada Supreme Court.
- Duane Baehler, 47, of Tulsa, Oklahoma was “involved in a fiery crash that killed his teenage son” in 2003. Police reported that Baehler had methamphetamine, cocaine and marijuana in his system at the time of the accident.

IX. Summary

For all of the reasons outlined above, legalizing marijuana for medicinal purposes is not in the interests of protecting the public safety of Minnesota’s citizens, nor is it in the best interest of persons who suffer from the types of chronic or debilitating diseases or medical conditions specified in S.F. 345. Marijuana is a dangerous addictive drug that poses significant health risks to those who use it. Legalizing marijuana for “medicinal use” will only increase the access of both youth and adults to marijuana, which will not only increase the likelihood of violent behavior but will often lead to experimentation with other even more dangerous illegal drugs. As noted by the Office of National Drug Control Policy;

“Even if smoking marijuana makes people “feel better”, that is not enough to call it a medicine. If that were the case, tobacco cigarettes could be called medicine because they are often said to make people feel better. For that matter, heroin certainly makes people “feel better” (at least initially), but no one would suggest using heroin to treat a sick person.”

The bottom line is that at the present time, there is no proven medicinal value in using marijuana to treat illnesses or disease and, in fact, a legal form of THC, which can be controlled for its strength and which delivers none of the harmful side effects of smoking marijuana already exists for use through a doctor’s prescription.

Marijuana use, even by those using it for medicinal purposes, is significantly harmful to the body. Smoking pot delivers three to five times the amount of tars and carbon monoxide into the body as does smoking cigarettes and it also damages pulmonary immunity and impairs oxygen diffusion. We agree with the Office of National Drug Control Policy, that it is hard to understand how changes such as these could be good for someone dying of cancer or AIDS.

Perhaps most importantly of all, as a prohibited Schedule I controlled substance under the Federal Controlled Substance Act (CSA), the manufacture, distribution or possession of marijuana is a federal crime. The Minnesota Legislature should not substitute its judgment for that of Congress and the Administrators of the U.S. Drug Enforcement Administration and the Federal Drug Administration as to the fact that marijuana is a dangerous drug with no accepted medical use and as to determining what is the appropriate way to deliver safe medications to our citizens. It is not sound public policy to enact state laws which encourage law abiding citizens to commit federal crimes.

It is for all these reasons that the MCAA strongly opposes the adoption of the law in Minnesota which would legalize the use of marijuana for medicinal purposes. This opposition is shared by associations representing our law enforcement partners within Minnesota.

Abstainers Are Not Maladjusted, but Lone Users Face Difficulties

Key findings:
• Although some consider experimenting with marijuana normal behavior for adolescents, those adolescents who abstain are not maladjusted as others have reported.
• Young abstainers do better than experimenters into young adulthood.
• Even strict abstainers — youth who avoid all drugs — fare well in life.
• Solitary substance use is not uncommon among youth.
• Young solitary users are an overlooked at-risk group who face a wide range of psychosocial and behavioral difficulties as teens and young adults.

A lot of adolescents experiment with marijuana — the National Institute on Drug Abuse estimates that 46% of high school seniors have tried this drug at some time. Pushing boundaries is what young people do, and some researchers believe that trying marijuana is a normal part of growing up. Does that mean that young people who do not indulge are somehow maladjusted?

Jonathan Shedler and Jack Block[1] raised this possibility in a report in 1990. They suggested that adolescents who experimented with marijuana were better adjusted emotionally and socially than their counterparts who avoided all drugs. Specifically, abstainers were observed to be anxious, emotionally constricted, and lacking in social skills compared with experimenters. Not surprisingly, these findings caused widespread comment in the drug-prevention community.

Now, RAND Corporation researchers have revisited Shedler and Block’s classic study and have uncovered evidence that challenges those initial findings. Kids who abstained from marijuana through the last year of high school were not socially or emotionally troubled. And they had better outcomes as young adults.

A second study looked at a largely ignored group of adolescents: kids who go off by themselves to use marijuana and other harmful substances. The researchers documented a wide range of psychosocial and behavioral difficulties faced by youth who use harmful substances while alone, rather than only in social settings like parties. And the troubles followed them into young adulthood.

For policymakers, these two studies help clarify the picture of youthful marijuana use: Marijuana abstainers do well, solitary users do poorly, and kids who use marijuana only in social settings are in between.

Digging for Clues About Youthful Marijuana Use
To re-examine the provocative findings of Shedler and Block, the RAND researchers, led by Joan Tucker, a social psychologist, mined a wealth of data on youthful substance use accumulated since 1985 by the RAND Adolescent/Young Adult Panel Study. This database contains survey responses from thousands of individuals who answered questions about their use of harmful substances, about their social and emotional well-being and behavior, and about school. The survey was given in grades 7, 8, 9, 10, and 12, and again at ages 23 and 29. The database was used to evaluate the effectiveness of the Project ALERT drug use prevention program that RAND developed for middle-school students. For their study, the researchers examined responses to the surveys given in 12th grade and at age 23. They divided the responders into abstainer and experimenter categories, which replicate as closely as possible those used in the 1990 Shedler and Block study:

Abstainers — those who had never tried marijuana or any other illicit drug.

Experimenters — those who had used marijuana less than 10 times in the year before being surveyed and less than three times in the preceding month, and none or only one other illicit drug in their lifetime.

A different picture emerges of youth and marijuana
From their analyses of survey responses, the RAND researchers pieced together a picture of marijuana abstainers and experimenters as teens and as young adults that contradicts that painted by earlier studies. Their key findings, some of which are shown in the figure, include

Youth who stayed away from marijuana through their senior year of high school functioned better overall than did seniors who experimented with the drug. Compared with experimenters, abstainers

• had more parental support
• devoted more time to homework
• spent more time in extracurricular school activities
• earned better grades
• got into less trouble
• were emotionally better off.

Both groups were similar in that

• on average, they rarely felt lonely
• they reported similar levels of peer support and ease in interacting with the opposite sex.

The one exception was that,

• although abstainers were socially active, they went to parties and dances significantly less frequently than did experimenters.

By the time they turned 23, those who had avoided marijuana in high school functioned better overall as young adults than those who had experimented with it in their youth. Compared with experimenters, abstainers

• were better educated
• were happier with their friends
• were less involved in deviant behavior (stealing and drug selling).

Both groups were similar in that

• they showed no differences in their satisfaction with family life and with general mental health, or with limitations due to emotional problems.

The emotional and social well-being of strict marijuana abstainers — those who had tried neither marijuana nor cigarettes and had not used alcohol in the past year — was also compared with that of experimenters, both in high school and as young adults:

• Even this more-stringent subgroup of marijuana abstainers did not show the adjustment problems suggested by earlier studies.

Why did two different pictures emerge?
The conflicting findings may be due to methodological factors. For example, the RAND team examined longitudinal data for more than 3,000 individuals who were originally recruited from 30 California and Oregon schools. These schools were chosen to represent a wide range of community types, socioeconomic status, and racial/ethnic composition. Thus, the RAND sample was considerably larger and more diverse than the 100 or so youth from the San Francisco Bay area whom Shedler and Block followed.

Young Solitary Substance Users: An Overlooked, At-Risk Group
Surprisingly little research looks at the sizable minority of teens who use marijuana and other harmful substances when alone rather than only in social settings. In a second study, researchers again used the RAND Adolescent/Young Adult Panel Study database for clues about the extent of solitary substance use, as well as about the well-being, behavior, and future risks, of this largely ignored group. For this study, these youth are referred to as “solitary users,” even though they may also use marijuana, cigarettes, or alcohol in social settings with others. This time, the researchers analyzed responses to the surveys given in 8th grade and at age 23. They found that:

Although they constitute a small percentage, solitary users are an overlooked, at-risk group:

• In 8th grade, 4% of young people said they sometimes or often used marijuana alone rather than limiting its use to parties or other social occasions. This figure was 16% for cigarettes and 17% for alcohol.

By 8th grade, solitary substance users are worse off than classmates who use only in social settings. Compared with social-only users, solitary users

• engaged in heavier and more-frequent drug use
• got into more trouble (e.g., stealing, acting out at school)
• confided less in their parents about personal problems
• performed more poorly in school (had lower grades, spent less time on homework, participated less in extracurricular school activities).

Solitary users are not social outsiders. Contrary to what might be expected, these youth are not loners. They are socially active teens who spend more time hanging out with friends, going to parties, and dating than do youth who limit substance use to social settings. Popularity with peers may help compensate solitary users for their poorer academic track records and behavioral problems in the short term.

Solitary use foreshadows problems down the road. Compared with social-only substance users, teen solitary users faced more difficulties as young adults: They made fewer educational strides, had poorer health, and experienced more substance-use problems.

Solitary users perceive drug consequences differently than do social-only users. Solitary users more strongly believed that turning to marijuana, cigarettes, or alcohol helped them get away from their problems, relax, and have more fun — an optimistic bias that could lead them to underestimate the potential for serious negative consequences.

Implications for Drug-Prevention Programs
New insight into youthful substance use emerged from the RAND studies that can help improve drug-prevention programs for adolescents and teens.

Experimentation with drugs has sometimes been viewed as developmentally appropriate and adaptive. In contrast, the RAND results indicate that youth who experiment with marijuana are worse off in many respects than those who abstain throughout their teenage years. This insight helps the drug-prevention community put into perspective the conflicting conclusions from prior studies about marijuana use and its consequences.

The research also documented the wide range of psychosocial and behavioral difficulties that lone substance users, as opposed to strictly social users, face as teens and young adults. These findings suggest that drug-prevention programs should pay closer attention to this at-risk group of young people.

Source: http://www.rand.org/pubs/research_briefs/RB9265/index1.html 2007
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[1] Shedler J, and Block J, “Adolescent Drug Use and Psychological Health: A Longitudinal Inquiry,” American Psychologist, Vol. 45, No. 5, May 1990, pp. 612–630.
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This Highlight summarizes RAND Health research reported in the following publications:
Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Are Drug Experimenters Better Adjusted Than Abstainers and Users?: A Longitudinal Study of Adolescent Marijuana Use,” Journal of Adolescent Health, Vol. 39, No. 4, 2006, pp. 488–494.

Tucker JS, Ellickson PL, Collins RL, and Klein DJ, “Does Solitary Substance Use Increase Adolescents’ Risk for Poor Psychosocial and Behavioral Outcomes? A 9-Year Longitudinal Study Comparing Solitary and Social Users,” Psychology of Addictive Behaviors, Vol. 20, No. 4, 2006, pp. 363–372.

The human brain is also a system of subsystems and there is now overwhelming evidence that the development of the human brain continues well into adolescence up to age 20. We know that the brain is vulnerable to toxic substances that can cause cognitive dysfunctions in adults. There is substantial literature on the consequences of acute and chronic marijuana exposure in adults, including measures of cognitive and behavioral effects, as well as some measures of alterations in brain function, primarily in the domains of learning and memory. There have been relatively few studies, however, of the effects of exposure to marijuana during development,
Some have reported that a delay in adolescent brain development is common when alcohol and or other drug usage including marijuana – begins at a young age. Some frequent users feel a lack of initiative and concern about the future, find it hard to become or stay motivated, and think things will take care of them selves, (Wapner, Roger, 1995). As a result, the normal maturation process is interrupted. Development of coping skills, a code of ethics, acceptance of responsibility, and other signs of maturity frequently cease or regress. A frequent user’s emotional development may be delayed when he starts using, and may take much longer to develop once the user has become clean and sober for an extended period of time. Drug misuse usually leads to denial. Denial is one of the hallmarks of chemical dependency. Frequent users not only deny that their drug use is a problem; they may begin using denial to pretend other problems do not exist either. Forgotten birthdays, missed social engagements, and unmet commitments are all no big deal . (Wapner, Roger, 1995)
Jonathon Shedler and Jack Block (University of California, Berkeley) have done extensive studies of teenagers, which included abstainers, occasional users, and frequent users. Frequent users are described (by family and peers) as not dependable or responsible, not productive or able to get things done, guileful and deceitful, opportunistic, unpredictable and changeable in attitudes and behavior, unable to delay gratification, rebellious and nonconforming, prone to push and stretch limits, self-indulgent, not ethically consistent, not having high aspirations, and prone to express hostile feelings directly. (Shedler and Block, 1990)
Marijuana Effects
The specific effects of marijuana, however, vary greatly, depending on the quality and dosage of the drug, the personality and mood of the user, the user s past experiences with the drug, the social setting, and the user s expectations.
Considerable consensus exists however among regular users that when marijuana is smoked and inhaled, a state of slight intoxication results. This state is one of mild euphoria distinguished by increased feelings of well-being, heightened perceptual acuity, and pleasant relaxation, often accompanied by a sensation of drifting or floating away. Sensory inputs are intensified. Often a person’ s sense of time is stretched or distorted, so that an event that lasts only a few seconds may seem to cover a much longer span. Short-term memory may also be affected, as one notices that a bite has been taken out of a sandwich but does not remember having taken it. For most users, pleasurable experiences, including sexual intercourse, are reportedly enhanced. When smoked, marijuana is rapidly absorbed and its effects appear within seconds to minutes but seldom last more than 2 to 3 hours (Butcher, Mineka, & Hooley, 2004).
Marijuana may lead to unpleasant as well as pleasant experiences. For example, if a person uses the drug while in an unhappy, angry, suspicious, or frightened mood, these feelings may be magnified. With higher dosages and with certain unstable or susceptible individuals, marijuana can produce extreme euphoria, hilarity, and over talkativeness, but it can also produce intense anxiety and depression as well as delusions, hallucinations, and other psychotic-like experiences. Evidence suggests a strong relationship between daily marijuana use and the occurrence of self-reported psychotic symptoms (Tien & Anthony, 1990).

One study exploring past substance use history in incarcerated murderers reported that among men who committed murder, marijuana was the most commonly used drug. One-third indicated that they used the drug before the homicide, and two-thirds were experiencing some effects of the drug at the time of the murder (Spunt et al., 1994).
Marijuana does not lead to extreme physiological dependence, as heroin does. It can, however, lead to psychological dependence, in which the person experiences a strong need for the drug whenever he or she feels anxious or tense. In fact, recent research has reported that many marijuana use abstainers reported having withdrawal-like symptoms such as nervousness, tension, sleep problems, and appetite change (Budney, Hughes, et al., 2001; Kouri and Pope, 2000). One recent study of substance abusers reported that marijuana users were more ambivalent and less confident about stopping use than were cocaine abusers (Budney, Radonovich, et al., 1998).
Self Diagnosis
1. Does your periodic marijuana use and intoxication interfere with your performance at work or school?
2. Is your periodic marijuana use and intoxication physically hazardous in situations such as driving a car?
3. Do you or have you had legal problems as a consequence of arrests for marijuana possession?
4. Do you or have you had arguments with spouses or parents over the possession of marijuana in the home or its use in the presence of children?
If you answered Yes to any one of the above you may meet criteria for a diagnosis of Cannabis Abuse and I would recommend that you undergo an alcohol/ substance abuse evaluation by a Certified Substance Abuse Counselor (CSAC) and comply with all treatment recommendations.
If you are having psychological or physical problems associated with compulsively using marijuana, such as:

