Position Statement – December 2011

The flawed proposition of drug legalisation

Various well funded pressure groups have mounted campaigns to overturn the United Nations Conventions on drugs. These groups claim that society should accept the fact of drugs as a problem that will remain and, therefore, should be managed in a way that would enable millions of people to take advantage of an alleged ‘legal right’ to use drugs of their choice.

It is important to note that international law makes a distinction between “hard law” and “soft law.” Hard law is legally binding upon the States. Soft law is not binding. UN Conventions, such as the Conventions on Drugs, are considered hard law and must be upheld by the countries that have ratified the UN Drug Conventions.

International narcotics legislation is mainly made up of the three UN Conventions from 1961 (Single Convention on Narcotic Drugs), 1971 (Convention on Psychotropic Substances), and 1988 (Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances):

• The 1961 Convention sets out that “the possession, use, trade in, distribution,import, export, manufacture and the production of drugs is exclusively limited to medical and scientific purposes”. Penal cooperation is to be established so as to ensure that drugs are only used licitly (for prescribed medical purposes).

• The 1971 Convention resembles closely the 1961 Convention, whilst
establishing an international control system for Psychotropic Substances.

• The 1988 Convention reflects the response of the international community to increasing illicit cultivation, production, manufacture, and trafficking activities. International narcotics legislation draws a line between licit (medical) and illicit (non-medical) use, and sets out measures for prevention of illicit use, including penal measures. The preamble to the 1961 Convention states that the parties to the Convention are “Recognizing that addiction to narcotic drugs constitutes a serious evil for the individual and is fraught with social and economic danger to mankind”. The Conventions are reviewed every ten years and have consistently been upheld.

The UN system of drug control includes the Office of Drugs and Crime, the International Narcotics Control Board, and the Commission on Narcotic Drugs. The works of these bodies are positive and essential in international drug demand and supply reduction. They are also attacked by those seeking to legalise drugs.

It is frequently and falsely asserted that the so-called “War on Drugs” is inappropriate and has become a very costly and demonstrable failure. It is declared by some that vast resources have been poured into the prevention of drug use and the suppression of illicit manufacturing, trafficking, and supply. It is further claimed that what is essentially a chronic medical problem has been turned into a criminal justice issue with inappropriate remedies that make “innocent” people criminals. In short, the flawed argument is that “prohibition” monies have been wasted and the immeasurable financial resources applied to this activity would be better spent for the general benefit of the community.

The groups supporting legalisation are: people who use drugs, those who believe that the present system of control does more harm than good, and those who are keen to make significant profits from marketing newly authorised addictive substances. In addition to pernicious distribution of drugs, dealers circulate specious and misleading information. They foster the erroneous belief that drugs are harmless, thus adding to even more confused thinking.

Superficially crafted, yet pseudo-persuasive arguments are put forward that can be accepted by many concerned, well intentioned people who have neither the time nor the knowledge to research the matter thoroughly, but accept them in good faith. Frequently high profile people claim that legalisation is the best way of addressing a major social problem without cogent supporting evidence. This too influences others, especially the ill informed who accept statements as being accurate and well informed. Through this ill-informed propaganda, people are asked to believe that such action would defeat the traffickers, take the profit out of the drug trade and solve the drug problem completely.

The total case for legalisation seems to be based on the assertion that the government assault on alleged civil liberties has been disastrously and expensively ineffective and counter-productive. In short, it is alleged, in contradiction to evidence, that prohibition has produced more costs than benefits and, therefore, the use of drugs on a personal basis should be permitted. Advocates claim that legalisation would eliminate the massive expenditure incurred by prohibition and would take the profit out of crime for suppliers and dealers. They further claim that it would decriminalise what they consider “understandable” human behaviour and thus prevent the overburdening of the criminal justice system that is manifestly failing to cope. It is further argued irrationally that police time would not be wasted on minor drug offences, the courts would be freed from the backlog of trivial cases and the prisons would not be used as warehouses for those who choose to use drugs, and the saved resources could be used more effectively.

Types of drug legalisation

The term “legalisation” can have any one of the following meanings:

1. Total Legalisation – All illicit drugs such as heroin, cocaine, methamphetamine, and marijuana would be legal and treated as commercial products. No government regulation would be required to oversee production, marketing, or distribution.

2. Regulated Legalisation – The production and distribution of drugs would be regulated by the government with limits on amounts that can be purchased and the age of purchasers. There would be no criminal or civil sanctions for possessing, manufacturing, or distributing drugs unless these actions violated the regulatory system. Drug sales could be taxed.

3. Decriminalisation – Decriminalisation eliminates criminal sanctions for drug use and provides civil sanctions for possession of drugs. To achieve the agenda of drug legalisation, advocates argue for:

• legalising drugs by lowering or ending penalties for drug possession and use – particularly marijuana;

• legalising marijuana and other illicit drugs as a so-called medicine;
• harm reduction programmes such as needle exchange programmes, drug injection sites, heroin distribution to addicts, and facilitation of so-called safe use of drugs that normalize drug use, create the illusion that drugs can be used safely if one just knows how, and eliminates a goal of abstinence from drugs;

• legalised growing of industrial hemp;
• an inclusion of drug users as equal partners in establishing and enforcing drug policy; and

• protection for drug users at the expense and to the detriment of non-users under the pretence of “human rights.”

The problem is with the drugs and not the drug policies

Legalisation of current illicit drugs, including marijuana, is not a viable solution to the global drug problem and would actually exacerbate the problem. The UN Drug Conventions were adopted because of the recognition by the international community that drugs are an enormous social problem and that the trade adversely affects the global economy and the viability of some countries that have become transit routes.

The huge sums of illegal money generated by the drug trade encourage money laundering and have become inextricably linked with other international organised criminal activities such as terrorism, human trafficking, prostitution and the arms trade. Drug Lords have subverted the democratic governments of some countries to the great detriment of law abiding citizens.

Drug abuse has had a major adverse effect on global health and the spread of communicable diseases such as AIDS/HIV. Control is vitally important for the protection of communities against these problems. There is international agreement in the UN Conventions that drugs should be produced legally under strict supervision to ensure adequate supplies only for medical and research purposes. The cumulative effects of prohibition and interdiction combined with education and treatment during 100 years of international drug control have had a significant impact in stemming the drug problem. Control is working and one can only imagine how much worse the problem would have become without it. For instance:

• In 2007, drug control had reduced the global opium supply to one-third the level in 1907 and even though current reports indicate recent increased cultivation in Afghanistan and production in Southeast Asia, overall production has not increased.

• During the last decade, world output of cocaine and amphetamines has stabilized; cannabis output has declined since 2004; and opium production has declined since 2008. We, therefore, strongly urge nations to uphold and enhance current efforts to prevent the use, cultivation, production, traffic, and sale of illegal drugs. We further urge our leaders to reject the legalisation of currently illicit drugs as an acceptable solution to the world’s drug problem because of the following reasons:

• Only 6.1% of people globally between the ages of 15 and 64 use drugs (World Drug Report 2011 UNODC) and there is little public support for the legalisation of highly dangerous substances. Prohibition has ensured that the total number of users is low because legal sanctions do influence people’s behaviour.

• There is a specific obligation to protect children from the harms of drugs, as is
evidenced through the ratification by the majority of United Nations Member States of the UN Convention on the Rights of the Child (CRC). Article 33 states that Member States “shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances”.

• Legalisation sends the dangerous tacit message of approval, that drug use is
acceptable and cannot be very harmful.

• Permissibility, availability and accessibility of dangerous drugs will result in
increased consumption by many who otherwise would not consider using them.

• Enforcement of laws creates risks that discourage drug use. Laws clearly define what is legal and illegal and emphasise the boundaries.

• Legalisation would increase the risks to individuals, families, communities and world regions without any compensating benefits.

• Legalisation would remove the social sanctions normally supported by a legal system and expose people to additional risk, especially the young and vulnerable.

• The legalisation of drugs would lead inevitably to a greater number of dependencies and addictions likely to match the levels of licit addictive substances. In turn, this would lead to increasing related morbidity and mortality, the spread of communicable diseases such as AIDS/HIV and the other blood borne viruses exacerbated by the sharing of needles and drugs paraphernalia, and an increased burden on the health and social services.

• There would be no diminution in criminal justice costs as, contrary to the view held by those who support legalisation, crime would not be eliminated or reduced. Dependency often brings with it dysfunctional families together with increased domestic child abuse.

• There will be increases in drugged driving and industrial accidents.

• Drug Control is a safeguard protecting millions from the effects of drug abuse and addiction particularly, but not exclusively, in developing countries.

• Statements about taxation offsetting any additional costs are demonstrably flawed and this has been shown in the case of alcohol and tobacco taxes. Short of governments distributing free drugs, those who commit crime now to obtain them would continue to do so if they became legal.

• Legalisation would not take the profit out of the drug trade as criminals will always find ways of countering legislation. They would continue their dangerous activities including cutting drugs with harmful substances to maximise sales and profits. Aggressive marketing techniques, designed to promote increased sales and use, would be applied rigorously to devastating effect.

• Other ‘legal’ drugs – alcohol and tobacco, are regularly traded on the black market and are an international smuggling problem; an estimated 600 billion cigarettes are smuggled annually (World Drug report 2009). Taxation monies raised from these products go nowhere near addressing consequential costs.

• Many prisons have become incubators for infection and the spread of drug related diseases at great risk to individual prisoners, prison staff and the general public. Failure to eliminate drug use in these institutions exacerbates the problem.

• The prisons are not full of people who have been convicted for mere possession of drugs for personal use. This sanction is usually reserved for dealers and those who commit crime in the furtherance of their possession.

• The claim that alcohol and tobacco may cause more harm than some drugs is not a pharmacokinetics of psychotropic substances suggest that more, not less, control of their access is warranted.

• Research regularly and increasingly demonstrates the harms associated with drug use and misuse. There is uncertainty, yet growing evidence, about the long-term detrimental effects of drug use on the physical, psychological and emotional health of substance users.

• It is inaccurate to suggest that the personal use of drugs has no consequential and damaging effects. Apart from the harm to the individual users, drugs affect others by addiction, violence, criminal behaviour and road accidents. Some drugs remain in the body for long periods and adversely affect performance and behaviour beyond the time of so-called ‘private’ use. Legalisation would not diminish the adverse effects associated with drug misuse such as criminal, irrational and violent behaviour and the mental and physical harm that occurs in many users.

• All drugs can be dangerous including prescription and over the counter medicines if they are taken without attention to medical guidance. Recent research has confirmed just how harmful drug use can be and there is now overwhelming evidence (certainly in the case of cannabis) to make consideration of legalisation irresponsible.

• The toxicity of drugs is not a matter for debate or a vote. People are entitled to their own opinions but not their own facts. Those who advocate freedom of choice cannot create freedom from adverse consequences.

• Drug production causes huge ecological damage and crop erosion in drug producing areas.

• Nearly every nation has signed the UN Conventions on drug control. Any government of signatory countries contemplating legalisation would be in breach of agreements under the UN Conventions which recognise that unity is the best approach to combating the global drug problem. The administrative burden associated with legalisation would become enormous and probably unaffordable to most governments. Legalisation would require a massive government commitment to production, supply, security and a bureaucracy that would necessarily increase the need for the employment at great and unaffordable cost for all of the staff necessary to facilitate that development.

• Any government policy must be motivated by the consideration that it must first do no harm. There is an obligation to protect citizens and the compassionate and sensible method must be to do everything possible to reduce drug dependency and misuse, not to encourage or facilitate it. Any failures in a common approach to a problem would result in a complete breakdown in effectiveness. Differing and fragmented responses to a common predicament are unacceptable for the wellbeing of the international community. It is incumbent on national governments to cooperate in securing the greatest good for the greatest number.

ISSUED this 21st day of December, 2011 by the following groups:
Drug Prevention Network of the Americas (DPNA)
Institute on Global Drug Policy
International Scientific and Medical Forum on Drug Abuse
International Task Force on Strategic Drug Policy
People Against Drug Dependence & Ignorance (PADDI), Nigeria
Europe Against Drugs (EURAD)
World Federation Against Drugs (WFAD)
Peoples Recovery, Empowerment and Development Assistance (PREDA)
Drug Free Scotland

Following the Scottish example, England has piloted drug courts using specially trained magistrates to closely supervise treatment-based community sentences. This initial report found no major glitches but low throughput and uncertain cost-benefits.

Summary The Dedicated Drug Court framework for England and Wales provides for specialist courts which exclusively handle cases relating to drug misusing offenders from conviction through sentence to completion (or breach) of a community order with a Drug Rehabilitation Requirement (DRR). Two magistrates’ courts (Leeds Magistrates’ Court and West London Magistrates’ Court) have been piloting drug courts implemented in line with the Ministry of Justice’s framework.

The critical factors for implementation success are an understanding of local context and scale of need, the enthusiasm of the local judiciary and partner agencies, good partnership working, availability of resources to deliver the drug court and its associated treatment services, the depth of understanding by all staff of offender motivation and, in particular, recognition of the points at which an offender is most likely to make progress in reducing or stopping drug use. Continuity of judiciary is key to successful implementation of a drug court. It provides the focus for communication between the court and the offender and across magistrate panels. Continuity of judiciary was a strong planned feature of both courts. Based on analysis undertaken with data from the Leeds pilot, there is strong evidence that continuity of magistrates has a statistically significant impact on several key drug court outcomes. Greater continuity of magistrates experienced by offenders is associated with their being less likely to miss a court hearing, more likely to complete their sentence, and less likely to be reconvicted.

Break-even analysis showed that (compared to normal adjudication) an extra 8% of offenders seen by the courts would need to stop taking drugs for five years or more following completion of the sentence to provide a net economic benefit to the wider society, and 14% in order to provide a net economic benefit to the criminal justice system. A robust quantification of impact was not possible because of the difficulties in collecting sufficient data on a comparison group of offenders not processed through drug courts.

Findings Commissioned by the UK Ministry of Justice, the report describes the implementation rather than the outcomes of England’s pilot drug courts. In line with international understandings, the courts were intended to specialise in drug-related offenders, presided over by sentencers specially trained for this task who order treatment-based sentences and closely supervise the offender’s progress, aided by regular tests for illegal drug use. The aim is maximise the rehabilitative impact of the sentence by increasing compliance and engagement with treatment through criminal justice pressure (ultimately the prospect of receiving a more typical punishment-based sentence if the drug court’s order fails) and rewards (of which one of the most powerful seems to be the unfamiliar experience of being congratulated by a judge or magistrate).

The report identified no critical fault lines in the implementation of the courts. However, these were particularly promising sites: the Leeds court built on a pre-existing system and in London, court staff were enthusiastic about the proposal and had already been working towards creating a drug court. Nevertheless, offender throughput was lower than expected. Over the 17 months of the evaluation, the London court sentenced just 60 new offenders while in Leeds the total was 276. Low throughput raised costs per offender. Compared to a standard 12-month drug rehabilitation requirement order implemented through normal adjudication, supervising the order through the drug courts cost £4633 extra per offender.