1. Craving;
2. Withdrawal symptoms;
3. Irritability;
4. Sleeplessness; and/ or
5. Anxiety
- when trying to quit, then a diagnosis of Cannabis Dependence should be considered rather than Cannabis Abuse. Likewise, I would recommend that you undergo an alcohol/ substance abuse evaluation by a Certified Substance Abuse Counselor (SAC) and comply with all treatment recommendations.
Multiple Addictions
In 2001, marijuana was a contributing factor in more than 110,000 emergency department visits in the United States. In a survey of drug-related visits to the emergency room (DAWN Report, 2001), 16 percent of drug-related visits were for marijuana abuse. Many of these emergency room visits, as one might suspect, involved the use of other substances along with marijuana. If you had trouble answering Yes to one of the above self-diagnosis questions, because you have used alcohol and/ or other drugs along with marijuana and you cannot contribute your problems to marijuana alone, then you may meet the criteria for Poly-substance Dependence and or Poly-behavioral Addiction, see below. other addictions co-exist, the initial therapeutic intervention for any addiction needs to include an assessment for other addictions. National surveys revealed that very high correlation exists between cannabis abuse and/ or other substance abuse and behavioral addictions.
Poor Prognosis
We have come to realize today more than any other time in history that the treatment of Cannabis Dependence and other lifestyle diseases and behavioral addictions related to gambling, food, sex, and/ or religion, (etc.) are often a difficult and frustrating task for all concerned. Repeated failures abound with all of the addictions, even with utilizing the most effective treatment strategies. But why do 47% of patients treated in private addiction treatment programs (for example) relapse within the first year following treatment (Gorski, T., 2001)? Have addiction specialists become conditioned to accept failure as the norm? There are many reasons for this poor prognosis. Some would proclaim that addictions are psychosomatically- induced and maintained in a semi-balanced force field of driving and restraining multidimensional forces. Others would say that failures are due simply to a lack of self-motivation or will power. Most would agree that lifestyle behavioral addictions are serious health risks that deserve our attention, but could it possibly be that patients with multiple addictions are being under diagnosed (with a single dependence) simply due to a lack of diagnostic tools and resources that are incapable of resolving the complexity of assessing and treating a patient with multiple addictions?
Diagnostic Delineation
Thus far, the DSM-IV-TR has not delineated a diagnosis for the complexity of multiple behavioral and substance addictions. It has reserved the Poly-substance Dependence diagnosis for a person who is repeatedly using at least three groups of substances during the same 12-month period, but the criteria for this diagnosis do not involve any behavioral addiction symptoms. In the Psychological Factors Affecting Medical Condition s section (DSM-IV-TR, 2000); maladaptive health behaviors (e.g., unsafe sexual practices, excessive alcohol, drug use, and over eating, etc.) may be listed on Axis I, only if they are significantly affecting the course of treatment of a medical or mental condition. Since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning, it is no wonder that repeated rehabilitation failures and low success rates are the norm instead of the exception in the addictions field, when the latest DSM-IV-TR does not even include a diagnosis for multiple addictive behavioral disorders. Treatment clinics need to have a treatment planning system and referral network that is equipped to thoroughly assess multiple addictive and mental health disorders and related treatment needs and comprehensively provide education/ awareness, prevention strategy groups, and/ or specific addictions treatment services for individuals diagnosed with multiple addictions. Written treatment goals and objectives should be specified for each separate addiction and dimension of an individuals life, and the desired performance outcome or completion criteria should be specifically stated, behaviorally based (a visible activity), and measurable.
New Proposed Diagnosis
To assist in resolving the limited DSM-IV-TRs diagnostic capability, a multidimensional diagnosis of Poly-behavioral Addiction, is proposed for more accurate diagnosis leading to more effective treatment planning. This diagnosis encompasses the broadest category of addictive disorders that would include an individual manifesting a combination of substance abuse addictions, and other obsessively-compulsive behavioral addictive behavioral patterns to pathological gambling, religion, and/ or sex / pornography, etc.). Behavioral addictions are just as damaging – psychologically and socially as alcohol and drug abuse. They are comparative to other life-style diseases such as diabetes, hypertension, and heart disease in their behavioral manifestations, their etiologies, and their resistance to treatments. They are progressive disorders that involve obsessive thinking and compulsive behaviors. They are also characterized by a preoccupation with a continuous or periodic loss of control, and continuous irrational behavior in spite of adverse consequences.
Poly-behavioral addiction would be described as a state of periodic or chronic physical, mental, emotional, cultural, sexual and/ or spiritual/ religious intoxication. These various types of intoxication are produced by repeated obsessive thoughts and compulsive practices involved in pathological relationships to any mood-altering substance, person, organization, belief system, and/ or activity. The individual has an overpowering desire, need or compulsion with the presence of a tendency to intensify their adherence to these practices, and evidence of phenomena of tolerance, abstinence and withdrawal, in which there is always physical and/ or psychic dependence on the effects of this pathological relationship. In addition, there is a 12 – month period in which an individual is pathologically involved with three or more behavioral and/ or substance use addictions simultaneously, but the criteria are not met for dependence for any one addiction in particular (Slobodzien, J., 2005). In essence, Poly-behavioral addiction is the synergistically integrated chronic dependence on multiple physiologically addictive substances and behaviors (e.g., using/ abusing substances – nicotine, alcohol, & drugs, and/or acting impulsively or obsessively compulsive in regards to gambling, food binging, sex, and/ or religion, etc.) simultaneously.
Multidimensional Treatment
Since chronic lifestyle diseases and disorders such as diabetes, hypertension, alcoholism, drug and behavioral addictions cannot be cured, but only managed – how should we effectively manage poly-behavioral addiction?
The Addiction Recovery Measurement System (ARMS) is proposed utilizing a multidimensional integrative assessment, treatment planning, treatment progress, and treatment outcome measurement tracking system that facilitates rapid and accurate recognition and evaluation of an individual s comprehensive life-functioning progress dimensions. The ARMS hypothesis purports that there is a multidimensional synergistically negative resistance that individual s develop to any one form of treatment to a single dimension of their lives, because the effects of an individual ‘s addiction have dynamically interacted multi-dimensionally. Having the primary focus on one dimension is insufficient. Traditionally, addiction treatment programs have failed to accommodate for the multidimensional synergistically negative effects of an individual having multiple addictions, (e.g. nicotine, alcohol, and obesity, etc.). Behavioral addictions interact negatively with each other and with strategies to improve overall functioning. They tend to encourage the use of tobacco, alcohol and other drugs, help increase violence, decrease functional capacity, and promote social isolation. Most treatment theories today involve assessing other dimensions to identify dual diagnosis or co-morbidity diagnoses, or to assess contributing factors that may play a role in the individual s primary addiction. The ARMS theory proclaims that a multidimensional treatment plan must be devised addressing the possible multiple addictions identified for each one of an individual s life dimensions in addition to developing specific goals and objectives for each dimension.
Conclusion
This article was not written with the intent to demonize or glorify the most widely used illicit and top US cash crop (U.S. growers produce nearly $35 billion worth of marijuana annually, making the illegal drug the country’s largest cash crop, bigger than corn and wheat combined, an advocate of medical marijuana use said in a study released on 18 Dec. 06, WASHINGTON), Reuters. Nor was it written to advocate the use or non-use of marijuana whether legally for medicinal purposes or illegally.
There are numerous articles readily available that already accomplish that mission. It is my hope though, that the 10 to 15 percent of individuals that have multiple complex problems involving marijuana usage will find the help that they need. Considering the wide range of addictive behaviors in our world today, one should always take into account an individual s ethnic, cultural, religious, and social background prior to making any clinical judgments, and it would be wise to not over-pathologize in this area. However, since successful treatment outcomes are dependent on thorough assessments, accurate diagnoses, and comprehensive individualized treatment planning – Poly-behavioral Addiction needs to be identified to effectively treat the complexity of multiple behavioral and substance addictions.
Sources:
National Institute on Drug Abuse, Marijuana Facts Parents Need to Know, September 2004, What is Marijuana, How is Marijuana Used?
Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings, September 2006
Substance Abuse and Mental Health Service Administration, Initiation of Marijuana Use: Trends, Patterns and Implications, July 2002.
National Institute on Drug Abuse and University of Michigan, Monitoring the Future 2005 Data From In-School Surveys of 8th-, 10th-, and 12th-Grade Students, December 2005
Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance United States, 2005, June 2006
National Institute on Drug Abuse and University of Michigan, Monitoring the Future National Survey Results on Drug Use, 1975 2005, Volume II: College Students & Adults Ages 19 45 (PDF), 2006
Bureau of Justice Statistics, Drug Use and Dependence, State and
Federal Prisoners, 2004, October 2006
National Institute on Drug Abuse, InfoFacts: Marijuana, April 2006
National Institute on Drug Abuse, Research Report Series Marijuana Abuse, October 2001.
Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits, April 2006
Substance Abuse and Mental Health Services Administration, Mortality Data from the Drug Abuse Warning Network, 2001 (PDF), January 2003.
Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Highlights 2004 (PDF), February 2006
Federal Bureau of Investigation, Crime in the United States, 2005, September 2006
National Drug Intelligence Center, National Drug Threat Assessment 2007, October 2006
Bureau of Justice Statistics, Drug Use and Dependence, State and Federal Prisoners, 2004, October 2006
United States Sentencing Commission, 2005 Sourcebook of Federal Sentencing Statistics, June 2006
National Drug Intelligence Center, National Drug Threat Assessment 2007
James Slobodzien, Psy.D. CSAC, is a Hawaii licensed psychologist and certified substance abuse counselor who earned his doctorate in Clinical Psychology. The National Registry of Health Service Providers in Psychology credentials Dr. Slobodzien. He has over 20-years of mental health experience primarily working in the fields of alcohol/ substance abuse and behavioral addictions in medical, correctional, and judicial settings. He is an adjunct professor of Psychology and also maintains a private practice as a mental health consultant.

A large multi-cohort analysis has investigated factors affecting long-term response to potent antiretroviral therapy. Four to six years after starting anti-HIV treatment, higher rates of AIDS and mortality were seen in injection drug users and in those who had had AIDS-defining events or CD4 cell counts less than 25 cells/mm3 before starting therapy. The study, conducted by the Antiretroviral Therapy Cohort Collaboration, was published in the December 15th issue of the Journal of Acquired Immune Deficiency Syndromes.

Previous studies have found that rates of AIDS-related illness and death are higher in people who begin antiretroviral therapy with lower CD4 cell counts. Poorer response has also been found in injection drug users (IDUs) compared to other patients. However, most studies to date have looked at response over relatively short time periods. In this study, the Antiretroviral Therapy Cohort Collaboration (an international alliance of investigators from sixteen cohort studies of people with HIV – see www.art-cohort-collaboration.org) analysed data from 20,379 HIV-positive adults who had been on anti-HIV drugs for up to six years.

Participating cohorts were included if they had enrolled at least 100 treatment-naïve patients, 16 years of age or older, who had begun treatment with a combination of at least three antiretroviral agents. People with baseline viral loads less than 1000 copies/ml were excluded as possibly not treatment-naïve. This yielded a total of 20,379 patients from twelve European and North American cohorts. (A prognostic model based on this same data set was recently published – see the aidsmap report here)

Baseline characteristics were as follows: median age, 36; median CD4 cell count 224 cells/mm3; median month of therapy initiation, February 1999. Before treatment initiation, 2737 patients (23%) had already had a diagnosis of AIDS; 3231 (16%) were presumed infected due to IDU.

Of the initial regimens, 66% were NRTI/PI, 24% NRTI/NNRTI, 7% NRTI only, 2% triple-class; and 2% other (NRTI-sparing, or including T-20). The majority of participants (88%) began on a three-drug regimen.

Over a total of 61,798 person-years of follow-up, 1844 participants developed at least one AIDS-defining event, and 1005 died. AIDS-defining events and deaths were analysed by: baseline CD4 cell count (<25, 25 to 49, 50 to 99, 100 to 199, 200 to 349, and >350 cells/mm3), baseline viral load (<100,000 or ≥100,000 copies/ml), presumed mode of transmission (IDU or other), and AIDS diagnosis before baseline (yes or no).

Consistent with previous studies, lower baseline CD4 cell counts were consistently the strongest predictor of poorer outcomes. The effect was strongest for the lowest baseline counts, and tended to decline with length of time on therapy for all strata of CD4 count.

Beginning therapy at a baseline CD4 cell count between 200 and 349 continued to show a benefit until the four-year mark. Compared to those beginning at >350 cells/mm3 (the comparator group), the hazard ratio for progression to AIDS at one to two years on therapy was 1.5 (95% confidence interval [CI]: 1.0 to 2.3), 1.4 at two to three years (95% CI: 1.0 to 2.1), and 1.0 at four to six years (95% CI: 0.6 to 2.0). For each time period, hazard ratios were progressively higher for each lower CD4 stratum. For baseline CD4 counts <25 cells/ mm3, the hazard ratio for developing AIDS was 3.7 at one to two years (95% CI: 2.2 to 6.1), 2.4 at two to four years (95% CI: 1.5 to 3.8), and 2.3 at four to six years (95% CI: 1.0 to 2.3). At four to six years, the hazard ratio for mortality was 2.5 (95% CI: 1.2 to 5.5) for baseline CD4 counts <25 cells/ mm3.

For people presumed infected through IDU, at four to six years on HAART, the hazard ratio for AIDS was 1.6 (95% CI: 0.8 to 3.0) and the hazard ratio for mortality was higher at 3.5 (95% CI: 2.2 to 5.5). Note that cause of death was not analysed and was not necessarily directly due to HIV; mortalities due to hepatitis-related liver disease, overdose, trauma and other causes were not excluded. Mortality rates were still lower than would be expected in the absence of anti-HIV therapy.

Diagnosis of AIDS before the initiation of anti-HIV treatment also continued to predict AIDS-defining events at four to six years, with a hazard ratio of 2.3 (95% CI: 1.2 to 4.4); the predictive value for mortality ceased to be significant. HIV viral load (greater than, or less than, 100,000 copies/ml) was not a significant predictor of progression or death at any time point.

The study was limited by declining numbers of patients in follow-up after longer periods on antiretroviral treatment. At the end of the fourth year of anti-HIV therapy, 6838 participants were still being followed (23% of the original cohort); only 791 (4%) were followed for more than six years. As most original patients were still being followed up at the time of analysis, the researchers "do not believe that informative censoring is likely to be an important source of bias." However, results may have been confounded by socioeconomic and other factors which caused people to begin treatment late in the course of HIV progression. Larger hazard ratios for mortality than for development of AIDS were seen in several groups, which may be evidence of such confounding. Also, race and ethnicity were not included in the analysis due to lack of sufficient data.

The researchers concluded that "rates of AIDS and death were persistently higher in patients infected [through injection drug use]", and that "although the prognostic value of baseline CD4 count and a prior AIDS diagnosis declined with time, patients who were severely immunodeficient when they started therapy experienced higher rates of AIDS and death up to 6 years later." They believe these results may "strengthen the case for screening for HIV, because delaying treatment… has long-term disadvantages."

Reference
Antiretroviral Therapy Cohort Collaboration. Importance of baseline prognostic factors with increasing time since initiation of highly active antiretroviral therapy: collaborative analysis of cohorts of HIV-1–infected patients. J Acquir Immune Defic Syndr 46 (5):607-615, 2007.

Source: Wednesday, January 2, 2008

http://www.aidsmap.com/en/news/8ACEB690-26EB-4583-BF14-A4353CE335EC.asp

Bertha K. Madras, Ph.D., Deputy Director, Demand Reduction, Office of National Drug Control Policy

This is the second in a series of articles on how specific drugs affect the brain and body.

The brain drain
Myths that downplay the risks associated with drug use permeate youth culture and are embraced to rationalize experimentation with addictive drugs. Scientific evidence can help educators and parents de-bunk these dangerous myths.
Adolescents and young adults are the principal age groups using addictive drugs and are at the greatest risk for experiencing adverse consequences as a result of the early introduction of drugs into their brains. Early drug use can compromise academic achievement, school attendance, homework, participation in extracurricular activities, and school behavior. Drug use at a young age is also associated with addiction, violence, accidents, delinquency, criminal activity, and even death. As with any major public health problem, the inability to predict which young people will suffer detrimental, potentially life-threatening consequences from drug use is itself a reason to engage in widespread prevention efforts.
The brain has approximately one hundred billion nerve cells, with each cell producing 10,000 or more “wires” that connect with other cells. A critical component of brain development is accurate “wiring.” Imaging technologies that compare adolescent brains with those of adults have shown that the “wiring” of the adolescent brain is still immature, compared to the adult brain. Exposure to drugs before brain maturation may affect brain development, interfering with the wiring and circuitry of the brain in much the same way as a computer technician can damage a circuit board by zapping it with electrical jolts during the assembly process.
In the short term, a single dose of a drug can result in poor performance in a school or sports activity, accidents, violence, unplanned risky behavior, and the risk of overdosing. It can trigger repeated drug use, which is associated with serious health consequences, loss of desire to fulfill obligations, truancy, disorderly conduct, and social or family problems. Repeated drug use can also lead to addiction. Studies show that the earlier an adolescent begins using drugs, the more likely he or she will be to develop a substance abuse problem or become addicted to substances. Conversely, if an individual does not start using drugs during the teen years, he or she is less likely to initiate or develop a substance abuse problem later in life.
Statistics make a compelling case for focusing on preventing youth drug use. In 2006, among persons with substance dependence or abuse, the percentage dependent on or abusing illicit drugs was much higher in the 12-17 age group (57.4 percent) than among 18- to 25-year-olds (36.9 percent) or adults age 26 or older (24.1 percent), according to the 2007 National Survey on Drug Use and Health (NSDUH). One hundred eighty-one thousand youth (12-17 year-olds) received treatment for alcohol or illicit drugs (NSDUH 2007). Although prevention is a key to interrupting the progression to addiction, deterring marijuana use and prescription-drug misuse is particularly challenging because of the myths associated with these drugs.
Myth No. 1: Marijuana is a ‘soft’ drug
Marijuana use should not be considered a rite of passage. It is neither a “soft” drug nor a safe drug. The effects of marijuana can last up to 24 hours after administration, continuing to compromise reflexes, cognitive ability, and other brain functions. Driving while under the influence of marijuana is dangerous, as the use of this drug can impair motor function, concentration, and perception, thereby increasing the likelihood of road accidents. According to the 2006 Monitoring the Future study, the percentage of high school students who reported driving under the influence of marijuana (10.6 percent) was nearly as high as the percentage of those driving under the influence of alcohol (12.4 percent).
Accumulating evidence makes a forceful case for abstention from marijuana use. One study found that high school students who abstained from marijuana functioned better than occasional or frequent users during high school and during the transition to adulthood. During high school, abstainers fared better than experimenters and frequent users of marijuana on the basis of school engagement, deviant behavior, family and peer relations, and mental health. They were more likely to do homework and get better grades. When they turned 23, abstainers were twice as likely to graduate from college and much less likely to steal or to sell illicit drugs.
A long-term analysis of marijuana potency funded by the National Institute on Drug Abuse (NIDA) reveals that the strength of marijuana has increased substantially over the past two decades. Today, marijuana is more potent than ever before, and this elevated potency may be leading to an increase in teen marijuana treatment admissions and a rise in the number of marijuana-related emergency room episodes.

These worrisome results add to the growing body of evidence that the effects of youth marijuana use may endure into adulthood. Adolescents who used marijuana are twice as likely to use illicit drugs when they become young adults. In fact, in one study, individuals of twin pairs who used marijuana by age 17 had 2.1 to 5.2 times higher risk of other drug use (cocaine, heroin), alcohol dependence, and drug abuse/dependence than their co-twin who did not use before the age of 17.
Experiments with animals seem to corroborate these findings. Animals, which were not subject to environmental stressors, were exposed to the active ingredient of marijuana during adolescence. They were given a drug-free period and then, as adults, were given access to heroin. After maturation into adulthood, the early-exposed animals consumed higher amounts of heroin and showed greater heroin-seeking behavior than the non-exposed group. The effects of early exposure to marijuana were not restricted to behavior: components of the system in the brain that modulates pain and pleasure were changed in the animals’ adult brains, after exposure during adolescence.
Collectively, these findings suggest that marijuana, introduced during adolescence, may influence the biology of the brain, promote drug-seeking behavior, and affect social function during the transition to adulthood.
How addictive is marijuana, and how realistic is the perception that it is a “soft” drug? The 2007 NSDUH reported that in 2006, among adults aged 18 or older who first tried marijuana at age 14 or younger, 12.9 percent were classified with illicit drug dependence or abuse, a considerably higher number than the percentage (2.2 percent) who had first used marijuana at age 18 or older. Marijuana also ranked first as the most reported illicit drug resulting in abuse/dependence.
Early, frequent use of marijuana may be an independent risk factor for psychosis—even if use precedes the onset of schizophrenia or another form of psychosis. Marijuana may induce acute psychotic symptoms in vulnerable people and a persistent psychosis in some individuals who have not had prior signs of psychosis. Marijuana may also exacerbate psychosis in people with symptoms of schizophrenia, and these effects can persist after the drug is cleared from the body.
As with other addictive drugs, heavy marijuana use has many health and social consequences. Heavy marijuana use into adulthood creates an expanding set of health risks, including exercise-induced heart pain and reduced lung function, as well as objective and self-reports of adverse social consequences. During pregnancy, heavy marijuana use can lead to impaired fetal growth and development.
Myth No. 2: Prescription drugs used for psychoactive effects are safer than “street drugs”
Several classes of controlled prescription drugs—medications prescribed by doctors for legitimate medical purposes—have abuse and addiction potential. These include opioids prescribed for the management of pain, drugs to treat attentional problems and anxiety, and drugs to promote sleep. These drugs are safe and effective when used according to doctors’ prescriptions and advice. Abuse or non-medical use of prescription drugs is the use of drugs not prescribed for the individual, use of drugs solely for the experience or feelings they cause, or use of drugs for which the intended person has made false or inaccurate claims to obtain them.
A disturbing trend emerged last year, when NSDUH reported that first-time non-medical users of prescription drugs now equal first time users of marijuana and that misuse of prescription drugs among 12- and 13-year-olds exceeds marijuana use. The misuse of opioid pain killers is of particular concern because of the large number of users, the high addictive potential, and the potential to induce overdose or death.
Also of concern is that approximately 598,542 visits to emergency departments during 2005 involved the non-medical use of prescription drugs or over-the-counter medication or dietary supplements, with the majority involving multiple drugs (Drug Abuse Warning Network, 2005).
There are many factors contributing to the increased misuse of prescription drugs. There is a perception among young people that prescription drugs are safer than illicit street drugs. Moreover, many teens are not aware of the consequences of prescription drug misuse. Prescription drugs are also more easily attainable from friends and family.
There are indications that long-term misuse of pain medications can lead to addiction, and that intravenous use of this class of drugs places a person at increased risk of HIV and other infectious diseases. Additionally, because many of the prescription drugs that are abused share similarities with illicit drugs in the way they act on the brain, it is probable that some of the harmful consequences will be the same.
It is important for adults to recognize this growing problem and to help young people understand the risks of using prescription drugs non-medically. When used properly, under the supervision of a doctor, prescription drugs can be safe and effective. Used improperly, however, they can have serious consequences.
Preventing initiation and identifying problem use
Using marijuana or misusing prescription drugs in any amount is not safe. Scientists, educators, counselors, community coalitions, prevention experts, and others are working to expose dangerous drug myths and to increase awareness of the adverse physical, mental, emotional, and behavioral changes that can be associated with these substances. Testing students for drug use may help prevent initiation and identify drug users at an early stage, before a dependency sets in, thereby protecting adolescents and their fragile brains from the harmful effects of drug-using behavior.
A complete list of citations for this article is available at www.randomstudentdrugtesting.org

Source: Strategies for Success, Isssue 2 Vol.1 Fall 2007

In this national fellowship report, project directors from the first 10 Reclaiming Futures sites share the lessons they learned in creating and implementing a model for helping teens in trouble overcome drugs, alcohol and crime.

The directors offer specific steps for planning and instigating the changes, provide real-life examples from diverse communities across the nation, and provide a road map for communities to adopt the six-step model all at once or one step at a time.

The report recommends screening each teen for drug and alcohol problems, assessing the severity of his/her drug and alcohol use, providing prompt access to a treatment plan coordinated by a service team; and connecting the teen with employers, mentors, and volunteer service projects.

The report describes how judges, probation officers, treatment specialists, families and community members can take steps right now to improve the future of these youth.

Upon completion of a brief survey, the full report is available as a PDF to download at no cost.

http://www.reclaimingfutures.org/?q=judicial_report_survey&reportname=ProjectDirectors

Publication Year: 2007

Publisher

Reclaiming Futures
Portland State University
527 SW Hall, Suite 400
Portland, or 97201
Phone: 503.725.8911
Website: http://www.reclaimingfutures.org

Infections among injecting drug users

Key Messages
1. Needle and syringe sharing has declined in recent years, however with around a quarter of injecting drug users continuing to share the level remains higher than in the mid-1990s.

2. Injecting into the groin and the injection of crack cocaine, which are associated with higher levels of
infection and risky injecting, have become more common.

3. Injecting site infections are common, with around one third of injecting drug users reporting having had an
abscess, sore or open wound at an injecting site in the last year.

4. Transmission of HIV and HCV infection through injecting drug use remains higher than in the late 1990s, with a fifth of recent initiates having hepatitis C and around one in 100 having HIV. Overall almost half of injecting drug users are now infected with hepatitis C and about one in 90 with HIV.

5. There has been a marked increase in the number of injecting drug users receiving the hepatitis B vaccine,
with two-thirds now reporting vaccination.

6. Services to reduce injecting related harms and support for those who want to stop injecting should continue to be developed in line with published guidance.

Key Findings
Behaviours: Levels of reported needle and syringe (direct) sharing have declined in recent years, following an increase in the late 1990s. In 2007, around a quarter of injecting drug users (IDUs) reported direct sharing in the previous month; this level remains higher than in the mid-1990s when about a sixth reported this. The sharing of other injecting equipment remains even more common. There are also indications that
two other factors associated with a greater risk of infection have become more common, with almost one in three IDUs now reporting injecting into the groin (femoral vein) and athird reporting the injection of crack-cocaine.

Hepatitis C: Overall, almost half of IDUs in the UK have been infected with hepatitis C. However, there are marked variations in hepatitis C prevalence within the UK, with low prevalences found in some areas. The overall prevalence of hepatitis C infection among IDUs has probably increased in recent years. Current levels of hepatitis C transmission remain higher than in the late 1990s with a fifth of IDUs becoming
infected within three years of starting to inject.

HIV: The incidence of HIV among IDUs is higher than in the late 1990s with around one in 100 now becoming infected within three years of starting to inject. The overall prevalence of HIV infection among IDUs however remains low compared to many other countries. In England & Wales, the overall HIV
prevalence among IDUs is currently around one in 90. Within England and Wales prevalence has increased amongst IDUs outside London: where it has risen from around one in 400 in 2002 to about one in 150 in 2007. However, the prevalence is higher in London, with around one in 20 HIVinfected. In Scotland, the prevalence of HIV among IDUs was around one in 350 in 2007, which is the lowest level reported
since this was first measured in 1989.

Voluntary confidential diagnostic testing: Uptake of testing for hepatitis C among IDUs in contact with drug services, after increasing markedly, now appears to be levelling off with around three-quarters having ever had a test. It is estimated that around half of IDUs with hepatitis C in contact with these services remain unaware of their infection, and that this proportion has not changed in recent years. There are also likely to be many current and former IDUs not in contact with services that will be unaware they have hepatitis C. Whilst most IDUs in contact with services report having had a test for HIV at some point, only two thirds
of those with HIV are aware of their infection.

Vaccination: The proportion of IDUs reporting uptake of hepatitis B vaccination has increased in recent years, with around two-thirds now reporting accepting at least one vaccine dose. However, the transmission of hepatitis B continues among IDUs.

Bacterial infections: Injecting site infections, which may cost the NHS as much as £47 million per annum, remain common with around one-third of IDUs reporting having had an abscess, sore or open wound at an injecting site in the last year. There are continuing problems ranging from localised injection site infection through to invasive disease associated with meticillin resistant Staphylococcus aureus and severegroup A streptococcal infection. The ongoing occurrence of wound botulism and tetanus cases also remains a concern.

One of many reasons that attendance at Alcoholics Anonymous (AA) meetings helps people with alcohol use disorders stay sober appears to be alleviation of depression. A team of researchers has found that study participants who attended AA meetings more frequently had fewer symptoms of depression – along with less drinking – than did those with less AA participation. The report will appear in the journal Addiction and has been release online.

“Our study is one of the first to examine the mechanisms underlying behavioral change with AA and to find that AA attendance alleviates depression symptoms,” says study leader John F. Kelly, PhD, associate director of the Massachusetts General Hospital (MGH) Center for Addiction Medicine. “Perhaps the social aspects of AA helps people feel better psychologically and emotionally as well as stop drinking.”

The authors note that problems with mood regulation such as depression are common among people with alcohol problems – both preceding and being exacerbated by alcohol use. Although AA does not explicitly address depression, the program’s 12 steps and social fellowship are designed to support participants’ sense of well being. While mood problems often improve after several weeks of abstinence, that process may happen more quickly in AA participants. The current study was designed to investigate whether decreasing depression and enhancing psychological well-being help explain AA’s positive effects.

The researchers analyzed data from Project MATCH, a federally funded trial comparing three treatment approaches for alcohol use disorder in more than 1,700 participants. While participants in that study were randomly assigned to a specific treatment plan, all were able to attend AA meetings as well. Among the data gathered at several points during Project MATCH’s 15-month study period were participants’ alcohol consumption, the number of AA meetings attended, and recent symptoms of depression.

At the beginning of the study period, participants reported greater symptoms of depression than would be seen in the general public, which is typical among alcohol-dependent individuals. As the study proceeded, those participants who attended more AA meetings had significantly greater reductions in their depression symptoms, along with less frequent and less intensive drinking.

“Some critics of AA have claimed that the organization’s emphasis on ‘powerlessness’ against alcohol use and the need to work on ‘character defects’ cultivates a pessimistic world view, but this suggests the opposite is true,” Kelly says. “AA is a complex social organization with many mechanisms of action that probably differ for different people and change over time. Most treatment programs refer patients to AA or similar 12-step groups, and now clinicians can tell patients that, along with supporting abstinence, attending meetings can help improve their mood. Who wouldn’t want that?”

Source:http://www.medicalnewstoday.com/articles/177607.php

“Drug [including alcohol] addictions are medical diseases which deserve parity in national healthcare programmes…” states scientist and professor Carlton Erickson, as he reveals the neurobiological research.
Although this article was first printed in Addiction Today journal in 2002, the vast majority of alcohol and drug workers remain unaware of these vital facts. Read on…
Public and professional stigma against addictive diseases is a major social problem when dealing with conditions which have traditionally been dealt with by behavioural and spiritually-based programmes. Reducing this stigma is critical, as negative attitudes damage the level and quality of patient care – and funding for prevention, education and research.
For far too many years, the “field” of drug addiction treatment and prevention has drifted aimlessly, based on insufficient research evidence that addictions are brain diseases and about the pharmacology of addicting drugs. Much of the confusion is based on an incomplete understanding of the differences between intentional drug abuse and pathological drug dependence, the “new term for addiction”.
There is also a great deal of misinformation about the pharmacology of addicting drugs. This picture is changing rapidly, based on new neuroscience (brain) research which strongly indicates that the pleasure pathway – the medial forebrain bundle – of the brain is affected by all addictions, particularly in the pharmacological qualities of euphoria, craving and a theoretical concept of “drug need”.
This is the psychological correlate of behavioural “impaired control”. The neuroanatomical and neurochemical bases of drug need have yet to be demonstrated in the laboratory. But the research technology, such as brain scans, is now at hand to test the theories.
Everyone who cares about the victims of addiction must become more scientifically literate about the implications of new research findings, and ‘spread the news’ that biomedical research is on the threshold of proving what recovering people already know – that drug dependencies are medical diseases which deserve parity in present and future national healthcare programmes. Drug dependence must also be ‘handled’ differently from drug abuse in terms of responsibility and culpability in law enforcement.
This article covers the latest research on the neurobiology of dependence, including how the brain’s pleasure pathway works. It covers the differences between chemical abuse and chemical dependency, the latest therapies for drug dependency, and research methodologies which promise even more exciting breakthroughs in understanding “addictions” in the future. This information has important implications for prevention and education of the public about the true causes of drug problems, and how society can best deal with such problems.

SOLUTIONS
The solution. First, get rid of “Spam”: an acronym for stigma, prejudice, anger and misunderstanding. All of these lead to myths – widely-held, inaccurate beliefs – as compared to research-generated facts.
And there are some dangerous myths in this world. These include the myths that club drugs and marijuana are not addicting… that everyone who uses cocaine or heroin is addicted… that caffeine is highly addicting… that the form of a drug and how it is taken affects its “addiction potential”… and that alcoholics can stop drinking, since all they have to do is go to AA meetings.

TWO CRITICAL DEFINITIONS.

It is vital that professionals carry out assessments to distinguish between chemical abuse and dependence. As the cover story by Norman Hoffman in the last issue of Addiction Today emphasises, assessment directly affects what type of treatment is most effective for each client, and thus their care plan, choice of treatment unit and outcome results. To distinguish between the two is the most humane, most cost-effective and most professional course of action.
Chemical abuse is intentional overuse of substances in cases of celebration, anxiety, despair or ignorance. It is about people making bad choices about the use of drugs. It declines with adverse consequences, supply reduction or change in drug-use environment. Drug abusers have a major economic impact on society; for example, it is estimated that property theft to fund drug habits accounts for at least £2billion a year in the UK.
The criteria for chemical abuse, according to the DSM-IV diagnostic and statistical manual, are:
1) a maladaptive pattern of drug use leading to impairment or distress, presenting as one or more of the following over a 12-month period –
• recurrent use leading to failure to fulfill obligations
• recurrent use that is physically hazardous
• recurrent drug-related legal problems, and
• continued use despite social/interpersonal problems
2) the symptoms have never met the criteria for chemical dependence.
Dependence is “impaired control” over drug use, probably caused by a dysfunction in the brain’s pleasure pathway. This is the disease of addiction, an “I can’t stop without help” disease. It requires formal therapy and/or 12 steps and might require anti-craving drug therapy. The DSM-IV criteria for chemical dependence are:
1) a maladaptive pattern of drug use, leading to impairment or distress, presenting as three or more of the following over a 12-month period –
• tolerance to the drug’s actions
• withdrawal (generally, physical withdrawal)
• drug is used more than intended
• there is an inability to control drug use
• effort is expended to obtain the drug
• important activities are replaced by drug use, and
• drug use continues despite negative consequences
2) two types of dependence can occur –
• physiological dependence, including tolerance and withdrawal, and
• non-physiological dependence, excluding tolerance and withdrawal.
The terms “physical addiction” and “psychological addiction” are no longer valid, since the DSM-IV term includes both psychological and physical components.

DOES DRUG ABUSE LEAD TO DEPENDENCE?
A five-year follow-up of 1,300 men and women (Schuckit et al 2001) found that only 3% of abusers met criteria for dependence five years after being diagnosed as abusers. But many people believe that abuse usually leads to dependence. Instead, the two conditions appear to be separate; abuse may be a milder disorder not usually progressing to dependence.

RISK OF DEPENDENCE.
Data from the National Co-morbidity Survey of 8,100 men and women aged 15-24 years old (Wagner & Anthony 2002) showed that different drugs are associated with different rates of dependence. In the 10 year study, 15-16% of cocaine users become dependent, 12-13%of alcohol users and 8% of marijuana users. Of those who became dependent on cocaine, 5-6% became dependent in the first year of use. Fully 80% of people who became dependent on cocaine over the 10 years had become dependent in the first three years. These are only single studies which deserve more replication, but they are interesting in that they begin to break down some myths that people have about the onset of dependence in users and abusers.

EARLY vs LATE ONSET.
So, although it “looks” as if most people evolve from abuse to dependence, people can become dependent during their first year of using drugs, including alcohol. People in recovery seem to understand that some people become “instantly” dependent with the very first use of the drug; most reports concern early onset with the use of alcohol and cocaine. There is only one explanation, and it lies in the physiology of the medial forebrain bundle, or MFB, also known as the mesolimbic dopamine system.
The neurobiological model of “impaired control” characteristics.
A key point is that the “dependence” brain areas are in the part of the brain that governs unconscious thought. Dependence is not a “lack of will power” because
• the main problem with dependence lies in the MFB
• problems with the frontal cortex portion of the MFB produce a pathological impairment of decision-making.
Dependence is not mainly under conscious control.

BASIC NEUROBIOLOGY: NEUROTRANSMITTERS INVOLVED IN DEPENDENCE.

Dependence is probably due to a functional dysregulation – meaning: they aren’t working right! – of one or more neurotransmitter chemicals in the MFB. These include dopamine (which is affected by cocaine, amphetamines or alcohol), serotonin (alcohol or LSD), endorphins (alcohol or opioids such as heroin), gamma-aminobutyric acid (alcohol or benzodiazepines – antianxiety agents), glutamate (alcohol) and acetylcholine (nicotine or alcohol).
The dysregulation could be related to too much or too little neurotransmission, abnormal breakdown of neurotransmitters or abnormal receptor function. How does it come about? Is it due to genetic ‘malfunctions’, to drug-induced changes, or to other aspects of the environment? Neurobiological research points to genetics and drug-induced changes as being primary causes of dependence, whereas the environment is a major, though secondary, contributor to drug abuse and thus dependence.

THE RATIONALE BASED ON GENETICS.Abnormal genes lead to abnormal proteins. This results in abnormal transmitter-synthesising enzymes, abnormal transmitter-breakdown enzymes, or abnormal receptors. This is the cause of neurotransmitter dysregulation in the pleasure pathway. Impaired control appears to be due to this brain-chemistry disruption. It is the reason that scientists and clinicians now believe that dependence is a chronic medical brain disease.

SUMMARY.
Addicting drugs seem to ‘match’ the transmitter system that is not normal. To treat such individuals, detoxification – weaning people off the drug of choice – is the first step. Then, ideally, abstinence-based treatments are attempted, which traditionally have the greatest chance of success. But abstinence is not for everyone, so more treatment choices are becoming available through scientific research. For some, continued use of a similar drug (such as methadone for heroin- dependent people) or the initial drug (nicotine patches for people who stop smoking) is the choice, because some people report that they “need” a chemical to “feel normal” – in other words, to overcome the non-normal transmitter system.

TODAY’S TREATMENT OPTIONS.
More options create greater chances for helping people. Today’s options include some or all of the following:
• traditional – 12-step programmes/abstinence
• talk – inpatient/outpatient/aftercare
• misunderstood but useful – harm reduction, including methadone
• new – brief motivational counselling, cognitive behavioural therapy, motivational enhancement therapy, ‘significant others’ therapy, vouchers
• medical treatment – new medications to enhance abstinence, anticraving medications, methadone, buprenorphine, vaccines, drugs to alleviate withdrawal.
So, if addictions are a medical disease, why do we treat them behaviourally? What is the similarity between behavioural or talk therapies and pharmacotherapies in the way they work? Simple. Behavioural therapies probably change brain chemistry! If this is a brain disease, and people get better in behaviourally-based therapies, then brain chemistry has to change. Recent brain-scan research is confirming this rational conclusion.

DISRUPTING NERVE CELLS: EXPLANATION.

The basis of chemical dependence is dysregulation of nerve cell transmission – (see picture on the right) and there is an excellent description of this on the author’s university website here. Also, most drugs used to treat mental disorders, including chemical dependence, have their most basic action on individual nerve cells
Carlton Erickson PhD is a research scientist who has been studying the effects of alcohol on the brain for over 30 years. He is the Pfizer Centennial Professor of Pharmacology and director of the Addiction Science Research and Education Center, College of Pharmacy, University of Texas. He has published over 150 scientific and professional articles, has co-edited and co-authored books and is associate editor of the scientific journal Alcoholism: Clinical and Experimental Research. He is also a recipient of the Betty Ford Center Visionary Award 2000. He has spoken to about 70,000 professionals and people in recovery since 1978 and presents every two years at the UK/European Symposium on Addictive Disorders.
Source : www.addictiontoday.org. Sept. 17th 2008

From the founding of National Families in Action during the height of the War on Drugs to Joseph A. Califano’s book, How to Raise a Drug-Free Kid, parents and communities have been touted as the keys to preventing alcohol and other drug problems among youth, and research now shows that environmental and genetic risk factors can be trumped by parental engagement during the critical adolescent years, according to Nora D. Volkow, M.D., director of the National Institute on Drug Abuse (NIDA).
“Parents are incredibly important in raising drug-free kids, but in many instances they are not there or are not involved” — absences that can have measurable effects on brain development as well as other aspects of growing up — said Volkow. For example, studies of orphans have demonstrated that the brains of children who lack connections to parents actually mature more slowly, raising the risk of drug use and other impulsive behaviors. Half of all vulnerability to addiction can be traced to an individual’s genetic background, but that hardly means that a child’s fate is sealed if they have a family history of addiction. Rather, Volkow said that addiction is, in many ways, a developmental disorder that is intimately linked to the maturation of the brain from childhood through adolescence and into early adulthood.
Delivering the keynote address at the Nov. 17 CASACONFERENCESM How to Raise a Drug-Free Kid: The Straight Dope, organized by the National Center on Addiction and Substance Abuse (CASA*) at Columbia University, Volkow compared this brain development to a sculptor taking a block of stone and transforming it into a work of art.
“In childhood the brain is particularly ‘plastic,’” said Volkow. “It is open to stimuli much more than as an adult, and these stimuli affect brain formation both physically and chemically. A child’s cerebral cortex — the brain’s center for memory, attention, perceptual awareness, thought, language, and consciousness — starts out larger than that of an adult, but shrinks as the brain differentiates during the first two decades of life. “The brain of an adult is much more connected than that of a child,” noted Volkow.
The frontal cortex — critical for using cognitive control to regulate desires — is the last part of the brain to fully differentiate, said Volkow, which helps explain why adolescents are especially prone to risk-taking and experimentation. As the brain advances on its “developmental trajectory” it can be strongly influenced by environmental factors, she said. Social stresses are crucially important,” Volkow said, pointing to the Adverse Childhood Experience (ACE) Study research showing that risk of drug abuse rises tenfold among individuals who experience five or more “adverse childhood experiences,” such as recurrent physical or emotional abuse.
“Studies of children raised in orphanages showed that their brain connectivity was much less developed than those with normal parenting,” added Volkow; the effect was most pronounced among the children who had been living in orphanages the longest. The research “directly connected the lack of parenting to delays in the development of the brain,” she said. Children who are genetically predisposed to addiction rarely suffer from drug problems if they have parents who are actively involved in their lives, according to researchers. Those who have both genetic vulnerability and absent or uninvolved parents have a “very significant increase in drug addiction,” however, according to Volkow.
Studies of prevention programs like “Preparing for the Drug-Free Years” (PDF) and “Communities That Care” demonstrate that parents, families and communities can create an environment that is protective against youth drug abuse. Moreover, said Volkow, researchers have found that interventions can actually improve dopamine levels in the brain. Even though kids may be born to very adverse environments, the plasticity of the brain now gives us a path forward in terms of identifying interventions to help reverse the changes caused by these stimuli and increase the likelihood that kids will be able to stay drug-free,” said Volkow.
The NDPA would agree with the comments below – you can be an excellent parent and still have a child who chooses to use drugs…. However, the article ids also correct in stating that parents who know as much about illegal drugs as their children and who parent ‘actively’ (i.e. know where their children are, who are their friends, how are they achieving in school etc.) are less likely to have the problem of drug use in their family.
COMMENTS ON THIS ARTICLE:
Posted by Amy Rosenman, MD on 07 Dec 09 02:07 PM EST
This review is too simplistic.There are still many children brought up in ideal circumstances who develop drug problems. This review still seems to “blame” the family for something beyond their control in many circumstances. However, knowing that family involvement and support is crucial gives many hope that recovery is possible. I too have worked with families of addiction for many years in my medical practice. 12 step programs are very valuable and help keep the family relationships constructive.
Posted by Emily on 07 Dec 09 06:28 PM EST
I agree that parental involvement helps prevent drug abuse, but I know of families that were doing everything right, and their child still became addicted to drugs. In at least one case, the child had no risk factors for substance abuse other than an alcoholic grandparent. I think it is important for parents to know that a family history of alcoholism or drug abuse should not be ignored. In such cases, parents need to be better educated regarding what to do to prevent substance abuse and how to recognize it when it happens.
Posted by Jay Arr on 10 Dec 09 10:35 AM EST
We are the product of our reactions to all the forces of our genes, enviroment, inter-personal relationships,cultural impact, and our reactions to them. Sometimes we are the victims by being stuck in a prison of emotional immaturity. Alcohol and drugs beckon us to escape this life of lies and the lies eventually become our reality. The reality is SAD-S for stigma, A for apathy, and D for denial..I was saved by Alcoholics Anonymous-25 years ago.
Source: CASA Conference. Columbia University Nov. 17th 2009