With no comparison group of normally adjudicated offenders, the evaluation was unable to say whether this was money well spent. They were, however, able to calculate the drug use reductions the courts would have to ‘buy’ in order to meet their extra costs – as noted in the abstract, the answer was 8% of offenders ceasing drug use for at least five years compared to the numbers doing so on a normally adjudicated drug rehabilitation requirement order. This calculation though excludes the base costs of normal adjudication and of a normally supervised drug rehabilitation requirement order. This seems to mean that the 8% would also have to be over and above the proportion of offenders who remain abstinent after normal judicial processing. The report gives no indication of how much success would be needed to match the total costs incurred by the criminal justice system in implementing all the elements of a drug court-supervised drug rehabilitation requirement order.

The report’s emphasis on offenders seeing the same magistrate(s) for their sentencing and throughout subsequent progress reviews is backed by evidence from Leeds that continuity is substantially associated with better compliance and drug use and crime outcomes. Steps were taken to reduce the risk that continuity was caused by high compliance and good progress rather than vice versa. However, without actually allocating offenders at random to see or not see the same magistrates, it is impossible to eliminate this possibility. Assuming the effect was real, it is of concern that organising continuity was a challenge, and especially so for ‘breach’ hearings dealing with unacceptable failures to comply with the order, which national regulations required to occur within a set period. Unfortunately, these crucial junctures are just when continuity is most needed, requiring an understanding of whether the offender will do better on a revised order, or the order has failed and should be revoked, often resulting in imprisonment.

A final caution over any such report is that some leading criminologists accuse the UK government of manipulating and distorting criminological research for political gain, to the point where the professor of criminology at the Open University has called for a boycott of government-commissioned work. The featured report was commissioned by the UK Ministry of Justice, a ministry carved out in part from the Home Office, one of the main targets of these accusations.

Scotland preceded England in formally piloting drug courts in Glasgow from 2001 and in Fife the following year. As in England, implementation was not entirely smooth but better than might have been expected. There was a high but it was thought acceptable failure rate, probably aided by Scotland’s more flexible application of drug treatment and testing orders, predecessors to the drug rehabilitation requirements used later by the English courts. However, crime impacts were questionable. Within one year 50% of drug court offenders had been reconvicted and within two years 71%, and the average frequency of reconvictions only slightly dipped in the two years after the order was imposed compared to the two years before. There was no clear crime-reduction benefit from supervising the orders through the drug courts (at an average cost of nearly £18,500 per order) as opposed to normal adjudication. But, as in England, the costs imposed on society by persistent, high-rate offending and drug-related mortality and morbidity, are such that even modest improvements might be cost-beneficial overall.

International experience and research relating to drug courts suggests it is important for courts to emphasise rewards as well as punishments, see offenders frequently enough to apply these swiftly in response to progress, deploy a range of rewards and sanctions short of revocation which are consistently applied, have a strong and sure ultimate sanction when the programme fails, make these consequences absolutely clear to offenders, have rapid access to a range of treatment options, maintain continuity in the judge dealing with the case, and to attend to the range of the individual’s needs. Willingness to continue despite some initial offending makes the structure imposed by stringent requirements and monitoring a positive feature rather than one which leads most offenders to fail. Consistent judicial supervision, the fact that this forces addicts (back) in to treatment, and drug testing which provides a shared measure of how treatment is progressing, probably all play their parts.

Source: www.findings.org.uk March 2009

Conference in Moses Room, House of Lords, 28th November 2002-11-28 CONSENSUS OF CONFERENCE

● In the light of the most recent international evidence regarding the adverse effects of cannabis, we urge the Prime Minister and the Home Secretary to reconsider their determination to reclassify Cannabis from a schedule B to schedule C drug.

● We are concerned that reclassification sends the message ‘it is ok to take cannabis’ or ‘cannabis is harmless’ or ‘taking cannabis is legal now’, especially to young people. We therefore strongly oppose reclassification.

● Instead, we urge the Prime Minister and the Home Office not to play down the many adverse and sometimes irreversible health effects of cannabis but to send out the clear message that cannabis is both harmful and, for that reason, illegal.

● We urge the Prime Minister – in the light of recent evidence – to reassess the adverse physical, emotional, mental and spiritual impact cannabis abuse has on individuals, but also to assess the adverse effects of cannabis on society including families with a special reference to ethnic minorities, the education system, the National Health Service, the Police, the criminal justice system.

● We are concerned that drug prevention is not given the emphasis it deserves, that ‘mixed messages’ are sent out and in particular we are very concerned at public funding of organisations whose ‘drug education material’ appears to promote rather than prevent drug abuse.

● We urge the Prime Minister to allocate more resources on prevention of cannabis abuse. Prevention is better than cure. We believe that these resources will be well spent. Our society and especially our young people deserve to be protected from cannabis abuse.

The fashionable party drug mephedrone has been linked to up to 98 recent deaths in Britain, the Government’s advisers warned last night, as they called for tougher action to combat the proliferation of legal highs.

The Advisory Council on the Misuse of Drugs (ACMD) said unscrupulous manufacturers made a mockery of the law by falsely advertising addictive substances as “plant food” or “bath salts”. Its chairman, Professor Les Iverson, warned young users of “designer drugs” were playing “Russian roulette” with their lives – and said the effects were already being seen in hospitals. He said: “We are not seeing just a nice party drug but something that can kill.”

Prof Iverson released figures showing that in the past two years mephedrone had been confirmed as a factor in 42 deaths and had not been ruled out as contributing to another 56.
Users of designer drugs – created in labs to mimic the make-up of banned substances such as ecstasy and amphetamines – suffered such extreme side-effects that they had to be sedated. They had also been treated for paranoia, psychosis, high heart rates and raised blood pressure, he said. He added: “Users are playing Russian roulette. They are buying substances marked as research chemicals. The implication is that you should do the research on yourself to find out whether they’re safe or not. This is a totally uncontrolled, unregulated market.”

The first large quantities of legal highs, or psychoactive drugs – many made in China – appeared in Britain two years ago. They can be easily bought online or from shops selling drug paraphernalia and herbal goods. Some undergraduates also sell them to fellow students. The ACMD said: “Many people importing these new substances appear to have had no previous involvement in the illicit drug trade and are just in it to make a quick buck. They have included students who have set up websites to supply nationally and who also supply the local student population.”

Ministers have outlawed several such substances, but the ACMD warned that producers were sidestepping the bans by tweaking the composition of drugs. It backed creating a new system of broader bans in which all substances chemically similar to controlled drugs were automatically made illegal. The ACMD also called for suppliers to have to demonstrate that legal highs were not being produced for human consumption and for a fresh drive to alert the public to their dangers.

Roger Howard, chief executive of the UK Drug Policy Commission, backed the proposals. He said: “We have rapidly growing numbers of psychoactive drugs on the market and it’s increasingly difficult for police to identify the different drugs they are finding.”

The Home Office said it was considering the recommendations and added: “The Government is leading the way in cracking down on legal highs by outlawing not just individual drugs but whole families of related substances.”

By numbers…
2009 The year police made first seizure of mephedrone. It was banned in 2010.
£15 Approximate price of a gram before it was classified.
98 The number of deaths recently linked to mephedrone.