Children in families experiencing alcohol or drug abuse need attention, guidance and support. They may be growing up in homes in which the problems are either denied or covered up. These children need to have their experiences validated. They also need safe, reliable adults in whom to confide and who will support them, reassure them, and provide them with appropriate help for their age. They need to have fun and just be kids.
Families with alcohol and drug problems usually have high levels of stress and confusion. High stress family environments are a risk factor for early and dangerous substance use, as well as mental and physical health problems. It is important to talk honestly with children about what is happening in the family and to help them express their concerns and feelings. Children need to trust the adults in their lives and to believe that they will support them. Children living with alcohol or drug abuse in the family can benefit from participating in educational support groups in their school student assistance programs.
Those age 11 and older can join Alateen groups, which meet in community settings and provide healthy connections with others coping with similar issues. Being associated with the activities of a faith community can also help. Dependence on alcohol and drugs is our most serious national public health problem. It is prevalent among rich and poor, in all regions of the country, and all ethnic and social groups. Millions of Americans misuse or are dependent on alcohol or drugs. Most of them have families who suffer the consequences, often serious, of living with this illness. If there is alcohol or drug dependence in your family, remember you are not alone. Most individuals who abuse alcohol or drugs have jobs and are productive members of society creating a false hope in the family that “it’s not that bad.”
The problem is that addiction tends to worsen over time, hurting both the addicted person and all the family members. It is especially damaging to young children and adolescents. People with this illness really may believe that they drink normally or that “everyone” takes drugs. These false beliefs are called denial; this denial is a part of the illness. Alcoholism and other drug addiction have genetic and environmental causes. Both have serious consequences for children who live in homes where parents are involved. More than 28 million Americans are children of alcoholics; nearly 11 million are under the age of 18. This figure is magnified by the countless number of others who are affected by parents who are impaired by other psychoactive drugs.
Alcoholism and other drug addiction tend to run in families. Children of addicted parents are more at risk for alcoholism and other drug abuse than are other children. Children of addicted parents are the highest risk group of children to become alcohol and drug abusers due to both genetic and family environment factors. Biological children of alcohol dependent parents who have been adopted continue to have an increased risk (2-9 fold) of developing alcoholism. Recent studies suggest a strong genetic component, particularly for early onset of alcoholism in males. Sons of alcoholic fathers are at fourfold risk compared with the male offspring of non-alcoholic fathers. Use of substances by parents and their adolescent children is strongly correlated; generally, if parents take drugs, sooner or later their children will also. Adolescents who use drugs are more likely to have one or more parents who also use drugs. The influence of parental attitudes on a child’s drug taking behaviors may be as important as actual drug abuse by the parents. An adolescent who perceives that a parent is permissive about the use of drugs is more likely to use drugs.

Source: Public Service Announcement from SAMHSA in the public domain 27th Jan 2010

Parents who try to teach responsible drinking by letting their teenagers have alcohol at home may be well intentioned, but they may also be wrong, according to a new study in the latest issue of the Journal of Studies on Alcohol and Drugs.

In a study of 428 Dutch families, researchers found that the more teenagers were allowed to drink at home, the more they drank outside of home as well. What’s more, teens who drank under their parents’ watch or on their own had an elevated risk of developing alcohol-related problems. Drinking problems included trouble with school work, missed school days and getting into fights with other people, among other issues.

The findings, say the researchers, put into question the advice of some experts who recommend that parents drink with their teenage children to teach them how to drink responsibly — with the aim of limiting their drinking outside of the home.

That advice is common in the Netherlands, where the study was conducted, but it is based more on experts’ reasoning than on scientific evidence, according to Dr. Haske van der Vorst, the lead researcher on the study.

“The idea is generally based on common sense,” says van der Vorst, of Radboud University Nijmegen in the Netherlands. “For example, the thinking is that if parents show good behavior — here, modest drinking — then the child will copy it. Another assumption is that parents can control their child’s drinking by drinking with the child.”

But the current findings suggest that is not the case.

Based on this and earlier studies, van der Vorst says, “I would advise parents to prohibit their child from drinking, in any setting or on any occasion.”

The study included 428 families with two children between the ages of 13 and 15. Parents and teens completed questionnaires on drinking habits at the outset and again one and two years later.

The researchers found that, in general, the more teens drank at home, the more they tended to drink elsewhere; the reverse was also true, with out-of-home drinking leading to more drinking at home. In addition, teens who drank more often, whether in or out of the home, tended to score higher on a measure of problem drinking two years later.

The findings, according to van der Vorst, suggest that teen drinking begets more drinking — and, in some cases, alcohol problems — regardless of where and with whom they drink.

“If parents want to reduce the risk that their child will become a heavy drinker or problem drinker in adolescence,” she says, “they should try to postpone the age at which their child starts drinking.”

Available at: http://www.jsad.com/jsad/link/71/105

Source: H. van der Vorst Journal of Studies on Alcohol and Drugs 71 (1), 105-114. Jan 2010

Amsterdam: – The alderman of Rotterdam, responsible for education, Leonard Geluk wants that all middle schools are going to perform drug tests among their students in order to track down traces of use. Geluk responded to the outcome of a test, done by the topicality show Netwerk on 12 different schools in Rotterdam. At half of these schools traces of cocaine were found. It is new and startling to find that cocaine is used at so many schools. I am really worried about this.

Netwerk had these tests performed in the same way the police and military police use to track down drug use. Besides traces of drugs, traces of marihuana use were found on 10 out of these 12 schools. At one school traces of heroin use were found. If you, as a parent, send your child to a school in Rotterdam, you can not and will not expect that your child encounters drugs, and especially not cocaine. The truth of the matter is very different and concerning.

Alderman Geluk pleas to perform drug tests on students who are allegedly drug users. Geluk is –by this plea- quicker than the minister of Justice, who has promised the Chamber a letter about the use of spray to track down traces of use. If there are any legal difficulties about using this spray, we have to check the other possibilities in order to be able to test on drugs.

Source: Renee Besselling Eurad Secretariat 15.01.08

OTTAWA — A new national program designed to prevent youth from using drugs received $10 million from the federal government Wednesday.

The money is slated to go toward the Drug Prevention Strategy for Youth, a new five-year plan led by the Canadian Centre on Substance Abuse, the government-supported national agency for substance abuse. The strategy will target youth between the ages of 10 and 24 and will have several goals: to reduce the number of youth using illegal drugs, to delay and deter the onset of drug use, to reduce the frequency of drug use, and to reduce multiple drug use among those young people who do use.

The funding comes out of the government’s $64-million National Anti-Drug Strategy, launched last fall. Part of that plan includes a two-year mass media campaign by Health Canada aimed specifically at youth. Health Minister Tony Clement, speaking at the Ottawa-based CCSA, said there hasn’t been a “serious or significant” anti-drug campaign in almost 20 years, and one is long overdue. He said the CCSA’s national prevention strategy is key to the government’s plan.

“This project will reach out to young people and will provide them and their parents the plain truth on the harms of illicit drug use,” said Clement. “We will discourage young people from thinking there are ‘safe’ amounts, or ‘safe’ drugs. And we will highlight the fact that, for young people, having clear and unimpaired judgment is a safety issue,” the health minister said.

The CCSA’s strategy will complement Health Canada’s media blitz with a new consortium media corporations, marketing and advertising agencies, youth agencies and parent groups. It will reinforce many of Health Canada’s messages, but on a wider platform, and with high-risk populations targeted.

According to the CCSA, the average age a Canadian tries an illegal drug for the first time is around 14 or 15, so prevention messages need to start as early as 10 years of age. Sixty per cent of illegal drug users in Canada are 15 to 24 years old, according to the national substance abuse agency, and young people are the most likely to use and abuse substances, and to experience harm as a result.

Source: Canwest News Service January 31, 2008

http://www.canada.com/vancouversun/news/story.html?id=a9d26354-09a5-4fc0-a6aa-89d120ed22b1

VANCOUVER, British Columbia (Reuters) – Canada’s “Prince of Pot” believes the Canadian government wants to punish him by blocking a plea deal with U.S. authorities, who want him to face charges of selling marijuana seeds from his Vancouver store to American customers.
Canada refused to go along with Marc Emery’s deal with U.S. prosecutors to plead guilty in return for the United States dropping charges against two co-accused and allowing him to serve most of the sentence in a Canadian prison, the marijuana activist said on Friday.
The B.C. Marijuana Party founder said Prime Minister Stephen Harper’s Conservative government is pursuing a get-tough policy on drug use and is upset by his long-running campaign for marijuana legalization.
“They want to make an example out of me,” Emery told CKNW radio in Vancouver. “They just don’t like me.”
Emery was arrested in 2005 at the request of U.S. officials for allegedly selling millions of dollars in seeds to U.S. buyers, mostly by mail-order, from the seed business he operated openly in Canada for years.
A U.S. Drug Enforcement Agency statement in 2005 hailed Emery’s arrest as blow to the “marijuana legalization movement” and cited his financial support of pro-pot groups in Canada and the United States.
Emery is also charged with money laundering, but he says he can prove he declared all his earnings to Canadian tax officials and gave most of the profits to charities and political candidates.
He is scheduled to appear in a Vancouver court next month, with an extradition hearing likely to start late in the year.
Source: Reuters Canada 28th March 2008

POLICE have raided 100 cannabis factories capable of producing more than £60m worth of the drug for home and export. More than 100 cannabis factories capable of producing nearly £60 million of a super-strong variety of the drug every year have been found in Scotland.

The Scotsman can reveal the alarming scale of cannabis cultivation in a country which has never before witnessed large-scale illegal drug production.It comes as Gordon Brown, the Prime Minister, insisted he is determined to see cannabis upgraded back to a Class B drug in order to send a signal to young people that its use was “unacceptable”.

But a government drugs advisory panel appears set to recommend that it stays at Class C .

In Scotland about 43,000 plants – mainly a high-strength variety known as “skunk” – have been recovered from houses, garages, and disused factories since south-east Asian crime gangs began setting up illicit production plants in the summer of 2006. An explosion in cannabis cultivation has been witnessed over the past 18 months as organised crime, sensing massive profits from a previously non-existent drug export trade, has moved in after being forced out of England and Wales.

For an outlay of about £30,000, individuals can set up a cultivation capable of reaping more than £500,000 worth of cannabis every year. They rig up high-powered lighting and watering systems in order to grow the skunk plants quickly. Despite the high demand for cannabis in the UK, police suspect the operation has yielded so many plants that much of it is being exported into lucrative markets in Europe and beyond.

The phenomenon has alarmed police and prosecutors, triggering a massive operation to root out factories and causing a senior judge to take the unusual step of issuing sentence guidelines to ward off potential growers. The trade is fuelling a growing human trafficking problem. A number of illegal immigrants involved in running cannabis factories, mainly from China and Vietnam, have been arrested since a Scottish police crackdown – called Operation League – began in December 2006. Some are locked in properties 24 hours a day in temperatures exceeding 38C as the bosses threaten to harm their families back home.

Detective Chief Superintendent Stephen Whitelock, head of intelligence at Strathclyde Police, said: “Within Strathclyde to date we’ve identified 70 cultivations and recovered over 35,000 plants. That equates to a maximum street value of £11million. More than 50 people have been arrested. “Across Scotland we’re talking over 100 cultivations and over 43,000 plants worth around £14million.”

Each plant is capable of producing four harvests every year, meaning the 100 factories smashed by police would have created an annual revenue of nearly £60 million had they gone undetected. More than two-thirds of the cannabis factories shut down by police have been found in Strathclyde, but others have been uncovered in towns virtually the length and breadth of the country, including Ayr, Thurso, Newmachar, Cambuslang and Livingston.

As well as the production of the illegal drug, police are extremely concerned about the risk of a fatality if a factory catches fire.

One officer told The Scotsman that the vast amount of heating equipment used to cultivate cannabis, and the fact that many of the factories tap straight into the electricity mains supply to avoid detection, meant it was “miracle” there have been no serious blazes. Each factory typically uses around 20 times the power used for a normal house to grow the cannabis. The cost to power companies is thought to be about £2 million a year.

Police, who say the number of officers on Operation League fluctuates depending on the amount of information they receive, have been known to monitor power supplies and even use infra-red cameras in spotter planes to identify areas of unexplained heat. Mr Whitelock said Operation League had been a huge success, revealing that most factories had been uncovered following tip-offs from the public.

“The main point of Operation League was to put it into the public arena, the threat of organised crime. We’ve had a great response from the public, speaking to officers and phoning Crimestoppers. “The public are generally aware what to look for – that gives us the eyes and ears of five million people in Scotland.

“They’ve had a significant impact on those involved in this area of criminality. But it remains a profitable concern for those involved. “They’re using Scotland as a base to cultivate cannabis for a market elsewhere that has yet to be identified. “Scotland is a consumer society for drugs. But we are now seeing cannabis being produced within our own shores.” He added: “We have identified the production sites, we have identified those involved in the manufacture and production of the plant. But there are obviously plants being cultivated and that is where our knowledge gap is: where do the plants go?”

Police believe the same crime network is involved because of similarities in electrical work and joinery they have found in their raids. Mr Whitelock appealed to landlords to help stamp out cannabis cultivation, insisting they have a responsibility to check what is going on in their properties.

He said police had a “better understanding” of the problem thanks to Operation League. “But it would be naive to say there are no other cannabis activities ongoing,” he added. “The primary people involved are south-east Asian organised crime groups. There are many links also with indigenous crime groups,” added Mr Whitelock.

Last November, Scottish judges were given tough new sentencing guidelines in an attempt to crack down on cannabis farms. Lord Hamilton, the Lord Justice General, said the move was needed to tackle a big increase in the farms, warning that even low-level cannabis “gardeners” should expect to face between four and five years in prison.

Source: The Scotsman.4.4.2008

Australia’s drinking, smoking and drug-taking caused a lot of sickness, disease, premature death, reduced productivity, crime and accidents in the year to July 2005. The report shows costs were up to $56 billion, from about $34 billion when the estimate was last made in the late 1990s.
The latest estimate puts the cost of alcohol-associated problems at $15 billion. It estimates Illicit drugs cost Australia about $8 billion. But by far the biggest problem is tobacco. The report says it cost $31.5 billion – 56 per cent of the total.
“The smoking rates are reducing but the delayed health effects of past smoking are still being seen,” Health Minister Nicola Roxon said. “So we do hope that in the future, pretty long term in the future, that the lower rates of smoking will see a decline in this social cost.”
Professor Simon Chapman from the School of Public Health at the University of Sydney says Australia is a world leader in anti-tobacco campaigns, but more practical steps need to be taken to make smoking history. “We could begin by putting all cigarettes under the counter in the way that pharmaceutical, ethical drugs are not displayed,” he told AM.
“We could put them in plain packaging rather than the really enticing attractive boxes which are highly market researched to appeal to young people. We could put the price of cigarettes up a lot more and we could regulate the product itself. It’s the only product that is taken into the body which is not subject to, sort of quality controls, safety controls.”
The Labor Party says it is taking a different approach to the previous government in health policy, putting more emphasis on prevention. The director of the Australian Institute of Health Policy Studies, Professor Brian Oldenburg, says there is little detail so far.
“I think at least compared to the previous government, there is the expressed intent to really put more effort into prevention, but we are still waiting to see how that is going to work its way through the system,” he said. Ms Roxon will release the figures on the social costs of drugs and alcohol at the first ever national illness prevention summit, which begins in Melbourne today.

Source: ABC News April 9th 2008

MAASTRICHT, Netherlands (Reuters) – Sitting among the mellow smokers in a coffeeshop in Maastricht it is easy to forget that a plan to relocate half of the cannabis-selling outlets to the city limits has aroused fury. The southern Dutch city has been trying for five years to push seven shops to three new “coffee corners” at its northern, western and southern borders.

The marijuana equivalent of out-of-town shopping malls would serve the 1.5 to 2 million people who pour into the city each year in search of a powerful puff. Neighboring Belgian districts and the Dutch community of Eijsden, enraged by the prospect of coffeeshops on their doorsteps, forced Maastricht to back down after winning a legal challenge last month.

The Dutch city has now put forward a watered-down proposal to place two coffeeshops in a single “coffee corner” at its southern edge for a trial period of three years. Its neighbors are still not happy.
“We see reckless driving, car theft… We already have the highest level of crime of any countryside district in Belgium and 95 percent of it is due to drugs,” said Huub Broers, mayor of the Belgian district of Voeren, just south of Maastricht.

About 80 percent of the city’s coffeeshop customers are foreign — of which 60 percent come from Belgium and the rest from France and Germany. Most buyers come at the weekends but even on a weekday morning, there are Belgian cars clustered around coffeeshops. “Slow Motion,” near the station, is anything but, with a stream of customers in and out within minutes.

DRUGS GANGS

Both proponents and critics of the plan generally agree that the coffeeshops and the vast majority of their customers who come for a joint or a small bag of hash are not the problem, although residents do complain about congestion and parking.

The trouble comes from the criminals they attract, notably about 500 “drug runners” on the streets peddling substances such as cocaine, ecstasy or heroin. Western Europe is the world’s largest market for cannabis resin and Europe is the second-largest global market for cocaine, the United Nations International Narcotics Control Board said in March.

John Walters, director of U.S. national drug control policy, said earlier this month the euro’s gains against the dollar may be behind an enormous increase in the availability of cocaine in Europe: selling in euros may be more profitable than in dollars.

“Maastricht is plagued by drug gangs,” said Brice de Ruyver, a professor of criminology and drugs expert at Ghent University. “The coffeeshops themselves need huge quantities of illicit supplies. Then you have trouble in the city because of dealers. The reasoning is that whoever is interested in cannabis in a coffeeshop may also want something harder as well.”

Residents attest to the problems.

“You see the dealers jump out in the middle of the street flagging down French or German cars. They get in and can be aggressive,” said the owner of Nautica Jansen, a water sport shop beside two floating coffeeshops on the river front. While Voeren’s mayor fears Maastricht’s plan would simply move the criminals towards his district, Maastricht argues it is difficult to stamp out drug crime in the tight central streets.

At more isolated sites outside the city, the Dutch say, policing would be easier and dealers less able to reach people driving into gated coffeeshop enclosures. Marc Josemans, chairman of the Maastricht coffeeshop association, believes illegal dealers would find demand reduced.

That would in turn cut supply: “It’s a normal market mechanism,” he said. “We cannot prove it, because no one has given us the chance.” A survey by Joseman’s association found that a third of customers would prefer out-of-town sites: not surprising, given that so many are foreign.

CLAMPDOWN

The Dutch have cracked down on coffeeshops: there are now around 700, compared with around 1,200 in 1997. In Maastricht, all customers must prove they are at least 18 years old and there are plans to bring in finger scanners to ensure no one buys more than 5 grams per day.

“It’s easier for a terrorist to enter Europe than for a dope smoker to get inside a coffeeshop,” said Josemans “Tolerance in Europe has declined. You see that towards foreigners, religions. And that’s a key reason why the number of coffeeshops has fallen.”

But in Belgium, the rules have softened. Belgians are no longer prosecuted for possessing up to 3 grams (0.1 ounces) of cannabis and can grow a single plant, but would still face arrest for selling resin, plants or seeds in their country. De Ruyver says the coffeeshops cannot simply be labeled a Dutch problem. “If 60 percent of those visiting the shops on the border are Belgian, we must take our responsibility too,” he said.

Source: Reuters 20th April 2008

Re: Take ideology out of decisions, by Keith Baldrey, In My Opinion, Burnaby NOW, May 7.
Mr. Baldrey makes a number of misleading statements about me and about opponents of Insite in general. I am the author of the “flawed and questionable report” criticizing the Insite evaluations that Mr. Baldrey referred to. Mr. Baldrey and other supporters of Insite and of harm reduction as the new way to deal with drugs seem to lack any real argument for Insite and its parent ideology – yes, ideology – so they attack the critics themselves. So please let me respond.
First, my report was not flawed or questionable. I am more than amply qualified to comment on printed research reports. In fact, any grad student would see the flawed assumptions and conclusions made in the Insite evaluations, regardless of what journal they were published in. I have worked in the addictions field in B.C. and in Canada for almost 30 years, and, until I disagreed with harm reduction, I was well respected by the people who now attack me merely for expressing professional concerns about the direction drug policy was taking – downward.
Second, I did not write the report for a “prohibition group,” as Mr. Baldrey asserts. I wrote it for the Royal Canadian Mounted Police, a key stakeholder in Insite and in drug problems in Canada. They merely wanted a review by someone not ideologically wed to Insite. I stand behind the report and everything I said as true and valid based on reading the published Insite research.
I did not write the paper as director of research for the Drug Prevention Network of Canada, or for them. Incidentally, the Journal of Global Drug Policy and Practice, in which my article was published, is a scientific peer-reviewed journal. Public accusations otherwise should be made with caution.
Third, my paper was but one of three academic reports critical of Insite. Garth Davies, a colleague of Neil Boyd’s at Simon Fraser University, wrote one that was equally critical. A federal panel of experts recently released another, saying essentially the same things.
For example, drug overdose deaths have actually increased in Vancouver and in the Downtown Eastside since Insite was initiated. Insite may or may not be preventing up to one overdose death a year. This is fact.
But Mr. Baldrey refers to reports claiming overdoses have gone down. Somebody is indeed putting out misleading information, but it is not me or others concerned about Insite. It is Insite and its supporters. The fact is that Insite is not doing what it set out to do – reduce infections, prevent overdose deaths and reduce public disorder.
Nor is it demonstrating a unique ability to get people into treatment where they belong. It is drawing funds that could be used for more effective things and taking our attention from the real problems – drug use and addiction.
Mr. Baldrey refers to specific people as experts in harm reduction, etc. What he does not say is that these individuals, and many others involved with Insite, are avid proponents of legalizing drugs. I do not fault them or anyone else for holding this ideology, except when people use their positions or authority to unilaterally push it on the public or to lend credence to it by their names, when no such credence exists.
The fact that so many supporters of Insite and of harm reduction are so rabidly pushing it and skewing the facts even when flaws are identified, and that they disparage their opponents, tells me they are so caught up in ideology themselves that they can no longer be objective.
And as for “moralizing,” no one is moralizing here. The Insite test study did not meet its stated objectives. That is not moralizing.
But Mr. Baldrey seems to be saying that any “moralizing” is bad. The fact is “moralizing” is to some extent inevitable in any human discourse. We all have some moral reference point that underlies our ideas and choices at the deepest levels. Trying to entirely exorcize human debate of values – the outgrowth of our morality – is itself impossible.
Mr. Baldrey, you are very loose and misleading in your accusations. I could go on in pointing them out. But suffice it to say, throwing mud and attacking people is neither professional nor a sign of a noble cause.
It comes from an arrogant belief that anyone who disagrees with harm reduction or Insite is somehow stupid, misinformed or an ideologue. I am frankly embarrassed at how deeply this blind arrogance has gotten into otherwise intelligent people and at the utter lack of professionalism their attacks display.
Colin Mangham, PhD, is a Langley resident.
Source: Canada.com – Burnaby Now May 10th 2008

In different forms it’s been sold as plant food, but little is known about a new recreational drug hitting Australian streets, other than it prompts acts of horrendous self-mutilation by some users. Within the past few months in Sydney there have been reports one user tried to castrate himself while under the influence of the drug. Another severed half a finger using a kitchen appliance and degloved his penis in an apparent circumcision attempt.
The drug in question is 4-methylmethcathinone or mephedrone – but more commonly known as 4-MMC, MMCAT, bubbles, megatron, bath salt or miaow miaow. As a derivative of methandienone, the drug is a prohibited substance in Australia.
Continuing to prove hugely popular on the UK clubbing scene, the drug is believed to be partly responsible for the deaths of a woman in Sweden in 2008 and a 14-year-old girl in England in November. It has since been made illegal in some European countries.
The psychoactive drug creates a state of euphoria similar to, but not as extreme as cocaine, with an ecstasy-like hit at the end. Reports of little after-effects and a mild “come-down” have made the drug popular among young professionals who like to party at the weekend before having to return to work.
Since September 2008, the Australian Federal Police (AFP), along with Australian Customs and the Border Protection Service, have detected 25 attempts to import a combined total of more than 20kg of the drug. An AFP spokeswoman confirmed that mephedrone “is a new drug that has emerged in Australia”. While prohibited here, the drug is readily available for legal purchase abroad, predominantly in China and Israel.
In Tasmania, police have labelled the drug “Israeli’s”, because of its country of source, and report its popularity with people who believe it’s legal to possess. “We conducted an investigation at the start of the year and a number of persons were charged with trafficking,” Tasmanian Police Detective Inspector Ian Lindsay told The Mercury newspaper in October last year. He added that since those charges were laid there had been a “dramatic reduction” in the amount of mephedrone seized across the state.
In a report from the Tasmanian Department of Police and Emergency Management, the drug is said to have been possessed “in an attempt to circumvent existing legislation”. In the Northern Territory, a 16-year-old boy faced Darwin Youth Justice Court on January 15 for allegedly importing 1kg of mephedrone, ordered online from a legitimate chemical company in China. The court heard the boy paid $8,000 and was expected to pay an additional $12,000 when the drug arrived, the NT News reported. The matter is ongoing.
Brisbane-based Rave Safe project coordinator Michael Brennan said use of the drug in Australia was “worrying” and people continued to consume the substance without knowing its effects or what’s used in its production.
Typically, mephedrone is mixed with caffeine and the compound can take effect very quickly. However, for users of other recreational drugs, Mr Brennan said the effect may not be as strong as that to which they’ve become accustomed.
“Reports are that it’s incredibly more-ish, which can be a concern in itself,” he said. “It is one thing to pop one or two tabs of ecstasy, but taking this stuff, they could be inclined to take several hundred milligrams.
“In a way these things are more dangerous because people will take one or two doses and not get the effect they want so then they take a lot more of them. When a substance like this comes up that was really only invented only a few years ago, it’s hard to say what the effects will be, so it’s really worrying to me. It’s just a real unknown at this stage.” Typically, the drug is purchased in crystal form and snorted for quick effect, but can also be taken orally.
Mr Brennan said mephedrone had proven popular among ecstasy users, but added that few seemed to move onto long-term use. “I think some people are quite happy with that effect, that you don’t get this terrible after-effect with it,” he said.
“A lot of ecstasy users have been taking it for a try, but a lot of long-term users have gradually lost the attraction to it. And I would bet that 4M CC will slowly disappear into the background.”
As a stimulant, the drug affects the human cardio system and users have experienced varying symptoms including palpitations, paranoia, anxiety, depression, insomnia, headaches and short-term memory loss.
In one case, documented in an online forum, following the consumption of about 100mg over a week, a male user noticed his fingers and knees turn a dark red to purple colour before he passed out. After about six months, including a short stint in hospital, the discolouration disappeared, but the symptoms returned after again trying a small amount of mephedrone.
In the Sydney cases, it’s unknown whether the male users were also under the influence of other substances, but online discussions about the drug frequently list paranoia as a common side-effect. Both men were hospitalised for their injuries, but NSW Health does not have a system in place to record how many patients have been admitted to hospital due to the drug.
Nor is the use of mephedrone recorded by major agencies, including the National Drug and Alcohol Research Centre, the NSW Bureau of Crime Statistics and Research, or the Centre for Population Health.
The Australian Injecting and Illicit Drug Users’ League in Canberra has only anecdotal data about the drug. All agencies report having been made aware of the drug’s existence in Australia since about 2008, but concede there is little or no information about mephedrone.
Online forums suggest Australian use or sampling of the drug is most popular in states along the eastern seaboard. Part of the drug’s appeal is its relative cheapness, with online advertisements for various forms of mephedrone available from $170 for 100mg.

Source: www.smh.com.au 29th Jan 2010

Can your state afford to gamble on legalizing marijuana?

California is capturing national media coverage as the state debates the issue of legalizing and taxing marijuana. A legislative bill (AB 390) and three potential ballot initiatives propose different strategies to allegedly profit financially from marijuana. Promotion of those measures rely on a biased study. The study suggesting potential revenue gains is not only questionable, but also neglects to identify societal costs associated with marijuana.

In a written response to an article published by the Sacramento Bee, Police Chief Scott C. Kirkland addresses what the pro-drug lobby and the study they promote have neglected. His response may have been written to specifically address issues in California, but his points are relevant to other states considering similar measures.

Can your state afford to gamble on legalizing marijuana? After reading what Chief Kirkland has to say, I think you will agree the answer is NO; our nation cannot afford the damaging cost such efforts would have on society.

On August 6, 2009, the Sacramento Bee published an editorial by F. Aaron Smith entitled, “Legalized pot is more than a tax bonanza.” I would like the opportunity to present the other side.

My name is Scott C. Kirkland and I am currently the Police Chief in El Cerrito. I am on the Board of Directors for the California Police Chiefs Association as well as the California Peace Officers’ Association. Moreover, I am currently the Chair Person of the California Police Chiefs Medical Marijuana Task Force. The task force is comprised of representatives from the California Peace Officers’ Association, California Police Chiefs Association, California State Sheriff Association, California District Attorneys’ Association, California Narcotics Association, and other interested parties.

The purpose of this article is to write specifically about the financial aspect of the issue. I would be more than happy to contribute other articles that discuss the Assembly Bill specifically, the substance itself, or any other aspect of this issue should you so desire.

The advocates on this issue have once again selected a very well crafted message to the public. In essence, they are saying that the State of California should legalize and tax marijuana and that this action would allow the State to remain solvent. The argument would then be that with a solvent State, police officers, firefighters, and teachers will not be laid off. Mr. Smith states that there would be $1.4 billion in new tax revenue available to solve the state budget crises. But, let us examine those numbers and see if the State of California could afford such a gamble.

Yes, the Board of Equalization did identify a potential revenue stream from the sale of marijuana but are those numbers accurate? In their bill analysis, the sole report that is cited as the basis of their revenue projections is entitled, Marijuana Production in the United States (2006). The report was written by Jon Gettman, who served as President for the National Organization for the Reform of Marijuana Laws. He writes the “Cannabis Column” for the HighTimes.com. Mr. Gettman owns DrugScience.com which he cites six times in his report. Upon reading the report and comparing the report to various law enforcement data that is published, his estimates of marijuana crops are more than twice as high.

I believe it is and was irresponsible for the individuals that wrote the bill analysis not to have known who the author of the report was and to have questioned his credibility. In this day of Internet usage I have become in the habit of doing a “Google” search on authors upon reading their work. It is important to me to know where the author is coming from and it should be important for those who complete a bill analysis. It took me ten minutes to glean information about Mr. Gettman. I believe it is important for all who delve into this emotional issue to fully research it and failure to do so results in a slanted and inaccurate analysis.

Since the Bill Analysis is utilizing a study that shows double the estimates of any other law enforcement data, the Board of Equalization’s initial projections are simply wrong. I believe it is this type of financial forecasting that has caused the State of California so much trouble today.

In May of 2009, the National Center on Addiction and Substance Abuse (CASA) at Columbia University released a report entitled, “Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets.” This one hundred and seventy-six (176) page report documents for the first time the costs of the two legal substances that are abused today (Alcohol and Tobacco). The costs are substantial!

In 2005, the State of California spent $19.9 billion dollars on substance abuse and addiction or $545.09 per capita (population of 36.5 million). Once again I am talking specifically about Alcohol and Tobacco. But, the State of California collected $1.4 billion dollars of tax revenue or $38.69 per capita on the sale of Alcohol and Tobacco products. Yes, the costs far exceeded the revenue!

I believe it is also worth mentioning that as of June 19, 2009, California’s Carcinogen Identification Committee of the Office of Environmental Health and Assessment Science Advisory Board issued a ruling that listed marijuana smoke as causing cancer. This is just another reason why the financial analysis of the bill does not make economic sense. From a public health stand point, why would we, residents of California, want to legalize a crude substance that is known to cause cancer when the costs of substance abuse of the psychoactive drug will far outweigh the amount of monies the state receives? Are we that short sighted? How is the State of California going to find the monies to pay for the costs of abuse, treatment, and damage to youth? These are all unanswered questions that must be addressed in order for there to be a fair and impartial analysis that voters rely on when they go to the polls.

Source: Source: Save Our Society From Drugs Oct 2009

I have read with interest the article in “The Province” Newspaper from British Columbia dated February 16th, 2009 entitled “Huge Price Tag Leads to Call for Audit, and then the articles in the Ottawa Citizen recommended an injection site in Ottawa of Intravenous Drug users.
The newspaper investigated the cost of funding the “Downtown Eastside” in Vancouver dealing with providing housing and support for the residents. This is the first time such an investigation takes place and the result are staggering given the cost was approximately $360 million dollars per year. The article mentions that is cost approximately $ 1 million dollars a day with most of that for the roughly 5,000 disabled people in the community.
It further states that this spending continues to go unabated, with no one in control of the purse strings as conditions continue to deteriorate at street level.
Given these staggering statistics, I believe it would be a good time for the city of Ottawa to do a cost study of their homeless and addicted population to ascertain the cost before going forth with any other programs especially the recommendation for an injection site for intravenous drug users. It would be best practice to evaluate the pilot project in Vancouver when one reads Dr. Raymond R. Corrado’s and Dr. Irwin Cohen “Analysis of the Research Literature on INSITE: Vancouver’s Injection Site Summary”, and the Health Canada report on Vancouver’s Insite.
The stated Insite objectives were:
- Increasing access to health and addiction care;
- Reducting overdose fatalities;
- Reducing the transmission of blood borne viral infections like HIV and hepatitis C;
- Reducing other injection related infections such as skin abscesses; and
- Improving public order.
My question is, have they met their stated objective and if not should we not reconsider it’s effectiveness.
Dr. Carrado states:
“The pilot of a supervised injection site in Vancouver Downtown Eastside was established as a response to high rates of blood born disease (Hepatitis B, Hepatitis C and HIV/AIDS) and a large number of overdoses among intravenous drug users population”
Here are some of their findings:
Blood-borne diseases::
“Dr. Corrado states that there was a “GOOD LIKELIHOOD” that there was a reduction in the spread of blood-borne diseases since several of Insite clients stopped sharing syringes. However, he also underlines that due to the lack of direct measures of blood-borne diseases, it’s not possible to estimate the extent of the reduction.”
In the final report of Health Canada, the Expert Advisory Committees on Vancouver’s INSITE and other Supervised Injections Sites: What has been learned from research from Health Canada states:
Page 11
“There is no direct evidence that SIS’s reduce the spread of HIV infection, and the mathematical models used are based on assumption that may not be valid.
Baseline rates of needle sharing have not been reported for SIS users.
Self-reports of changes in needle sharing beyond the walls of SISs have been validated.
More objective evidence of sustained changes in risk behaviors and a comparison or control group study would be needed to confidently state that SISs have a significant impact on these behaviors.”
Dr. Carraro then states:
” Insite did achieve its objective of reducing the number of fatal drug overdoses. In fact, drug overdoses were minimized and deaths were avoided.”
The Health Canada report states:
Page 11
“There is no direct evidence that SIS influence overdose death rates and large scale and long term, case-controlled studies would be needed to show that SISs influence overdose death rates among those who use INSITE. Mathematical modeling is based on assumptions that may not be valid.”
The overdose rates increased in Vancouver since the Injection site opened it’s doors.
Dr. Irwin Cohen states in his report:
“Several limitations exist within the research and evaluation on supervised injection sites. There are methodological problems regarding outcome measures, as well as an overall lack of research rendering it difficult to compare supervised injection sites to other types of interventions ( i.e.: needle exchange programs and methadone treatment programs). Furthermore, the limitations also result in restricting comparisons of research findings form one study to another.
Health Canada study states the following with regards to limitations of research in the Cost-Effectiveness and Cost Benefit section on page 13 of report.
” While some longitudinal studies have been conducted, the results have yet to be published and may never be published given the overlapping design of the cohorts. Until these studies have been undertaken it will not be possible to show with any certainty that INSITE is cost-effective or to show that the economic benefits exceed the costs.
Mathematical models used to estimate benefit-cost ratios use estimates of the frequency of needle
sharing involving HIV positive and HIV negative injection drug users and estimates of HIV transmission rates have not been locally validated.
Mathematical models used to estimate benefit-cost ratios with respect to lives saves have incorporated an assumption about the economic value of the lives of injection drug users that has not been validated.”
In summary, on page 3 of the Health Canada report, Insite accounts for less than 5% of injections at the site. Many people have been referred to health and addiction care but have not been followed up to see how many have actually gone or how many have successfully recovered from their addiction? The report on page 11 states that Insite saves about one life a year as a result of intervening in overdose events, but overdose rates have increased in Vancouver. I’ve addressed the HIV/HepC results. In the area of Public order what they fail to mention is that the police presence was increased which could explain why there was no increase in crime and loitering. I do not feel that Insite has accomplished it’s stated objectives.
Given the above direct quotes from the Insite report and others, Ottawa should investigate if the site has met these objectives and if not then question the validity of the pilot project and should question whether it should follow suite based on these findings. The fact that it is costing $360 million dollars per year to manage the poorest postal code region in Canada without any improvement in the lifestyle of its residents should be audited and whatever change is required should be implemented without delay. The price tag speaks for itself.
Will Ottawa be next with these statistics given we are modeling Vancouver’s Downtown Eastside philosophy based on Harm Reduction as best practices.
Andre Bigras,
Drug Prevention Network of Canada.

Cigarette smoking rates among American teens in 2008 are at the lowest
levels since at least as far back as the early 1990s, according to the Monitoring the Future (MTF) study based at the University of Michigan, which has been surveying national samples of 8th-, 10th-, and 12th-grade students each year since 1991.

MTF tracks tobacco use with surveys administered to a national sample of over 45,000 students in about 400 secondary schools each year. This year represents the low point for smoking in all three grades. The proportions of students indicating any smoking in the prior 30 days (called “monthly prevalence”) stands at 7 percent, 12 percent, and 20 percent in grades 8, 10, and 12, respectively.

These rates reflect large declines since the recent peaks in the mid-1990s: 8th graders’ smoking rates are down by two thirds, 10th graders’ by more than half, and 12th graders’ by nearly half. “I can’t begin to tell you what a dramatic difference this is going to make in the health and longevity of this generation,” said Lloyd Johnston, the study’s principal investigator. “The fact that teen smoking is still declining is particularly encouraging, because a couple of years ago it looked like the long decline in youth smoking might be coming to an end.”