Source: The Independent 26th October

After only a few years of usage, crystal meth can devastate a user’s health.
A GP in the Dungannon District has warned parents of the alarming rise in illegal drug abuse among young teenagers. “GPs are seeing an increasing number of patients with drug problems and unfortunately this is showing up in kids of as young as 13 or 14”, he said.
“There is a combination of the old drugs such as cannabis and cocaine and some of the newer drugs such as methedrone. “One of the problems is people seem to have the idea that these newer “designer drugs” are safe. However, they have a number of side effects Severe nosebleeds have been reported after snorting as well as anxiety and paranoia.
“There is also the risk of over-stimulating the heart and the nervous system, which would increase the chances of having a fit. “They can also become a gateway to other drugs. Another problem with these newer drugs is that the long term effects are unknown as they have not been around long enough to have been properly studied. “If you have any concerns with drug misuse you can contact your GP for advice. There are also a number of helplines to contact for confidential advice. An excellent local service is Breakthru in Dungannon. “They offer guidance and counselling for drug and alcohol problems. Their number is 02887753228.
Drug dealers in the Coalisland area are giving free doses of crystal meth to young teenagers.
The drug is an intensive stimulant with disinhibitory qualities. It can either be snorted or injected, or in its crystal form ‘ice’ smoked in a pipe, and brings on a feeling of exhilaration and a sharpening of focus. Smoking ice results in an instantaneous dose of almost pure drug to the brain, giving a huge rush followed by a feeling of euphoria for anything from 2-16 hours.
Overuse can bring on paranoia, short term memory loss, wild rages and mood swings as well as damage to your immune system. Overdosing can lead to severe convulsions followed by circulatory and respiratory collapse, coma and death. Some people have died after taking small doses.
The mix of chemicals, method of use and the user’s lifestyle can do serious damage to the mouth (‘Meth mouth’), with teeth rotting to the gum line as a result of the meth vapours.

Source: www.tyronetimes.co.uk 11th March 2012

“National Drug Treatment Monitoring System (NDTMS) data on treatment modalities shows that 131,110 people received substitute prescribing treatment. During the same period, 5,350 people received PTB-funded treatment in residential rehabilitation centres.”

“We should be justly proud of what has been achieved in drug treatment. The sustained investment in recent years has resulted in significantly increased capacity, accessibility and take-up of drug treatment services. However, there is both the need and opportunity to further improve retention and treatment outcomes, not least by ensuring that problem drug users are able to access core services such as housing, employment and training opportunities. It is the time to evaluate where we are and how we can make drug treatment even better.” Martin Barnes Drugscope

posted by Peter O’Loughlin on 14 Mar 2009 at 5:05 am

What Mr. Barnes failed to mention.

1. Drug related deaths in accordance with the UK official definition are at their highest for 5 years. (Health Statistics Quarterly 39. Office of National Statistics)

2. The level of HIV and other blood born diseases among Injecting Drug Users is higher now than at the start of the decade.

3 .In London where the prevalence of HIV is higher than anywhere else in England, 1 in 20 Injecting Drug Users is infected.

4 .In the remainder of England and Wales HIV among IDUs has risen from approximately one in 400 to 1 in 250 in 2006.

5 .The prevalence of hepatitis C among IDUs has increased from 33% in 2000 to 42% in 2006.

6. Approximately on in 5 IDUs has hepatitis B, which represents an increase of something like 200 per cent since 1997.

The foregoing is neither ‘uninformed’, or ‘unwarranted’ criticism, they are however the inescapable facts which Mr. Barnes seems either keen to suppress or is unaware of, In either event his opinion that “we should be justly proud of what has been achieved in drug treatment”, is hardly a balanced judgment of the escalation in both drug related deaths and disease which is being inflicted on our society. Nor the increasing level of drug offences and drug related crime.

Whether or not this catastrophic outcome of our drug treatment strategy can be wholly attributed to the harm reduction treatment protocols which has dominated it for so many years, and of which Mr. Barnes is an enthusiast, is the principle cause of the seemingly out of control increase in death, disease and crime, is debatable, what is not debatable is that we have no reason or justification to be proud that we have presided over an escalating and avoidable loss of life, death and criminal activity; nor is Mr. Barnes justified in claiming that we have.

Follow-Up Opinions

Failings Found In Needle Exchange Services.
posted by Mary Brett on 17 Mar 2009 at 1:49 pm
Among other failings found in a survey by the NTA of needle exchanges in England 2006, 50% of DATS had no access to virus testing on site, 40% no immunisation in place, about a third lacked hygiene and safer technique discussions.

Data collection was poor – DATS able to provide numbers of clients and visits, quantity of equipment distributed and returned were in the minority. Only 74% of DATS, 55% of needle exchange service providers and 48% of pharmacies provided information. There was a lack of training for co-ordinators and access to facilities was mostly limited to the working week. Very few operated at weekends or during the evening or night. Largely missing was any monitoring of discarded needles or injuries arising from them to the public.
Has anything been done to improve this situation? From the latest figures, quoted here, it would appear not to be the case.
|

Quantity V Quality
posted by Peter O’Loughlin on 18 Mar 2009 at 6:11 am
Thank you for your revealing and interesting contribution Mary.

It seems as if the NTA’s obsession with numbers treated, rather than treatment outcomes could be a contributory factor to the spread of blood born disease.

It is also depressing to learn that those hardy souls in the front line for whom I have considerable respect and admiration, are being deprived of the fundamental training and facilities needed to improve outcomes.

No doubt the apparent focus on numbers is to enable those responsible to issue gushing reports of achievement through the simplistic process of counting the numbers of needles issued, rather than positive outcomes of how those who use the facilities might be engaged in recovery.

A case of ‘never mind the quality, feel the width’.

If we add to that the seeming disregard of the danger to the public caused by discarded needles, then harm reduction as it is being practised in this country is creating more problems than it is resolving.

It seems to me that those people who sit in their ‘ivory towers’ dreaming up ‘harm reduction’ solutions have failed to realise that addiction is not confined to office hours and that when the addicted are craving for a fix, the lack of a clean needle will not prevent them from using.

Now exactly what is it that Mr Barnes of DrugScope feels we have reason to be ‘justly proud of’?

Is it the number of needles issued?

The injury to children and others arising from discarded needles?

The lack of training and supervision and hygiene facilities? Or the escalation, in avoidable deaths and disease?

The one thing I do agree with Mr. Barnes on is that more, much more is needed to reduce both drug related deaths and disease, and the most realistic way of achieving that is through abstinence focused recovery.

What Mr Barnes seems unable to grasp is that there is a world of difference between abstinence and recovery. Nor does he seem willing to acknowledge that the outcome of addiction is always abstinence. The latter is not an option as Mr Barnes appears to be suggesting. It is achieved either through premature death, a reality which is already occurring, or abstinence focused treatment followed by on going after care; realities that neither Mr. Barnes or the NTA seem willing or able, to confront.

EACH year the Scottish Drug Misuse Database releases statistics laying bare the grim reality of drug addiction in Scotland. For a few days politician show angst at the tragedy that lies behind the statistics but somehow attention moves on as if this problem will resolve itself.

It is expected areas of high unemployment and poverty will feature prominently in the SDMD and yesterday’s figures offer little change. Glasgow, Dundee, Inverclyde and West Dunbartonshire all feature as areas showing significant levels of problematic drug abuse, though in truth all of Scotland is affected.

What continues to shock, however, is the numbers of young people under 15 years of age who present as problematic drug users and this year, as the figure records more than 100, that shock does not lessen.

Their first involvement is likely to occur as early as primary school but most often in first or second year secondary, their drug use developing usually from a habit of the illicit drinking of alcohol with school friends. Accessing of drugs builds from that background of irresponsible risk taking in public areas such as parks, isolated school play areas and the likes.

From my experience and talking to young people in prisons, it seems to me likely that school absenteeism arising from heavy drinking and the abuse of drugs (usually cannabis) created for these youngsters a self-imposed understanding of exclusion and thereafter educational failure that ensured that any chances they may have had of early success is denied.