Across the three grades combined, there was a statistically significant decline in monthly smoking prevalence from 13.6 percent in 2007 to 12.6 percent in 2008. All grades showed some decline this year, but it was greatest in the upper grades. This year’s declines are also greatest among males and students who say they are college-bound.

The study has actually tracked the smoking behavior of 12th graders for a considerably longer period, going back to 1975. Their smoking rate today is the lowest it has been over that entire 33- year period. The investigators note that in the early 1990s cigarette smoking was making a rapid comeback among American teens, one to which the MTF study drew considerable public attention. A number of governmental and other institutional responses to the growing threat followed, perhaps the most
important of which was the tobacco settlement between the industry and the state attorneys general. That settlement brought about some immediate changes in cigarette advertising in the country, including the termination of the Joe Camel ads, and it launched the American Legacy Foundation, which has sponsored national antismoking ad campaigns aimed at youth in the years since. It also forced the tobacco companies to raise the price of cigarettes considerably in order to cover the costs of the settlement, and increasing the price has been shown to be a deterrent to youth smoking. A number of states and some municipalities have raised prices still further by increasing their excise taxes on tobacco.

One important reason that smoking rates have been dropping for over 10 years is that fewer students even try cigarettes. The proportion of 8th graders who ever smoked a cigarette is down from 49 percent in 1996 to 21 percent in 2008—a decline of nearly six tenths.

Attitudes About Smoking
One belief that has proven to influence the likelihood that young people use a drug is their belief about whether its use poses a danger for the user. For cigarettes, there has been a substantial increase since 1995 in the proportions of teens who see pack-a-day smoking as involving “great risk” to the smoker. And the proportions of teens who said that they “disapproved” of pack-a-day smoking began to rise a year later and continued into recent years

However, the increase in perceived risk did not continue into 2008; indeed, there was a significant decline in this measure in 2008 among 12th graders. Disapproval of smoking, while quite high, appears to have levelled off in 2008, as well.
The great majority of teens today say that they “prefer to date people who don’t smoke”: 83 percent, 80 percent, and 75 percent in grades 8, 10, and 12, and nearly two thirds of them think that “becoming a smoker reflects poor judgment.”

These attitudes became more widespread after the mid-1990s, but have not grown much over the past few years, except in 12th grade, where the earlier cohorts of 8th graders are still working their way up the age spectrum, bringing their more disapproving attitudes toward cigarette smoking with them. The investigators say that teens should take note that becoming a smoker will make them less attractive to the great majority of the opposite sex—a high price to pay.

Availability of Cigarettes to Teens
The proportion of teens reporting that they could get cigarettes “fairly easily” or “very easily,” if they wanted some, has been declining for some years, particularly among younger teens. Today, 57 percent of 8th graders—most of whom are 13 or 14 years old—say they could get cigarettes fairly easily.

As high as that number is, it is down considerably from 77 percent in 1996. Availability for 10th graders is higher, as might be expected, but fewer of them say they could get cigarettes easily in 2008 (77 percent) than in 1996 (91 percent). It appears that the efforts of many states and communities to get retail outlets to stop selling to underage smokers have been having some success, the researchers say. Despite that, however, the majority of teens—even younger teens—still say that they can get cigarettes if they want them.

Source: Johnston, L. D., et al. (December 11, 2008) http://www.monitoringthefuture.org

As kids flood weed outlets, Ramon Cortines admits there’s no plan

Los Angeles City Hall is thrashing around as the City Council and mayor belatedly try to control a pot-shop explosion they ignited, which has spawned dozens of freewheeling weed emporiums near public schools. The Los Angeles school board’s response? Nada.

That’s what the Los Angeles Unified School District has done to stop kids from trekking a short distance from Fairfax, Hollywood and other high schools and middle schools to score buds at unregulated neighborhood pot shops that have opened, often in the same block as schools or very nearby.

The LAUSD school board and Superintendent Ramon Cortines have held no meetings about the impact on kids, have no idea how many children are turning to the flood of easy weed, have not tried to assess the money the dispensaries are making off healthy kids, and have not trained faculty and administrators in how to deal with ever-younger stoned students.

Now, following routine questions from L.A. Weekly, some school board members are pledging to deal with it.

The lack of interest from LAUSD’s top officials seems unlikely to help the district — already hammered by high dropout rates and intense competition from charter schools — to win back parents. Scott McNeely, of the Pico Neighborhood Council, complained to the City Council last summer when he heard about 17 dispensaries within a mile and a half of his home, three near elementary schools. “It’s a little discomforting when parents try to walk their kids to and from school and the kids smell marijuana smoke in the air,” he says. “It’s long past time for the LAUSD to weigh in on this issue and pressure the City Council, work with the City Council, just as we are doing. … The school board needs to raise a little hell.”

Some school board members believe the weed-and-kids situation is out of control. “After school you can see students stopping at the dispensary before going home,” says school board member Tamar Galatzan. “That’s unacceptable.”

The first sign that kids were being affected by the medical-pot explosion — and even directly targeted — arose at Grant High School in Van Nuys. It was the end of summer 2006 and time, apparently, to get back to the San Fernando Valley’s version of the three R’s: reading, writing and rolling joints.

On August 10 of that year, Van Nuys police found that a nearby marijuana dispensary, Pacific Support Services, had left fliers on cars in the Grant High School student parking lot. The fliers were emblazoned with the iconic, three-leaf marijuana bud, and underneath was a friendly message:

“It is still legal to own, grow and smoke marijuana as long as you do it properly. Qualification is simple and our experienced physicians are more than happy to help you,” it informed students, who probably had no idea California law gives seriously ill patients the right to smoke pot if they merely obtain a doctor’s verbal recommendation.

The flier language was directly aimed at those who might be tempted to spend their burgers-and-fries money: “$15 off with this flier. … If you do not qualify for a recommendation your visit is free.”

In other cities, the targeting of an academically struggling school like Grant High and its mostly minority, mostly working-class students, which resulted in a Los Angeles Daily News story, might have prompted school leaders to act. But it just floated right over the heads of the seven LAUSD board members.

“We had so many other things going on that I guess we just plain missed it,” says school board member Marguerite LaMotte, who represents much of South Los Angeles. “I can’t speak for the rest of the board but myself, I was more worried about the gangs, the liquor stores and all the other problems in my district. … There’s so much going on in my district.”

Since then, neither the school board nor Cortines has done anything — no new policies, rules or special teacher or principal training — to protect children from unregulated pot dispensaries.

Mayor Antonio Villaraigosa and the City Council today have no idea how many pot stores exist, where they are, where they are getting their pot, who is financing them or where the huge profits are going. The exact number of stores in L.A. is a highly fluid calculation, with dispensaries opening and closing daily and dozens filling out paperwork but never switching on the lights. On paper, there are more than 1,000; hundreds are believed to be actually operating.

An analysis by the Los Angeles Times showed that at least 240 of the 1,000 dispensaries are within 1,000 feet of a school, park or library. Teenagers can be seen heading into them after school lets out in Hollywood, Fairfax, Northridge, the San Fernando Valley, Wilshire District and other areas.

According to both police and residents, many medicinal-marijuana shops are covertly targeting healthy kids as young as 14 through street contacts who urge students to “get your card.”

Yet the City Council and school board have yet to open a meaningful dialogue. “On issues that impact LAUSD, there’s been a lack of formal or even informal communication and coordination between the [City] Council and the school board,” says board member Galatzan. “This is the latest manifestation of that problem.”

Galatzan, an attorney who works for the L.A. City Attorney’s Office dealing with street-level crime, supports a tough ordinance proposed by her boss, City Attorney Carmen Trutanich, which among other things would ban dispensaries within 1,000 feet of a school.

The Los Angeles City Council failed for years to adopt state-required local medical-marijuana regulations that other cities, including San Francisco, Oakland and Berkeley, long ago debated and approved.

Those three politically liberal cities cracked down on pot profiteers while adopting rules that allow the ill to easily obtain weed. The City Council here, gridlocked and unable to decide what to do, instead adopted a series of moratoriums — and then missed the state’s legal deadline for acting. Now the council is unhappy with Trutanich’s plan, and is looking at its options once again.

At the time of the Grant High incident, Los Angeles dispensaries had mushroomed from just four in 2005 to dozens in 2006. That was before the great medical-bud flood of the last 18 months.

LaMotte and recently elected school board member Steve Zimmer say they too support a 1,000-foot restriction. Zimmer, however, says his is a narrow endorsement of that one provision. He has problems with the rest of Trutanich’s ordinance, which bans the selling of pot over the counter and profiting from it. Zimmer particularly objects to calls to shut down the existing pot stores.

“I support the 1,000-feet restriction because I believe in creating ‘safe passages’ for our students to travel to and from school,” Zimmer says. “But I also support medical marijuana, and I think Trutanich and [Steve] Cooley are focused too much on suppression and not enough on harm reduction.”

Zimmer insists, “They won’t get one student to stop smoking weed by shutting down the dispensaries.”

Frank Sheftel, an advocate of the medical-marijuana movement and co-founder of the Toluca Lake Collective, a medicinal-pot outlet, favors a restriction of 600 feet, as with liquor stores and pharmacies. “Why create a different set of standards for this industry?” he asks.

But Galatzan notes that pharmacies require written physician prescriptions — not verbal recommendations, as with medical pot — and are so heavily regulated that no L.A. schoolchildren can score drugs at pharmacies. Moreover, liquor stores operate under strict laws forcing them to check age and I.D. Pot stores “are totally different from liquor stores, where kids are not allowed, because minors are [being] allowed into dispensaries,” Galatzan says.

David Berger, a special assistant to Trutanich, tells the Weekly that at least two police investigations are under way involving students and medical marijuana. One stems from a community complaint about a dispensary whose “stoned people” hang out next to a Lexington Avenue elementary school. The other is in Venice, where a pot store opened directly across from one public school and down the block from another. Berger says, “LAPD is documenting all this stuff for us now.”

Source:paulteetor@verizon.net. 5th Nov. 2009

Exclusive data reveals 134 people died of heroin-caused deaths in Victoria last year – the most annual fatalities since 2000 when the drug rivalled the road toll. Already this year, 59 heroin deaths have been verified – taking the total to almost 200 in less than two years – with 2009′s figure expected to rise dramatically as investigations into causes of death are completed. With heroin caps now selling for as little as $40 to $50 – about the same as a slab of beer – and police warning heroin purity and volumes are on the rise, experts predict scores more will die.
A Sunday Herald Sun investigation into drugs on Victorian streets reveals:
Drug detectives are battling Vietnamese organised crime syndicates which are using teams of mules to transport “alarming” quantities of heroin into Melbourne.
Victoria Police has compiled a hit list of more than 100 names of suspected couriers who will be detained if detected at airports.
While heroin is booming, an amphetamine drought has more than doubled the price of “ice” to up to $1000 a gram.
And, according to authorities, new groups are “champing at the bit” to fill the void in the speed market vacated by the execution and imprisonment of figures in the gangland war.
In an exclusive interview, one of the state’s top anti-drug enforcers, detective Sen-Sgt Dale Flynn, revealed the international heroin wave had started to break locally.”We’ve been anticipating some type of flood into Australia, into Victoria, and we’ve really just seen signs of that in the past six to 12 months,” he said.
Forensic, toxicology, police and corrections sources have noticed a rapid increase in heroin and its attendant harms in Victoria in recent months. “Identifying factors for us are we’re seizing more and the purity has increased and we’re getting more intelligence about heroin,” Sgt Flynn said. “If there was an increase in any particular drug, that would be a concern to us. Heroin is the one that has probably the most fatalities connected to it, so when that starts to increase that is a concern.”
A Victorian Institute of Forensic Medicine report on heroin deaths, obtained by the Sunday Herald Sun, details the startling rise in fatalities. A further analysis shows that including the part-year figures for 2009 from the National Coronial Information Service, there have been 2414 heroin deaths in Victoria since 1991.
Figures also show those who died in 2008 ranged from a 15-year-old female to a 57-year-old male, with increasing numbers of female victims. And ambulance officers had attended 614 non-fatal heroin overdoses in the first six months of this year, the Turning Point Alcohol and Drug Centre revealed.
VIFM chief toxicologist Dimitri Gerostamoulos said the increase was mirroring the spike that happened in the late 1990s. “There’s more heroin being produced nowadays than ever before, so there is quite a lot of heroin available,” he said.
Police said the amount of heroin being produced in Afghanistan and South-East Asia was significant. In recent years, brown heroin from Afghanistan had appeared locally as well as Asian white. “Probably the main issue at the moment is Vietnamese organised crime groups,” Sgt Flynn said. “They obviously have the contacts in Vietnam and South-East Asia that can get it here initially. They’re the ones that we seem to be targeting at the moment. We have a problem at the moment with Australian nationals getting paid to fly over to Vietnam, stay for a couple of days, receive some pellets of heroin that they insert internally then come back over.”
He said several heroin couriers had been arrested in Melbourne and around the nation in joint ventures between Victoria Police, Customs and the AFP. “But we don’t believe we’re getting all of them. Obviously there’s some that’s getting through,” he said. The deadly drugs are cut and processed locally, often in industrial areas, factories and homes. In September, heroin worth $5 million was seized from a West Footscray house. Victoria Police drug investigators have compiled a “hit list” of more than 100 names of suspected couriers who will be checked if detected passing through airports. “We don’t always just look at taking them out at the border, but we look for the Melbourne-based offenders to try to gather evidence and put them before the courts as well,” Sgt Flynn said.
Melbourne’s heroin hot spots include the CBD, St Kilda, Richmond, Footscray, Frankston, Collingwood, St Albans, Deer Park, Boronia, Dandenong, Reservoir, Fitzroy and Carlton. During the week the Sunday Herald Sun found used syringes dumped in city alleyways, car parks and near a needle exchange program just metres from a primary school.
The broad availability of heroin is causing its price to fall, while ecstasy and amphetamine stocks are falling, pushing up their street prices. A gram of smack can cost as little as $260, while a gram of ice, or crystal meth, now sells for $750 to $1000. A smaller cap of heroin costs between $40 and $50.
Needle exchange group ANEX said the heroin boom would bring a tide of disease if the right steps were not taken. “We need millions more needles in the needle exchange services to prevent HIV and hepatitis C,” ANEX chief John Ryan said. Overall, about half of injections are made without a clean syringe. More than 40,000 needles are distributed to drug addicts every month as part of a Frankston program – one of 19 needle and syringe programs throughout Victoria.
An analysis of Pharmaceutical Benefits Scheme data has found the number of prescriptions for methadone and other heroin recovery drugs in Australia almost tripled from about 2.4 million in 1992 to almost seven million in 2007. Victoria has recorded the greatest increase in addicts of any state, with almost 12,000 – more than double since 1998 – costing the taxpayer more than $22 million in treatments.
Source: Heraldsun.com.au 23 Nov. 2009

This study was designed to document knowledge about Kuwaiti drug users and to investigate whether or not there is an association between their poor self-concept and high level of anxiety. One hundred and seven incarcerated drug users, 107 individuals serving prison terms for offenses other than drug use, and 107 “normal” individuals were included in this pilot study. The Arabic version of Rosenberg’s Self-Esteem Scale and Spielberger’s State-Trait Anxiety Inventory were used to measure the subjects’ self-esteem and state-trait anxiety, respectively. The results documented revealed that there is a relationship between levels of self-esteem and anxiety in Kuwaiti drug user behavior.

Source: Substance Use & Misuse 1996, Vol. 31, No. 7, Pages 937-943

“ I would establish a strictly controlled distribution network through which I would make most drugs, excluding the most dangerous ones like crack, legally available.” – George Soros

Source: Soros on Soros: Staying Ahead of the Curve.
Published :New York John Wiley & Sons 1995

Decades of painful experience dealing with the misery, violence, and crime associated with drugs have left parents and public health officials with a responsibility to educate every new generation of young people about the devastating effects of illegal drug use.
Working against these efforts, however, is a small, but well-funded group of pro-drug advocates who argue that the legalization of drugs provides a cure-all for America’s drug problem. By placing pro-drug politics ahead of scientific consensus and common sense, these groups place obstacles in the way of making progress.

Drugs are Illegal because they are Harmful

Medical research has established a clear fact about drug use: once started, it can develop into a devastating disease of the brain, with consequences that are anything but enticing. Consider the facts:
The potency of retail marijuana has more than doubled since the mid-1980’s, leading to an increase in drug treatment need for teens. Today, more young people enter drug treatment for marijuana than for all other illegal drugs combined. (MPMP, NSDUH)
Young people who smoke marijuana weekly have double the risk of depression later in life. Additionally, teens aged 12-17 who smoke marijuana weekly are three times more likely than non-users to have suicidal thoughts.
(Source: British Medical Journal, SAMHSA)

Marijuana smoke contains 50 to 70 percent more carcinogenic hydrocarbons than does tobacco smoke. (Source: NIDA)

Drug Legalization Would Dramatically Increase the Costs to Our Society
If drugs were legalized, the United States would see significant increases in the number of drug users, the number of drug addicts, and the number of people dying from drug-related causes.
Studies show that attitudes about drugs drive youth drug use rates. By trivializing and advocating tolerance for illegal drug use, drug legalization groups send a message to young people that experimentation with dangerous illegal drugs is acceptable. Drug legalization would increase the occurrence of drug impaired driving. Drugs affect concentration, perception, coordination, and reaction time; many of the skills required for safe driving.

Who’s Really in Prison for Marijuana?
One of the primary arguments used by drug legalization advocates is based on a lie – that our prisons are filled with marijuana smokers. In fact, the vast majority of drug prisoners are violent criminals, repeat offenders, traffickers, or all of the above.
The most recent data available reveals that just 1.4 percent of the state inmate population were held for offenses involving only marijuana, and less than one percent of all state prisoners (0.3 percent) were incarcerated with marijuana possession as the only charge. (Dept. of Justice Bureau of Justice Statistics)
Out of all drug defendants sentenced in federal court for marijuana crimes in 2001, the overwhelming majority were convicted for trafficking, according to the U.S. Sentencing Commission. Only 2.3 percent—186 people— received sentences for simple possession, and of the 174 for whom sentencing information is known, just 63 actually served time behind bars.

Source: www.WhiteHouseDrugPolicy.gov 2007

A ground-breaking report into the use of the stimulant MDMA has revealed it claimed 82 Australians over five years from 2000 – and the number fatalities is increasing.
The National Drug and Alcohol Research Centre’s study into MDMA-related deaths is the most comprehensive examination to date, and has prompted calls for more research. Last year, Perth teenager Gemma Thoms collapsed at the Big Day Out and died in hospital. She swallowed three ecstasy pills at the festival gates to avoid being caught by police.
Her mum, Peta, is planning to hand out leaflets at today’s Big Day Out warning revellers about the dangers. Concert organisers had promised to design and print flyers for all the 40,000 people expected to attend the festival.
Additional figures obtained by The Sunday Times this week show 23 people died as a result of taking ecstasy in Australia from 2006 to 2008. There could be more, with a number of cases still under investigation. Of those, 10 deaths were reported in 2006, seven in 2007 and six in 2008, with 65 per cent of victims aged 20-29 and more than 70 per cent male.
More than 80 per cent of the deaths were unintentional and 15 of the 23 victims took other drugs with the MDMA, including cannabis or alcohol. In the earlier cases examined by the National Drug and Alcohol Research Centre, 91 per cent of the deaths were directly caused by drug toxicity and MDMA was the sole drug involved in a quarter of cases.
It also contributed to a number of drownings, cardiovascular problems and car crashes. Last week, The Sunday Times revealed that ecstasy had never been cheaper in Perth, with the street price dropping for the first time last year.
A survey by the National Drug Research Institute also found that young users were taking the party drug more often and in bigger quantities. The number who binged on the drug rose from 22 per cent in 2008, to 40 per cent in 2009.
Funded by the Federal Department of Health and Ageing, a separate National Drug and Alcohol Research Centre report found the median age of ecstasy fatalities was 26, with the youngest victim 17 and the oldest 58.
“There are a lot of accidental deaths where MDMA is thought to have played a role . . . and this seems to be a more prominent and prevalent concern,” the centre’s assistant director Louisa Degenhardt said. “A lot of bad things can happen when combining drugs because accidents happen when people are intoxicated with any drug.”
Royal Perth Hospital emergency 2medicine specialist Daniel Fatovich warned that cheaper prices meant more West Australians could afford more pills, increasing the risk of overdoses.