Opportunities for gainful employment were also denied. It is in these circumstances that many turned to heroin, diazepam and cocaine – drugs identified in the most recent statistics as the source of much of the problematic drug misuse recorded. A spiralling downturn in life chances, an increased likelihood of arrest and incarceration and real possibility of drugs-related death beckons.

The latest figures reflect a 131 per cent increase in drugs-related deaths over the ten-year period to 2008 giving us a new yearly total of 574 deaths. 574 tragedies.

It is not the writing of new drugs strategies that will bring about a change in this situation. It’s government leadership to ensure that enforcement, health, education and prisons all work with the voluntary sector towards the sole outcome of reducing problematic drug abuse.

Source: http://news.scotsman.com 31st March 2010

President joins calls for debate after figures reveal extent of violence since launch of military offensive against cartels in 2006.

Murders in Mexico’s drug wars are becoming increasingly gruesome.

Mexico’s president, Felipe Calderón, has joined calls for a debate on the legalisation of drugs as new figures show thousands of Mexicans every year being slaughtered in cartel wars.
“It is a fundamental debate,” the president said, belying his traditional reluctance to accept any questioning of the military-focused offensive against the country’s drug cartels that he launched in late 2006. “You have to analyse carefully the pros and cons and key arguments on both sides.” The president said he personally opposes the idea of legalisation.
Calderón’s new openness comes amid tremendous pressure to justify a strategy that has been accompanied by the spiralling of horrific violence around the country as the cartels fight each other and the government crack down. Official figures released this week put the number of drug war related murders at 28,000.
Until recently the government regularly played down the general impact of the violence by claiming that 90% of the victims were associated with the cartels, with the remainder largely from the security forces. In recent months it has started to acknowledge a growing number of “civilian victims” ranging from toddlers caught in the cross fire to students massacred at parties.
Momentum behind the idea that legalisation could be part of the solution has been growing since three prominent former Latin American presidents signed a document last year arguing the case.
César Gaviria of Colombia, Fernando Cardoso of Brazil and Ernesto Zedillo of Mexico urged existing governments to consider legalising marijuana as a way of slashing cartel profits.
This year Mexico’s national congress began a debate on the possibility that resurfaced again this week during a series of round table discussions between the Calderón, security experts, business leaders and civic groups.
The “Dialogue for Security: Evaluation and Strengthening” is part of a new government effort to counter the growing perception in Mexico that the president’s drug war strategy is a disaster.
“I’m not talking just about legalizing marijuana,” analyst and write Hector Aguilar Camin said during the Tuesday session, “rather all drugs in general.”
After accepting the need to directly address the proposal, Calderón made it clear he did not support it. “It requires a country to take a decision to put several generations of young people at risk,” he said, citing a likely increase in consumption triggered by lower prices, greater availability and social acceptability.
He added that the predicted “important economic effects by reducing income for criminal groups” would be limited by the integration of Mexican drug trafficking into international markets where drugs remain largely underground.
Calderón did not mention current moves to soften drug laws in the US, including a planned vote in California in November on an initiative that would allow marijuana to be sold and taxed. Nor did he address the home grown argument that legalisation would remove the roots of the violence raging in the country.
“Legalisation would render the war pointless as drugs would become just another product like tobacco or alcohol,” Jorge Castañeda, a legalisation advocate and former foreign minister, told W Radio. He added that even if it did prompt an increase in drug use. “It is worth considering whether this is preferable to having 28,000 deaths.”
The new death toll, which was not broken down, is significantly higher than the informal counts kept by newspapers. Milenio newspaper put the number of drug-related deaths in July at 1,234.
Some leading critics of Calderón’s strategy, however, do not believe legalisation is the key to reining in the cartels and the violence, preferring to emphasize the need to increase efforts to go after money laundering and political corruption.
Edgardo Buscaglia, and expert in organised crime around the world, argues that the recent diversification of the Mexican cartels into other criminal activities ranging from systematic extortion to people trafficking would give them ample reason to keep fighting each other, even if drugs were legal. “Legalising drugs would be good public policy,” he said, “but it would not be a tool with which to combat organized crime.”

Source: guardian.co.uk, Wednesday 4 August 2010 20.13 BST

Scottish Government figures show 168% increase at Craiginches since 2007
Drug seizures at Craiginches Prison in Aberdeen have nearly trebled in the last three years.
Scottish Government figures show there were 134 seizures at the jail last year, a 168% increase since 2007 when there were 50. The increase was far higher than the total across Scotland where drug seizures went up by 12% from 1,626 to 1,829 over the same period.
Labour called for a redoubling of efforts to rid Scotland’s jails of drugs. Yesterday, Chief Inspector of Prisons Brigadier Hugh Munro warned that drug testing needed to be tightened up because addiction programmes were rendered pointless by ineffective testing regimes.
The only other prison with a similar number of drug seizures in the north-east was Perth where the number has remained relatively static with an average of 138 over three years.
At Inverness Prison seizures were up from 11 to 19. The number at the two open prisons, Castle Huntly and Noranside, in Tayside, fell from 63 to 53, as did those at Peterhead, down from six to one.
North-east MSP and Labour justice spokesman Richard Baker said: “Drugs are far too prevalent in Scotland’s prisons and Brig Munro is quite right to say more needs to be done. “With a rising tide of drugs getting into our prisons there is a need to redouble our efforts to rid our prisons of drugs.”
The Scottish Prison Service (SPS) said increased seizures were a sign that efforts to reduce drug taking and smuggling into jails were working. An SPS spokesman said money had been invested in new technology such as mobile drug tracing and X-ray machines, and the “most effective deterrent” – sniffer dogs.
“New legislation will also tackle the issue of mobile phones which are a key element in drug trafficking in prisons,” he said. “High levels of finds, such as those at HMP Aberdeen which doubled in two years, are an indicator of success.”
The Tories released figures showing a 37% increase in the number of prisoners receiving the heroin substitute methadone. A snapshot of one day showed the number on the drug went up from 1,228 in 2006 to 1,679 this year. The percentage of the prison population on methadone went up from 17.1% to 21.5%.
Tory justice spokesman John Lamont said: “This is extremely worrying. This rise in prisoners in receipt of methadone suggests that efforts to move drug addicts towards abstinence are not working properly.”
A Scottish Government spokesman said the percentage of prisoners prescribed methadone had risen by less than 3% since the current SNP administration came into office in 2007. “Getting people into treatment is the most effective way of reducing drug use and breaking the links between drugs and crime,” he said. “Methadone has a role to play among a range of treatments and support available to help people recover from their drug problems.”
The SPS said 85% of prisoners on methadone were continuing medication prescribed before they were sentenced while 15% were on new prescriptions initiated in custody. “According to the latest prisoner survey in 2009, almost a quarter of prisoners are currently on a reducing methadone dose as part of their recovery programme,” a spokesman said.

Source: www.pressandjournal.co.uk 3rd Sept. 2010

BBC Radio 4’s Any Questions: The drug policy debate in early June mentioned an organisation in which I am involved – the UK National Drug Prevention Alliance – many times, so we must respond. In doing so, I hope to convey proven facts about the dangers of legalising drugs.

Nadine Dorries was correct that much modern cannabis is stronger than years ago but we do not agree with her figures. Typically, modern cannabis is three to four times stronger in THC, the psychoactive ingredient, than even the strongest cannabis of the 1960s and 1970s. This has been achieved by selective breeding and in response to consumer demand.

But the picture is more complex than ‘just’ THC strength. The presence – or rather absence in modern forms – of another chemical, CBD, appears to have aggravated the brain-damaging potential of cannabis. Use has also changed. Age of first use and regular use is earlier than in the 1960s and that is another damaging factor. The evidence caused the UKgovernment, with cross-party agreement, to reclassify cannabis upwards two years ago. At the time (Sky News, 6 April 2008), prime minister David Cameron admitted that a parliamentary committee, of which he had been a member, had been wrong about lowering the classification of cannabis. Lessons have been learned and are unlikely to be overturned.  Cannabis contributes substantially to academic under-achievement and very poor mental health, regardless of other effects.

On the wider question of decriminalisation and even legalisation of all drugs, the NDPA believes that a monstrous, well financed and very slick fraud is being perpetrated internationally and that this fraud has fooled some of the “great and good” who signed up as supporters. There is no evidence at all that either measure could reduce the total harm from drugs. The reverse is very much the case, with academic opinion saying that either measure would inevitably normalise and increase, use.  The manifest harm from the legal drugs and the legislation on alcohol and tobacco, as variously applied around the world, confirms that.  Comments on wishful good effects from decriminalisation were profoundly incorrect and reflect manipulative messages. For years, we have been bombarded with the Netherlandsas the example of sound drug policy – despite the fact that the country, through its policies, created the largest base for drugs-related criminality inEurope with supply, warehousing, distribution and manufacture at astonishing levels. At one stage, theNetherlands had more drug related murder than anywhere else inEurope. TheNetherlands is changing. It spends proportionally more than theUK on enforcement and is currently more effective and better organised than theUK.

Portugaland decriminalisation appears now to be “the new orthodoxy” for those with a certain direction of travel and for those “user advocates” who want more freedom to use, regardless of the wider social effects. ButPortugalis being misrepresented, as demonstrated below.

1. The number of new cases of HIV and Hepatitis C inPortugalis eight times the average in other EU countries.
2. Portugalhas the most cases of injected drug related Aids, with 85 new cases per million citizens.  Other EU countries average 5 per million.
3. Since decriminalisation, drug-related homicides have increased 40%.
4. Drug overdoses have increased substantially, by over 30% in 2005.
5. There has been an increase of 45% in post mortems testing positive for illegal drugs.
6. Amphetamine and cocaine consumption has doubled inPortugal, with cocaine seizures increasing sevenfold between 2001 and 2006.

Finally, the suggestion that legalisation would somehow remove criminality from drug supply is ridiculous. Criminality loves use-reinforcing substances and behaviours. Over 20% of theUKtobacco market is smuggled, counterfeit or both. In some other countries, the figures are worse. Legalisation or decriminalisation of substances unfit for human consumption should occur only if a demonstrable “public good” can be evidenced. The problem for the legalisation lobby is that it

cannot.

DAVID RAYNES is executive councillor of the

UK National Drug Prevention Alliance (http:// drugprevent.org.uk/ppp/about-us).

SourceAddiction Today July/August 2011

Contrary to the beliefs of those who advocate the legalization of marijuana, the current balanced, restrictive, and bipartisan drug policies of the United States are working reasonably well and they have contributed to reductions in the rate of marijuana use in our nation.

The rate of current, past 30-day use of marijuana by Americans aged 12 and older in 1979 was 13.2 percent. In 2008 that figure stood at 6.1 percent. This 54-percent reduction in marijuana use over that 29-year period is a major public health triumph, not a failure.

Marijuana is the most commonly abused illegal drug in the U.S. and around the world. Those who support its legalization, for medical or for general use, fail to recognize that the greatest costs of marijuana are not related to its prohibition; they are the costs resulting from marijuana use itself.

There is a common misconception that the principle costs of marijuana use are those related to the criminal justice system. This is a false premise. Caulkins & Sevigny (2005) found that the percentage of people in prison for marijuana use is less than one half of one percent (0.1-0.2 percent). An encounter with the criminal justice system through apprehension for a drugrelated crime frequently can benefit the offender because the criminal justice system is often a path to treatment.

“A useful analogy can be made to gambling. Legalized gambling has not reduced illegal gambling in the United States; rather, it has increased it.”

More than a third, 37 percent, of treatment admissions reported in the Treatment Episode Data Set, TEDS, collected from state-funded programs were referred through the criminal justice system. Marijuana was an identified drug of abuse for 57 percent of the individuals referred to treatment from the criminal justice system.

The future of drug policy is not a choice between using the criminal justice system or treatment. The more appropriate goal is to get these two systems to work together more effectively to improve both public safety and public health. In the discussion of legalizing marijuana, a useful analogy can be made to gambling. MacCoun & Reuter (2001) conclude that making the government a beneficiary of legal gambling has encouraged the government to promote gambling, overlooking it as a problem behavior. They point out that “the moral debasement of
state government is a phenomenon that only a few academics and preachers bemoan.”
Legalized gambling has not reduced illegal gambling in the United States; rather, it has increased it. This is particularly evident in sports gambling, most of which is illegal. Legal gambling is taxed and regulated and illegal gambling is not. Legal gambling sets the stage for illegal gambling just the way legal marijuana would set the stage for illegal marijuana trafficking.
The gambling precedent suggests strongly that illegal drug suppliers would thrive by selling more potent marijuana products outside of the legal channels that would be taxed and otherwise restricted. If marijuana were legalized, the only way to eliminate its illegal trade, which is modest in comparison to that of cocaine, would be to sell marijuana untaxed and unregulated to any willing buyer.

Marijuana is currently the leading cause of substance dependence other than alcohol in the U.S. In 2008, marijuana use accounted for 4.2 million of the 7 million people aged 12 or older classified with dependence on or abuse of an illicit drug. This means that about two thirds of Americans suffering from any substance use disorder are suffering from marijuana abuse or marijuana dependence.

If the U.S. were to legalize marijuana, the number of marijuana users would increase. Today there are 15.2 million current marijuana users in comparison to 129 million alcohol users and 70.9 million tobacco users. Though the number of marijuana users might not quickly climb to the current numbers for alcohol and tobacco, if marijuana was legalized, the increase in users would be both large and rapid with subsequent increases in addiction.

Important lessons can be learned from those two widely-used legal drugs. While both alcohol and tobacco are taxed and regulated, the tax benefits to the public are vastly overshadowed by the adverse consequences of their use. Alcohol-related costs total over $185 billion while federal and states collected an estimated $14.5 billion in tax revenue; similarly, tobacco use costs over $200 billion but only $25 billion is collected in taxes. These figures show that the costs of legal alcohol are more than 12 times the total tax revenue collected, and that the costs of legal tobacco are about 8 times the tax revenue collected. This is an economically disastrous tradeoff.

The costs of legalizing marijuana would not only be financial. New marijuana users would not be limited to adults if marijuana were legalized, just as regulations on alcohol and tobacco do not prevent use by youth. Rapidly accumulating new research shows that marijuana use is associated with increases in a range of serious mental and physical problems. Lack of public understanding on this relationship is undermining prevention efforts and adversely affecting the nation’s youth and their families.

Drug-impaired driving will also increase if marijuana is legalized. Marijuana is already a significant causal factor in highway crashes, injuries and deaths. In a recent national roadside survey of weekend nighttime drivers, 8.6 percent tested positive for marijuana or its metabolites, nearly four times the percentage of drivers with a blood alcohol concentration (BAC) of .08 g/dL (2.2 percent). In another study of seriously injured drivers admitted to a Level-1 shock trauma
center, more than a quarter of all drivers (26.9 percent) tested positive for marijuana. In a study of fatally injured drivers in Washington State, 12.7 percent tested positive for marijuana. These studies demonstrate the high prevalence of drugged driving as a result of marijuana use.
Many people who want to legalize marijuana are passionate about their perception of the alleged failures of policies aimed at reducing marijuana use but those legalization proponents seldom—if ever—describe their own plan for taxing and regulating marijuana as a legal drug. There is a reason for this imbalance; they cannot come up with a credible plan for legalization that could deliver on their exaggerated claims for this new policy.