Source www.perthnow.com.au January 30, 2010

Smoke and mirrors: Colorado teenagers and marijuana

By Christian Thurstone

Colorado’s public policies regarding the use of medical marijuana are a complete mess — and as the medical director of a busy adolescent substance abuse treatment program in Denver, I get to contend with this mess every day.
Take, for example, the 19-year-old whom I have treated for severe addiction for several months. He recently showed up in my clinic with a medical marijuana license. How did he get it? Easy, he said. He paid $300 for a brief visit with another doctor to discuss his “depression.” The doctor took a cursory medical history that certainly didn’t involve contacting me. The teenager walked out with the paperwork needed not only for a license to smoke, but also for a license permitting a “caregiver” to grow up to six marijuana plants for him. My patient, who had quit using addictive substances after a near-death experience, is back to smoking marijuana daily, along with his caregiver. So, that’s just one young person who managed to game the system, right? Not by a long shot.
In the last three months, I have seen more than a dozen young people — all between the ages of 18 and 25 and with histories of substance abuse — who received from other doctors what are essentially permission slips to smoke pot. Some of my colleagues recently reported seeing a young, pregnant woman who was granted a license to smoke marijuana because of her nausea. (Yes, you read that right.) Kids without licenses tell me about the potent pot they buy from from caregivers whose plants yield enough supply to support sales on the side.
Colorado schools are also scrambling to make sense of our muddled public policies. Educators ask me how to deal with students who have marijuana prescriptions for their attention-deficit/hyperactivity disorder and with the “medical marijuana specialists” seen passing out business cards in student parking lots. Here’s what I tell them: Good research shows that using marijuana makes anxiety, depression and ADHD worse, so let’s stop prescribing marijuana to our youth.
Colorado is just beginning to see much bigger and more costly problems associated with teen marijuana smoking. That’s particularly unfortunate because our state already ranks among the top five for adolescent marijuana use and among states providing the least access to adolescent substance abuse treatment. For teenagers, marijuana is an especially addictive drug. Nationally, almost 5.5 percent of high school seniors smoke marijuana daily, according to researchers at the University of Michigan. About 95 percent of the hundreds of young people referred to my clinic each year have problems with marijuana. I see teenagers who choose pot over family, school, friends and health every day. When they’re high, these young people make poor choices that lead to unplanned pregnancies, sexually transmitted diseases, school dropouts and car accidents that harm innocent people. When teenagers are withdrawing from marijuana, they can be aggressive and get into fights or instigate conflicts that lead to more trouble.
Now, almost every day, a kid asks me, “Doc, how can marijuana be bad? It’s a medicine.”
I recently reviewed medical marijuana licenses in Colorado and found that only 3 percent belong to people with cancer and 1 percent to people with HIV. Those illnesses are not open to much interpretation; you’ve either got them or you don’t. However, a whopping 90 percent of Colorado’s medical marijuana licenses have been awarded for “pain,” which is a highly subjective qualifying condition that makes it easy to abuse the system. Also interesting is that 70 percent of Colorado’s medical marijuana prescriptions are for men, and the biggest age group of licensees is 25- to 34-year-olds. Medical marijuana in this state is not being prescribed for end-stage illnesses. Instead, it is being handed to the demographic most likely to have addictions.
The medicinal value of smoked tetrahydrocannabinol — marijuana’s active ingredient — has hardly been studied in controlled trials, which is why the American Medical Association recently called for more research. In the absence of credible data, we’re allowing this public debate to be bombarded by junk science and blatant lies championed by people more interested in getting high than in alleviating the pain of end-stage illness.
Medically speaking, there’s probably little need for smoked marijuana. Tetrahydrocannabinol has been available as a pill for years. For patients too nauseous to take a pill, a tetrahydrocannabinol patch has been produced and studied but is not yet available for prescription. The pill and patch have been deemed effective, produce less intoxication and are far less addictive than smoked marijuana.
With such limited data, it’s incredible that marijuana bypassed FDA approval and the way medications are normally dispensed in pharmacies. It is ridiculous that this “medicine” can be sold in an array of flavors alongside pot brownies and candies. Also stunning is that marijuana has bypassed the Colorado Prescription Drug Monitoring Program, which enables me to look up all of my patients’ prescriptions. Now, I can see all of their meds — except for their marijuana. What Colorado has created is a backdoor way to legalize marijuana, and it has done so in a manner that makes a mockery of responsible medicine.
Let’s stop talking in terms of smoked marijuana’s medicinal value because we’re not even close to knowing what that is. Let’s instead answer the question that’s truly at the heart of all of this political wrangling: Is smoking marijuana a civil right? Before answering that question, Colorado should carefully study the social costs of accidents, aggression, school dropouts, STDs and teen pregnancy that will inevitably be the result of increased marijuana use. No medication — not even marijuana — is without side effects.
Christian Thurstone is a board-certified child/adolescent and addictions psychiatrist who conducts federally funded research on marijuana addiction in teenagers
Source: http://www.denverpost.com 31st Jan 2010

Decriminalization of drugs in Portugal – The real facts!
The national press, and especially the foreign, has referred with outlandish insistence, on the eve of two important elections in Portugal, the “resounding success” of the decriminalization of drugs launched in 2001 by the Socialist Government, neglecting all other European countries and in prejudice of the guidelines of the UN Conventions of which Portugal is a signatory.

Respect for the truth of the matter requires the Association for a Drug Free Portugal (APLD) to clarify to the Portuguese, and others, the real consequences of the implementation of this current policy, independent of particular party affiliation. Portugal adopted a unique and unmistakably questionable ‘solution’ to manage the nightmare of drugs.

Recent articles in the weekly British magazine, The Economist and The Cato Institute of Washington promote government options as a legitimate right. The problem is the rest; the manipulation of the facts and numbers is unacceptable!

In 2006, the total number of deaths as a consequence of overdose did not diminish radically compared to 2000, nor did the percentage of drug addicts with AIDS decrease significantly (from 57% to 43%). The opposite occurred.

Portugal faces a worrying deterioration of the drug situation. The facts prove “With 219 deaths from ‘overdose’ per year, Portugal has one of the worst results, with one death every two days. Along with Greece, Austria and Finland, Portugal registered an increase of deaths by more than 30% in 2005 ” and ” Portugal remains the country with the highest increase of AIDS as a result of injecting drugs (85 new cases per million residents in 2005, when the majority of countries do not surpass 5 cases per million). Portugal is the only country that recorded a recent increase, with 36 new cases estimated per million in 2005 when in 2004 only 30 were registered” (European Observatory for Drugs and Drug Addiction 2007). The European report also confirmed that in 2006, Portugal had registered 703 new cases of SIDA, which corresponds to a rate eight times higher than the European average!

The decriminalization of drugs in Portugal did not in any way decrease levels of consumption. On the contrary, “the consumption of drugs in Portugal increased by 4.2% – the percentage of people who have experimented with drugs at least once in their lifetime increased from 7.8% in 2001 to 12% in 2007 (IDT-Institute for Drugs and Drug Addiction Portuguese, 2008).

With regard to the consumption of cocaine “the latest data (surveys from 2005-2007) confirms the increasing trend during the last year in France, Ireland, Spain, The United Kingdom, Italy, Denmark and Portugal” (EMCDDA 2008). While rates of use of cocaine and amphetamine doubled in Portugal, seizures of cocaine have increased sevenfold between 2001 and 2006, the sixth highest in the world (WDR-World Drug Report, 2009).

With regard to hashish, it is difficult to assess the trends and intensive use of hashish in Europe, but among the countries that participated in field trials, between 2004 and 2007 (France, Spain, Ireland, Greece, Italy, Greece, Italy, The Netherlands and Portugal) there was an average increase of approximately 20% ” (EMCDDA, 2008).

In Portugal, since decriminalization has been implemented, the number of homicides related to drugs has increased 40%. “It was the only European country with a significant increase in (drug-related) murders between 2001 and 2006″ (WDR, 2009).

A recent report commissioned by IDT, the Center for Studies and Opinion Polls (CESOP) of the Portuguese Catholic University, based on direct interviews regarding the attitudes of the Portuguese towards drug addiction (which has strangely never been released), revealed the following: 83.7% of respondents indicated that the number of drug users in Portugal has increased in the last four years. 66.8% believe that the accessibility of drugs in their neighborhoods was easy or very easy and 77.3% stated that crime related to drugs has also increased (“Toxicodependências” No. 3, 2007).

This is the painful reality in Portugal- the attitude towards drugs and drug addiction. For the Portuguese government, drug addicts are essentially regarded as ‘sick’. This is not only a suicidal attitude, but a public expense. Pretend you are sick and the government pretends to treat you! The decriminalization of consumption, possession and acquisition for consumption has added to the illicit consumption of drugs. Legalizing a crime committed by “drug addicts” (or “the sick”) does not seem the most effective way to combat the problem, as shown by greatly increased rate of drug-related homicides recorded in Portugal compared to other countries with reduced dependence and related crime.

What is happening in Portugal is very peculiar; drug addicts, with the support of the government, rely on their status as ‘sick’. But these addicts often forget that they are ‘sick’ and are assumed as free and responsible people, who are able to decide whether they want treatment or not! As a result of decriminalization the addict is considered a patient and not a delinquent. The state can not choose, through a political policy, a solution that gives priority to feed the “disease” rather than a cure! Resounding success? Glance at the results!

Manuel Pinto Coelho
President of the Association for a Drug Free Portugal

Source: www.wfad.se Tuesday, 02 February 2010

Cannabis use among Britain’s young offenders is “out of control”, up by 75 per cent in some areas and fuelling a crime epidemic, with youngsters stealing to fund their addictions, according to two studies.

A national survey of Youth Offending Teams indicates that two-thirds of them have seen an increase in cannabis use of between 25 per cent and 75 per cent since David Blunkett, the then Home Secretary, downgraded the drug to class C in 2004. Some 90 per cent of all young offenders are using cannabis in some areas, a far greater proportion than the general youth population.

Research carried out by King’s College London has indicated that 25 per cent of young offenders in Sheffield have turned to crime to fund their habit. This contrasts with previous government research which said that “cannabis use was unlikely to motivate crime”.

A rise in young people smoking cannabis openly has led to a rise in the fear of crime in the community, leading Sheffield’s police chief to warn of the threat that cannabis poses to the “fabric of society”.

Fifty out of 51 of the youth courts in England and Wales are so alarmed that they have written to Jacqui Smith, the Home Secretary, urging an upgrading of cannabis back to class B. Within a month of Gordon Brown taking over as Prime Minister in June, Ms Smith signalled a review of the controversial decision to downgrade cannabis amid growing fears of the serious mental health implications of stronger varieties of the drug, first highlighted in the IoS in March. A detailed review in The Lancet concluded that the drug increases the risk of psychosis by 40 per cent – and younger users are most at risk.

But Mr Blunkett’s decision to reclassify the drug three years ago has had another, more sinister impact, with organised crime taking a much more active role in the production and distribution of cannabis.
Detectives say that the changing nature of cannabis – as imported cannabis gives way to the much more damaging skunk variety, grown in this country – has also played into the hands of criminals. Drugs experts and police also say that Britain for the first time is an exporter of the drug.

John House, the Chief Superintendent of South Yorkshire Police, said:
“Cannabis production in this country is rising exponentially. We used to be a net importer of cannabis from places like Morocco, but there are indications that we are now starting to export cannabis.”

Youth Offending Teams said that since reclassification dealers were finding it easier to convince young people to try what they now wrongly regarded as a relatively harmless drug. Nationwide, YOTs deal with 10,000 youngsters up to the age of 17 who come before the courts, but whose punishment falls short of being sent to a secure unit.

Darren Johnson, the secretary of the Association of Youth Offending Team Managers, said that cannabis consumption was “out of control” in some areas, with nine in every 10 youth offenders reporting that they used the drug.

Overall, official figures suggest cannabis use is stable, but that masks a very different picture among the most vulnerable youngsters in society, say experts. Lord Ramsbotham, the former chief inspector of prisons, said: “Downgrading cannabis was a mistake because it made it out to be less dangerous than it is. Adult minds and adolescent minds are different and young people must not play games with this stuff. ”

Ch Supt House, who commissioned the King’s College research, said: “The reclassification of cannabis was a decision taken based on a different drug. It wasn’t taken bearing in mind the strength of new cannabis, or the potential damage to social fabric caused by open cannabis smoking in the street by those who don’t perceive it as a serious crime.”

The number of cannabis factories closed down by the Metropolitan Police has more than doubled in the past two years as organised gangs invest more in cannabis production. In March, the charity DrugScope revealed that, on average, UK police were raiding three cannabis farms a day with 400 plants regularly recovered at raids. Around two-thirds to three-quarters of UK cannabis farms are now run by Vietnamese criminal gangs.

Tim Hollis, the Chief Constable of Humberside, and chairman of the Association of Chief Police Officers drugs committee, said: “A large number of police forces are increasingly coming across cannabis factories, where there is significant investment by criminals in the infrastructure to produce cannabis in considerable quantities. There is increasing evidence of the scale and the geographic spread. This isn’t just happening in urban areas, now we are finding them in the more traditional, rural areas.”

Growing new strains of cannabis under ultra-violet lights, dealers are producing stronger varieties such as skunk, linked with the massive rise in cannabis-related hospital admissions and addictions among young people. These have triggered the current government review by the Advisory Council on the Misuse of Drugs into whether cannabis should revert to being a class B drug. The Home Secretary will announce her decision next April – and experts are divided, with many believing the most pressing issue is one of mental health provision rather than primarily an issue of criminality.

Professor Sue Bailey, a forensic psychiatrist who works with young offenders with mental health problems, said: “From my own experience in clinical practice over the last three years I can say cannabis use has increased, the amounts young people are smoking have increased but the most critical factor is that they seem to be starting younger.”

Emma Warren, a mentor at Live, a magazine produced by young people in south London where half of the youngsters are referred by agencies such as YOTs and the Probation Service, said: “Cannabis is seen as very everyday, it is normalised, even more so than in previous generations.
While most people who smoke do so recreationally, the ones that do fall, fall harder now than they did before.” Mann-Ray, a 19-year-old photographer with Live, has never used cannabis but sees it as a part of everyday life. He said: “Everybody smokes now, even sensible people. They think it’s not a big deal, that it’s as harmless as air. In the past people used to hide it, but now they are really open, even at college.”

This worrying trend continues, according to Clare McNeil, spokeswoman for Addaction, a drug treatment charity: “Over half the young people we work with are being seen due to cannabis use and a quarter of these are using skunk – a proportion that is growing. Cannabis is seen by young people as a ‘safe’ drug and many young people will smoke skunk in the same way as they drink lager. Whether cannabis is class B or C doesn’t make any difference to the young people we work with, many of whom actually think the drug is legal.”

Rethink, the mental health charity, is calling for young people to be educated on the dangers of the drug after its research found that around half of young people think cannabis is safer than alcohol and a quarter say that it is better for you than coffee.

“Jacqui Smith should use the current review to deliver the ‘massive’
public education campaign which Charles Clarke promised in 2005,” says Jane Harris, the head of campaigns at Rethink. “This is the key task, which we should all focus on instead of fiddling with the classification system.”

And Darren Johnson, spokesman for YOT managers, said: “The main impact of reclassification would not necessarily be a change in use but rather a change in the police approach to it, namely the police would arrest more young people, thus bringing more into the criminal justice system.” Police or politicians alone will not be able to solve the problem, says Chief Constable Hollis: “Young people do not make choices based on the classification of drugs… we need to think about how we communicate with them to make better-informed choices, which is quite a challenge, but I think it needs some real humility and for us to be honest with ourselves. Clearly the police have a role to play… but anyone who thinks a police officer or a politician in a grey suit can stand up and say, ‘Don’t do this, children, because…’ and thinks that will have a huge impact is naive.”

Source: http://news.independent.co.uk/uk/crime/article2966955.ece 16.09.2007

THOUSANDS of pounds is being paid out in compensation to drug addict prisoners being forced to go cold turkey in Welsh jails, a Wales on Sunday investigation has revealed.
While many victims of crime receive paltry sums in compensation after the turmoil they have been through, the Prison Service is being forced to pay out to jailbirds having to go without drugs. It followed claims the practice amounts to assault and a breach of human rights.
Almost £11,500 was paid out to three drug addicts in Cardiff and Parc prisons in the past year alone.The sum paid to addicts was part of more than £50,000 paid out in compensation to prisoners in Welsh jails last year for a number of reasons.
The Ministry of Justice said they had to settle a number of compensation claims for prisoners due to “the way they went through detox”. But the payouts have been fiercely criticised, with one MP describing it as “a lose-lose situation for the taxpayer”.
The settlements originate from a test case two years ago when six claimants from across Wales and England were given the green light to sue the Home Office They said once in jail, and under the responsibility of the Prison Service in England and Wales, they were made to go cold turkey – where drugs are withdrawn or cut short.
Our probe comes amid increasing evidence convicts are exploiting human rights laws to make a profit from their time in jail. The figures were finally released after Wales on Sunday complained to the National Offender Management Service following seven months of heel-dragging by officials.
Conservative MP David Davies said: “Not only are they getting compensation, they are being funded by the taxpayer to put these claims in. It’s a lose-lose situation for the taxpayer. “Cold turkey is not all it’s cracked up to be. People seem to have got their ideas from Trainspotting.
“Actually, most informed medical opinion says taking alcohol away from an alcoholic can be a far more difficult experience for them. “I’ve got no sympathy for them, I’m afraid. Nobody forces them to get into crack in the first place.”
Peter Stoker, Director of the National Drug Prevention Alliance, said he thought lawyers were taking advantage of the system and big changes needed to be made. Prisoners should “absolutely” not be able to get drugs in jail, he added. He said: “They’ve been put up to it. There are a lot of liberal lawyers and organisations around and this is the kind of thing that they will come up with.
“My gut feeling is like a lot of people’s gut feeling, that I think there has to be a question as to what extent somebody who is convicted has foregone many of their human rights by committing the crimes they did in the first place. “I don’t think there’s anything wrong with trying to wean prisoners off drugs as soon as possible. “I find it as wacky as the general public do. All I can say is I think it’s now generating enough concern that it’s time the Government and the Prison Service looked at it again.”
But the charity Drugscope defended the practice, saying the Prison Service had a “duty of care” to prisoners with a drug addiction. Chief Executive Martin Barnes said: “It is clearly established in law that prisoners are entitled to the same standard of health care that they would receive in the community; the medical care received by claimants under the original action had fallen well below acceptable standards. After seeking legal advice, the Home Office accepted full liability in all the cases. “It is clear, however, that short, sharp, enforced detoxification is still the experience for many entering prison, even for those who were in receipt of a prescribed substitute drug such as methadone prior to custody. “Not only can enforced detoxification be extremely unpleasant, it does not mean that someone will remain free of drugs or their dependency.”
The Ministry of Justice said: “Each compensation claim received by the Prison Service is treated on its individual merits. Legal advice is sought and, on the basis of that advice, a decision is made on whether or not the claim should be defended. “We cannot therefore comment on individual cases or the reasons that they were settled, as the terms of each settlement vary and may be subject to confidentiality clauses.”
Source: Wales On Sunday : Jan 20 2008

An angry row has blown up over proposals to upgrade cannabis to a class B drug, with leading experts from the Advisory Council on the Misuse of Drugs (ACMD) accusing the Government of a “deliberate leak” of its plans.
Ignoring a directive not to speak to journalists about reports that the Government has already made its mind up, ACMD member Professor Les Iversen, a pharmacologist at Oxford University, said: “I was not pleased to read what appears to be a deliberate leak about the government’s alleged intention to reclassify, regardless of advice received.
“If ACMD were to recommend no change and this were to happen, I believe it would be the first time that any Home Secretary acted against the recommendations offered and it would call into question the whole function and future of this group.”
The outburst followed claims that Gordon Brown and the Home Secretary, Jacqui Smith, were determined to reverse the decision to downgrade the drug to class C when the ACMD completes its report in the next few months. Although its recommendations are not yet known, ministers are already making clear that Ms Smith is prepared to overrule the expert body.
But one former member of the influential council last night claimed the ACMD was totally opposed to the Government’s stance. “There is no way that the ACMD would support any reclassification of cannabis, unless there were some political shenanigans going on,” said the Reverend Martin Blakeborough.
Rev Blakeborough, who runs the Kaleidoscope drug abuse charity, said: “There is no significantly new evidence to suggest that cannabis is any more harmful than in the last review we did 18 months ago.”
“The only reason that the ACMD is being forced to discuss this matter is because every new Home Secretary seems to want to show how tough they are,” he added.
Professor David Nutt, chair of the ACMD’s technical committee, which will start taking evidence on classification at a public meeting next month, said: “In the end, as with all laws, it’s a political decision – the ACMD only advises.”
But David Raynes, of the National Drug Prevention Alliance, criticised the ACMD’s stance and said that it was dominated by people who advocate “harm reduction” and whose sympathies lie with pro-legalisation campaigners: “I actually think that the harm reduction/liberalisation/legalisation lobby is too strong in there (and in the Home Office). Some ACMD members are genuine but misguided, some are just the great and good with little understanding of the legalisation game that is being played by others.”
The controversy comes days after new figures revealed that almost 500 people are being treated by the NHS every week for cannabis-related mental health problems. Since the Government downgraded it from a class B to a class C drug in 2004, the number of adults being treated for its effects has risen from 11,057 in 2004-05 to 16,685 in 2006-07. Also, the number of children needing medical attention because of cannabis use has increased to more than 9,200 – up from 8,014 in 2005-06.
Fears over the hidden health risks of the drug, particularly on the mental health of young people, have prompted the calls for a review of cannabis. More than 2.5 million 16-24 year-olds have used the drug. The ACMD is expected to make its own recommendations known in April.
In a statement, a Home Office spokesman reiterated that the ACMD’s role is confined to providing “advice on classification”.