“Reducing marijuana use is essential to improving the nation’s health, education, and productivity.”

Future drug policies must be smarter and more effective in curbing the demand for illegal drugs including marijuana. Smarter-drug prevention policies should start by reducing illegal drug use among the 5 million criminal offenders who are on parole and probation in the U.S. They are among the nation’s heaviest and most problem generating illegal drug users.

Monitoring programs that are linked to swift and certain, but not severe,
consequences for any drug use have demonstrated outstanding results including lower recidivism and lower rates of incarceration. New policies to curb drugged driving will not only make our roads and highways safer and provide an important new path to treatment, but they will also reduce illegal drug use.

Reducing marijuana use is essential to improving the nation’s health, education, and productivity. New policies can greatly improve current performance of prevention strategies which, far from failing, has protected millions of people from the many adverse effects of marijuana use.
Since legalization of marijuana for medical or general use would increase marijuana use rather than reduce it and would lead to increased rates of addiction to marijuana among youth and adults, legalizing marijuana is not a smart public health or public safety strategy for any state or for our nation.

Source: Published: Tuesday, 20 Apr 2010 Robert du Pont,Institute for Behavior and Health

Wednesday 01 September 2010

The Local Alcohol Profiles for England (LAPE 2010) have just been released by the North West Public Health Observatory – profiling 23 alcohol-related indicators for every local authority and 24 for every primary care trust in England.
The profiles provide a national ‘map’ of alcohol-related harms.
Key findings from the profiles:
• Over the five years to 2008/09 there has been around a 65% increase in the number of people being admitted to hospital due to alcohol to 606,799 individuals – an increase of over 240,000 people.
• There were 945,469 admissions to hospital for alcohol-related harm in England in 2008/09. This is 825 alcohol-related admissions a day more than five years ago.
• Two thirds (65%) of all the local authorities suffering the highest levels of overall harms are in the North West and North East regions of England (1). The ten local authority areas with the highest levels of combined alcohol-related harm (2) are, in descending order, Manchester, Salford, Liverpool, Rochdale, Tameside, Islington, Middlesbrough, Halton, Oldham and Blackpool.
• By comparison East of England and South East region contain two thirds (65%) of all the local authorities with the lowest overall harm (1). The ten local authorities with the lowest levels of alcohol-related harm (2) are, in ascending order, Broadland, East Dorset, South Northamptonshire, Babergh, Three Rivers, South Norfolk, Hart, Sevenoaks, Wokingham and North Kesteven.
• Between 2006 and 2008 there were 11,247 deaths from chronic liver disease in men. The number of male deaths from chronic liver disease continues to rise steadily and increased by 12% for the five years up to 2008.
• Across England, there were 415,059 recorded crimes attributable to alcohol in 2009/10; equivalent to 8.1 crimes per 1,000 population. The highest rates of alcohol-attributable crime occur in the London region where there were 12.2 crimes per 1,000 residents, although this has decreased by 2.1% from the previous year. The lowest rate is in the North East region at 6.2 crimes per 1,000 which also showed the largest decrease (13.5%) from the previous year.
• Trends in alcohol-related harms vary between local authority areas. For instance, 64% saw an increase of over 5% in hospital admissions for alcohol-related harm in 2008/09, whilst only 7% showed a decrease of over 5%.
(1) Local authorities are categorised into five levels of harm using a clustering methodology that assigns LAs which have similar alcohol profiles to the same category. Months of life lost due to alcohol (males), months of life lost due to alcohol (females), NI39 (alcohol-related hospital admissions), alcohol-attributable recorded crimes, claimants of Incapacity Benefits due to alcoholism, increasing risk drinking, and higher risk drinking were used to determine clusters.
(2) Ranking for highest and lowest levels of alcohol-related harm use the same data as above and are ranked according to the highest combined rank across the seven harm indicators. City of London and the Isles of Scilly are excluded (figures for these areas should always be viewed with caution due to their small resident populations).
Visit the Local Alcohol Profiles for England website.

Source: www.alcoholconcern.org.uk 1.09.2010

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

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

Source: Jul 10, 2008 WorldWideAddiction.com

Notwithstanding research carried out by the National Treatment Agency (NTA) which clearly established that the majority of those who have developed dependence, wish to become drug free; here in the UK, the focus for the past 10 years has been on ‘harm reduction’, rather than seeking to engage users into abstinence focused recovery. The outcome of this disastrous and misguided policy has been an escalation in drug related deaths which are at their highest for 5 years, 325 of which are attributed to methadone, the flagship of the harm reductionists, together with a devastating increase in the spread of blood born disease among Injecting Drug Users (IDUs) The statistics provided by the Health Protection Agency for England and Wales are as follows:

• The level of HIV infection among Injecting Drug Users (IDUs) in England and Wales is higher now than at the start of the decade.

• In London where the prevalence of HIV in IDUs is higher than elsewhere in England and Wales, 1 in 20 IDUs is infected.

• In the remainder of England and Wales HIV among IDUs has increased from approximately 1 in 400 in 2002 to around 1 in 150 in 2006.

• The prevalence of Hepatitis C among IDUs has increased from 33 percent in 2000 to 42 per cent in 2006.

• Approximately 1 in 5 IDUs has Hepatitis B infection, which extrapolates as an increase approaching 200 per cent since 1997.

The escalating increase in blood born disease has occurred despite the plethora of needle exchange facilities throughout England and Wales, and the growth of supervised drug consumption rooms

It is self evident from the foregoing that here in the UK at least, it is not the lack of harm reduction measures which is contributing to avoidable deaths and the epidemic of blood born disease being wreaked on our society, but the use of toxic psycho active substances.

It is not so called prohibition which has failed, but the encouragement by way of the tacit permission, and in many instances, the not so tacit encouraging of continued use, inherent in the harm reduction ideology, which has failed users and society so abysmally.

The supporters of Harm Reduction, under their various guises have never allowed the truth to interfere with their propaganda, or indeed their more covert agenda, to legalise drug use; the main beneficiaries of which would be the pharmaceutical industry. Such a move would be to inflict further incalculable harm on society, since it would result in a growth of use and addiction, similar, if not more widespread, to that seen in the late 1800’s when most of the drugs which are controlled today, were in fact legal.

The growth of drug use during that period was the direct result of concerted efforts by leading members of the medical profession in promoting drug use, many of whom were influenced by Sigmund Freud, who was so unethical in his dealings that he accepted separate commissions from two competeing, large pharmaceutical companies, both of whom are still in business today, to write papers extolling the benefits of that destructive substance, cocaine, not only as the ‘elixir of life’, but also as a cure for alcohol and morphine addiction. The rest as they say is history

One has to ask is it a coincidence that many of the bodies, who are pressing for an end to what they term as prohibition, receive ‘research grants’ from the pharmaceutical industry?
Source: Daily Dose; posted by Peter O’Loughlin on 13 Mar 2009 at 6:23 am

Professor Susan GreenfieldIt is folly to legalise a drug that is known to leave users with permanent damage to their ability to reason, argues Susan Greenfield, the distinguished expert on brain processes (Sunday August 18 2002, The Observer) now that those anxious to look cool can puff cannabis freely in without fear of arrest, perhaps those of us who have argued that
relaxing the laws on cannabis is irresponsible and dangerous should
retreat gracefully behind our chintz curtains. Yet the downgrading of
the classification of cannabis perpetuates the same tired old myths
and the same serious problems.