Source: The Independent on Sunday. 20th January 2008

Gun crime has risen by four per cent, according to government statistics Drug offences have leapt by 21 per cent in just one year, latest figures showed yesterday, piling more pressure on Gordon Brown to reverse the Government’s “softly-softly” stance on cannabis.

The number of drugs crimes recorded by police has now leapt by more than 60 per cent in the three years since Labour relaxed the law on cannabis possession – downgrading it from Class B to Class C so that most users no longer face arrest. Home Office crime figures also show burglary rising by five per cent year-on-year – reversing a long term fall – and a significant four per cent rise in gun crime.

Overall crime levels were unchanged over the year, according to the figures, while there were slight falls in violent crime and car thefts.

Those successes were marred, however, by the huge rise in drug crime which soared to 55,700 in the three months to September last year – up by more than a fifth on the previous year and equivalent to more than 600 people every day caught dealing or possessing drugs.

Critics claimed the sharp rise was further evidence that former Home Secretary David Blunkett’s decision to relaxing the law on cannabis was a serious blunder. At the time of the controversial reclassification in 2004, the police counted 34,600 drugs offences between July and September, and since then the figure has climbed steadily to the present peak of almost 56,000.

The Home Office argues that the trend is due to police officers being more willing to hand out on-the-spot official cautions to cannabis users, without facing the paperwork and red-tape connected with arresting and prosecuting them. But critics claim that argument no longer explains the continuing trend three years after the law was relaxed.

Gordon Brown is currently weighing up whether to reverse David Blunkett’s move and to toughen the law by restoring cannabis to Class B. Chief police officers, magistrates and a range of medical experts have backed the move, and ministers are now waiting for the latest report from the Advisory Council on the Misuse of Drugs in the coming weeks.

The Advisory Council on the Misuse of Drugs will offer its latest report within the next few weeks. Pressure has grown for a change following further evidence of the serious mental health damage which cannabis users are facing as highly potent “skunk” varieties have become more popular – now accounting for
75 per cent of all drugs seized.

In some parts of the country the number of diagnosed mental disorders blamed on cannabis use have risen tenfold over the past decade, and the number of people undergoing treatment for cannabis use has soared to a record 25,000.

Yesterday’s figures also reveal a five per cent year-on-year rise in domestic burglary, as measured by the British Crime Survey, based on household interviews – which ministers claim gives the most accurate picture of crime trends.

Police recorded 67,000 break-ins from July to September – equivalent to
728 per day, or one every two minutes. The increase in BCS figures brings to an end a long-term decline in burglary levels, and will raise fears that increased drug use is driving a resurgence in thefts from homes.

The BCS results showed overall crime levels were stable, as were levels of violent crime and vehicle thefts. Shadow home secretary David Davis said: “These latest official figures show that Labour is failing to combat both violent crime and its causes.

“Violent crime is fuelled by drugs and Labour’s chaotic and confused policy on drugs. “Drugs wreck lives, destroy communities and are a major symptom of our broken society.

“The Government’s complacency shows they are part of the problem, not the solution.” Liberal Democrat home affairs spokesman Chris Huhne said: “Violent crime – including, most alarmingly, gun crime – is still far higher than 10 years ago and has to be tackled much more vigorously.

“Police should be devoting more time to stop and searches for knives and guns, and the Government needs to clamp down with a major new effort to stop gun smuggling.

“Nine times more officials are allocated to tackling cigarette smuggling than gun smuggling, which is a crazy set of priorities.” Home Secretary Jacqui Smith said: “These latest crime figures contain some excellent results and I am particularly pleased that the risk of being a victim of crime is now at a historically low level.”

Source: Daily Mail 24 Jan 2008

The UK has third highest teenage cannabis use in OECD. A report by UNICEF into child poverty in 21 industrialised countries found that the UK was third highest in terms of the proportion of 11, 13 and 15 year- olds who said they had taken cannabis in the last 12 months. The percentage of children who had used cannabis was 35 per cent in the UK, compared to 27 per cent in France, 18 per cent in Germany and less than 5 per cent in Sweden and Greece (UNICEF, An Overview of Child Well-Being in Rich Countries, 14 February 2007, Figure 5.2c).

• Increase in Class A drug use. The number of people using Class A drugs in the last year has gone up by a quarter, from 2.7 per cent in 1998 to 3.4 per cent in 2006-07(Home Office, Drug Misuse Declared: Findings from the 2006/07 British Crime Survey, October 2007).
Drug offences increased. Total recorded drugs offences have increased from 135,945 in 1998-99 to 194,502 in 2006-07, an increase of 43 per cent (Home Office, Crime in England and Wales 2006/07, July 2007).

Source: Keith Girling News Blog. 24th January 2008

Pushers caught with up to £100,000 of cocaine or heroin face downgraded sentences.

Mark Macaskill
DRUG dealers caught with heroin and cocaine worth up to £100,000 could be jailed for as little as 15 months under new guidelines issued by the Crown Office. Senior prosecutors have been ordered to ignore existing rules that state anyone caught with Class A drugs worth £20,000 or more should appear in the High Court, which can impose a maximum life sentence.
Now dealers caught with hauls worth up to £100,000 will appear before sheriff courts that can only hand out a maximum five-year jail term. It means that offenders – who in Scotland are eligible for release after serving a quarter of their sentence – could be back on the streets after 15 months behind bars.
The move is aimed at reducing the workload on the country’s High Courts, many of which are struggling to cope with a rising tide of crime. However, it has provoked anger among senior police officers, prosecutors and drugs campaigners who have accused the Crown Office of downgrading the offence to save money.
According to government figures published last year, heroin seizures in Scotland in 2005 rose by 27% on the previous year from 2,224 to 2,816, while cocaine hauls increased by 23% from 709 to 870 over the same period.
“The public will be getting more and more concerned that we are heading towards a soft touch Scotland,” said Bill Aitken, justice spokesman for the Scottish Conservatives. “I would be deeply concerned at anything that sends out a signal that drug trafficking is in any way seen as a second-class crime.”
Alistair Ramsay, chairman of Drugwise, the Glasgow-based drugs advice service, said: “You have to be horrified that these kinds of sentences are being used to save money and time. “If courts take a more lenient line, the message is clear that society, particularly in Scotland, is becoming more tolerant of drugs. That is the wrong message.”
A senior police officer, who asked not to be named, added: “My concern is that £100,000 is a lot of drugs – the equivalent of about 1Åkg of heroin. People have to be punished in relation to the quantity of drugs they are smuggling. This isn’t much of a deterrent.” There are already signs that the new guidelines are being implemented. Last week, a man who had pleaded guilty to smuggling £50,000 worth of heroin from Liverpool destined for Aberdeen, appeared at Dundee sheriff court.
The case was originally marked by the procurator fiscal for the High Court but, the decision was overruled by the Crown. He is expected to be sentenced next month. Last week, the Crown Office insisted that drugs offences were still viewed seriously and would be treated as such.
“We have a duty to review our prosecution policy on which court should hear a particular case,” it said.

Source: The Sunday Times April 20, 2008

“There are few substances which are surrounded by more controversy, and which have at the same time such important and potentially far-reaching public health implications”, the late Professor Henry wrote.
The ACMD, the body tasked to adjudicate the evidence on cannabis, never shared this view and as a result fell foul of the debate. It has taken the sacking of Professor Nutt, the brouhaha and the publicity surrounding it, to pull attention back to the science on cannabis effects; science that he and the ACMD were so slow to assess, so little interested in and so quick to dismiss.
Last week the BBC’s The Report programme asked the question of why on earth the ACMD recommended cannabis’ downgrading in the first place. Labour MP Gwyn Prosser explained. For those arguing in favour, in the pro-liberalism political climate of David Blunket’s accession to the Home Office, “it was all but a done deal, they were pushing at an open door ….” The ACMD was party to that process.
Its first cannabis report (the only one that the ACMD Chair ‘had pleasure in enclosing’ to the Home Secretary), which recommended reclassification to C, was just 22 pages long. As a review of the classification of cannabis preparations, ‘in light of the current scientific evidence’, it was nominal and cursory. It drew not at all on the “large scientific literature on the effects of cannabis on human health and human society” available at the time. Its recommendation was based on drugs use prevalence statistics, speculations about and reports on decriminalisation regimes. Of the 24 references listed, only 4 referred to the scientific literature on effects. Yet when Mary Brett, a biologist and former grammar school head of health education, surveyed it for herself, she found no less than 44 pre 2002 scientific publications on the negative impact of cannabis; evidence of psychosis in cannabis users dating back to 1972. The review skated over the evidence and paid lip service to cannabis harms alone.
Professor Robin Murray’s new research on the causal link between cannabis and schizophrenia was published eight months afterwards. In 2005 Charles Clarke not unreasonably requested the ACMD to examine all the evidence relating to mental health; he directed them to the changed content of cannabis; forensic lab data was already showing that consumption had shifted from imported resin to home grown herb with a much higher THC content and a dangerously altered THC/CBD ratio – ’skunk’ which had become a rite of passage for ever younger teenagers.
The ACMD were quick to express their misgivings. Politicians were ‘pandering to the media’ said Lord Adebowale, a non-scientist ACMD member. He was not convinced there was fresh evidence. Sir Michael Rawlins (then Chairman) also seemed to have closed his mind. At a conference in the April of that year he confirmed he would not be ‘confused’ by the new data. True to his word only 5 pages of the 36 page response dealt with the massive output on the effects of cannabis on mental health, described as a ‘biologically fraught hypothesis’. Cannabis could lead to short lived panic attacks and worsen the symptoms of schizophrenia, it conceded. It could ameliorate them too. It was not a necessary, nor a sufficient, cause for the development of schizophrenia. The evidence for consumption of more potent cannabis was lacking. That was the medicine doled out to the Home Secretary. He took it.
So when Jacqui Smith asked them to look at the evidence again the ACMD were visibly affronted. Sir Michael Rawlins made his discontent public, the 10 minutes slot for cannabis on the agenda collapsed to two. He devoted them to grumbling – saying that he wished they had not been asked. One (non scientific) Council member said afterwards he had no intention of ploughing through the evidence again.
In the meantime the ACMD’s deputy chair had already queered the pitch for a dispassionate review. In full media glare Professor David Nutt had published an article in the Lancet in which he set out to demonstrate, through delphically derived but incomplete polling, a new classification of harms in which alcohol and tobacco emerged more harmful than cannabis and ecstasy. His intention was clear – to invalidate the distinction between licit and illicit substances.
What he ignored (or perhaps pandered to) was the fact that while the excess mortality and healthcare costs associated with the use of tobacco and alcohol are well known, those for cannabis remain largely unknown. He took the lack of comparable definitive evidence on cannabis concerning the population as a lack of evidence of its harm for either individuals or society.
At 56 pages long, the ACMD’s final report referred to more scientific papers than before. But if a precautionary principle was applied it was to the data itself, not to its implications or to their classification recommendation. So cautious were they that they completely ignored the key published British longitudinal data on cannabis use and schizophrenia. They relied instead on a GP data base survey they decided to commission from one of their own members
The analysis they so bizarrely ‘ostracized’ was of a South East London longitudinal cohort covering the period between 1966 and 99 which uniquely allowed for the examination of trends in cannabis use prior to first presentation with schizophrenia. It demonstrated a continuous and statistically significant rise in the incidence of schizophrenia between 1965 and 1997, one which had doubled over the last 3 decades, with the greatest increase in people under 35. It suggested that up to 20% of schizophrenia cases could be cannabis attributable.
The ACMD’s decision to rely exclusively on a survey of its own commissioning which did not specifically look at cannabis use was curious. Presented by one of its own members, Professor Ilana Crome, as unpublished evidence, she reported the annual incidence of diagnosed schizophrenia and psychoses had fallen between 1996 and 2005. Professor Murray dismissed this as invalid: “I have known about this study since its inception and advised the authors that they were unlikely to be able to come up with meaningful results. Firstly, a major problem concerns the diagnoses. In my experience GP diagnoses of psychiatric disorders are not very accurate. Secondly, we do not know how many cases of psychosis are dealt with exclusively by psychiatrists and GPs don’t know.”
His contention is that there is no significant or well done study that has not shown early onset of cannabis use to be associated with psychosis. Since 2002 he points to no less than eight cohort studies all of which show the risk of psychosis to be higher in those that smoke cannabis – a risk that increases by 6 to 7 times for heavy smokers, risks that for adolescents are disturbingly high and that show early users run into greatest problems. Starting by 15 the risk is 4 times higher than starting at 18 – a data trend which suggests the risk multiplies for each year younger.
Yet the ACMD remained adamant that these studies did not meet their bar of ‘proof beyond reasonable doubt’ and that more research was required. Others scientists begged to differ saying the persistent association was robust to methodological challenges.
Whether recently published findings which confirm that THC induces a transient, acute psychotic reaction in psychiatrically well individuals would have persuaded them, is anyone’s guess. Meanwhile the ‘Cannabis Dependency Units’ as psychiatrists describe their first contact schizophrenia wards, continue to take their toll. And while Holland finds its three dedicated residential rehabs for their severest adolescent (13 – 20) cannabis dependents to be insufficient and is building more, to create 600 places, we, in the UK, have none. We leave our stoned and de-motivated youngsters on the streets. For that we can thank the ACMD’s lassitude.
Source: by Kathy Gyngell, UK Centre for Policy Studies 29th November 2009

This month, the National Treatment Agency published the staggering figure of nearly 25,000 young people under 18 getting “treatment” for their drugs and alcohol problems.[1] 10 years ago, the thought of so many young teenagers using drugs to this degree was unimaginable, writes Kathy Gyngell, chair of the Prisons and Addiction forum at the Centre for Policy Studies.
The sad fact is that, despite 10 years of a drug strategy purportedly designed to reduce use by young people, there are thousands of children beginning their lives so damaged by drugs that they need treatment. This is major social problem that can neither be denied nor brushed under the carpet. What teenagers do today determines the scale of the drugs problem tomorrow.
National school-age statistics show that a staggering 25% of UK children (aged 11–15) have tried drugs and that 10% of them use drugs regularly.[3] This is way higher than the European average. It is also likely that levels of teenage cannabis use are higher than the published statistics, as the Advisory Council on the Misuse of Drugs recently acknowledged.
Hospital admissions reflect the rising strength of cannabis and that children are moving earlier to Class A drugs. With the UK cannabis market dominated by high-THC skunk – which, according to a former head of the Dutch Police Narcotics Division, should now count as a ‘hard drug’ – what we are witnessing is an earlier and disturbing shift to hard drug use.
When drugs services and drugs advisors have no more urgent need than to highlight “the problems faced by young people when they reach 18 and are no longer eligible for specialist services” and “to ease their transition to adult services”, the outlook is dire indeed.
The NTA’s tables reveal that 1,600 teenagers are receiving “treatment” for heroin, cocaine and crack addiction. They reveal that 29%, some 6,000 in all of those in treatment, receive‘harm reduction’ interventions – usually understood to be a euphemism for prescribing an opiate substitute like methadone. As Professor Neil McKeganey, a leading expert in drugs misuse, said: “The idea of starting someone under 18 on a methadone prescription with an implicit expectation that they may be on that drug for the next 10 or more years is appalling. We need services to think beyond the chemical”.[6]
ONLY ONE REHAB FOR CHILDREN IN THE UK
The desperate fact though, is that there is still only one small dedicated residential rehabilitation centre [Middlegate Lodge] with statutory funding for no more than 12 children/teenagers at a time in the country.
Last year, Mike Trace, Chief Executive of the Rehabilitation of Addicted Prisoners trust, spoke of the urgent need for residential treatment for young, under 18, addicts.[7] Young addicts, he said, were unlikely to get better within the environment they had grown up and that had fed their problems.
How much of the National Treatment Agency’s dedicated funding of £25 million is spent on this?
How many teenagers are emerging drug free from their encounters with services?
It is simply not enough for the NTA to tell us that the proportion of young people who “complete an intervention according to the goals set out in their care plans’ is 57%. Unless we know what the goals of their care plans are in the first place and what the aspirations are for the young people in question, it is a meaningless statement. As we already know from adult services, “completing treatment” can be a measure of virtually nothing.

Source: Addiction Today Jan.2009

Hospitals and prisons will be supplied with syringes, swabs, citric acid and even spoons. The Government says the aim is to cut the numbers of addicts getting hepatitis C through sharing needles. But drug expert Professor Neil McKeganey said they should concentrate on getting addicts OFF drugs, rather than help to feed their habits.
Prof McKeganey, of Glasgow University’s Centre for Drug Misuse, said: “I think that the Scottish Government are labouring under the mis-apprehension that if they provide drug users with the means of using illegal drugs that they will effectively reduce some of the harm. “Yet we have in Scotland record levels of drug related death, record levels of hepatitis C infections these are indications of failure to prevent harm. I think that such a sum of money would be much more usefully spent on funding abstinence based programmes.”
He added: “Our government is so wedded to the principle of harm reduction that they are giving inadequate resources to those places which are about abstinence That is what we have been doing of the last 15 years and failing.
“If we continue doing that then we will continue to fail.”
The Scottish Government is inviting bids from firms to supply the gear.
A spokesman said: “Scotland is in the middle of a hepatitis C epidemic and it would be irresponsible to ignore that. To tackle this effectively we must reduce, as much as possible, the frequency of intravenous drug users sharing injecting equipment.”

Source: The Scottish Sun Tues.19th Jan 2010