Take the myth that cannabis is ‘just the same as’ alcohol. A glib yet logical riposte might be that if the drugs are truly identical why not just stick with the booze? What is the distinct appeal of cannabis that can be ignored in equating the two drugs? Such sophistry is inappropriate because alcohol and cannabis work on the brain and body in very different ways. Alcohol has a range of non-specific actions that affect the tiny electrical signals between one brain cell and another; cannabis has its own specialised chemical targets, so far less has a more potent effect.
Moreover, although drinking in excess can lead to terrible
consequences, there are guidelines for the amount of alcohol that
constitutes a ‘safe’ intake. Such a calculation is possible because we
know alcohol is eliminated relatively quickly from the body.

With cannabis, it is a different story. The drug will accumulate in
your body for days, if not weeks, so, as you roll your next spliff,
you never know how much is already working away inside you. I
challenge any advocate of cannabis to state what a ‘safe’ dose is.
Until they do, surely it is irresponsible to send out positive
signals, however muted? Another notion is that cannabis is less
harmful than cigarettes. I’m not sure how this idea came about,
certainly not as the results of any scientific papers. We do know
cannabis smoke contains the same constituents as that of tobacco:
however, it is now thought that three to four cannabis cigarettes a
day are equivalent to 20 or more tobacco cigarettes, regarding damage
to the lining of the bronchus, while the concentration of carcinogens
in cannabis smoke is actually higher than in cigarettes. And if
cannabis were ‘just the same’ as alcohol and cigarettes, why are
people not taking those already legal drugs for the much-lauded
pain-relief effects? After all, another case for the relaxation of the
laws on cannabis is the ‘medical’ one that it is an effective
analgesic. But there is a world of difference between medication
prescribed in a hospital, where the cost-benefit balance tips in
favour of pain relief, compared to a healthy person endangering their
brain and body needlessly. Even the most loony of liberals has not
suggested tolerance for morphine or heroin abuse, because they
are prescribed clinically as potent painkillers. And think about it:
if cannabis brings effective relief from pain, then how does it do so?
Clearly by a large-scale action on the central nervous system.
Further wishful thinking is that, because cannabis doesn’t
actually kill you, it is OK to send out less negative legal signals,
even though the Home Secretary admits that the drug is dangerous.
Leaving aside the issue that cannabis could indeed be lethal, in that
the impaired driving it can trigger could well kill, there is more to
life than death. It is widely accepted that there is a link between
cannabis and schizophrenia: as many as 50 per cent of young people
attending psychiatric clinics may be regular or occasional cannabis
users. The drug can also precipitate psychotic attacks, even in those
with no previous psychiatric history. Moreover, there appears to be a
severe impairment in attention span and cognitive performance in
regular cannabis users, even after the habit has been relinquished.
All these observations testify to a strong, long-lasting action on the
brain. Some attempts have been made in laboratories to work out
what cannabis could actually be doing to brain cells. So far,
some data have suggested that there can be damage to neurons, and at doses comparable to those taken on the street.

None the less, others argue that the experimental scenario of isolated neurons growing in a lab dish are hardly a natural situation, and that such data have to be interpreted with caution. But absence of evidence is not evidence of absence. The effects on the brain in real life are most probably
subtle and therefore hard to monitor: it’s not so much that cannabis
will create great holes in your brain, or deplete you wholesale of all
your best neurons. Instead, by acting on its own special little
chemical targets (and because it will therefore work as an impostor to
a naturally occurring transmitter), the drug is likely to modify the
configuration of the networks of brain cell connections. These
configurations of connections make you the unique person you are, since they usually reflect your particular experiences. So a change
will be hard to register from one person to another, and certainly
from one slice of rat brain to another: but still, it will make you
see the world in a different way – characteristically one depleted of
motivation.

It is hard for me, as a neuroscientist, to accept that a
drug that has the biochemical actions that it does, that hangs
around in the brain and body, and that has dramatic effects on brain
function and dysfunction, could not be leaving its mark, literally, on
how our neurons are wired up and work together. It is argued that
we will never stamp out cannabis use, and therefore we should
give up trying. But we will not stamp out murder or house break-ins or mugging, yet I’ve never heard an argument for freeing up police time
by liberalising the law on these acts. Laws, it is said, are
only enforceable when the majority wants them enforced, yet the
arguments used for easing up on cannabis apply equally to promoting
ecstasy or other mind-bending substances.
Do we really want a drug-culture lifestyle in the UK? Cynically, one could argue that it is politically expedient to court the youth vote, to open up the
inevitable prospect of revenue from a new source of taxes and to help
the ailing tobacco industry prosper from a great new product of
readymade packets of spliffs. The condoning of chemical consolation
also distracts from other problems. We have failed our young
people in providing homes and jobs and, by giving them an easy route into a chilled-out oblivion, have turned our backs on the far more challenging prospect of initiating policies to help them realise their
potential and live better and more fulfilling lives. They are paying a
high price for cool.

Source: www.guardian.co.uk/science Aug.2002

BYLINE: DR. KEVIN COSTELLO
Published on August 9,  2004- The Press Democrat PAGE: B9

Marijuana … what harm can a little dope do? The short answer is: Plenty.
First, is marijuana addictive? You bet it is. About one in eight people exposed to marijuana will become dependent on it. This makes it a little more addictive than alcohol. How do I define addiction? There’s a fancy medical definition or a more simple one: If you use marijuana every day you are probably addicted to it, especially if you have been doing this for a few months or more.So, let’s say you smoke marijuana every day. Isn’t that your business? Maybe yes, but most likely, no. When you are addicted to a substance your relationships in life are with that substance — not with other people.

In addiction medicine we have found that it is often best to ask the family members of the dependent individual how they feel. Frequently, there is a deep resentment and embitterment about the lack of support or the lack of emotional contact and empathy. A patient of mine was once asked by his wife to stop smoking marijuana for a few weeks, because her father was dying and she needed his support.

He managed to stop for a while, only to return to the addiction after his father-in-law died. It is remarkable how strong the dependency on marijuana can be.

Let’s say you don’t care about anyone else or that all your friends smoke or your significant other is tired of you and just as happy to have you stoned all the time.

What’s wrong with that?

There was an article in the Journal of the American Medical Association a few years ago, that looked at patients who used marijuana at least daily. The authors found that even 19 hours after stopping marijuana, these chronic users were not able to think as well (or memorize, or calculate, or analyze or perform other mental functions). In other words, if you smoke marijuana daily, you are always affected or “stoned” to a certain degree. You will not be able to realize your full intellectual capacity. This is especially important to high school and college students whose futures are determined by how well they do during that critically important eight-year window of academic opportunity.

Marijuana can also affect people in mid-career. A former patient of mine who was a Honda mechanic told me that he would read the shop manuals that came out every year seven or eight times. Despite the repetitive reviews, he was still not able to master the material. After stopping marijuana — which he had been using since high school — he found he only needed to read the manuals once.

One further caveat: some people seem to function very well on marijuana. They hold responsible positions and continue to perform relatively well. These folks are probably very bright and are able to accommodate the decrease in mental capacity. They may not, however, be the people you want performing brain surgery or negotiating an important contract.

Let’s say you really don’t care about any of the things that I’ve mentioned above. All you want is to smoke a little dope. A recent article, also in the Journal of the American Medical Association, showed that people who were using cocaine and methamphetamine (nasty stuff — there is a lot of evidence suggesting that these stimulants cause permanent brain injury) frequently followed a pattern of smoking cigarettes at a young age, then drinking alcohol, smoking marijuana and finally, progressing to harder drugs. The authors concluded that marijuana was not only a “gateway drug,” but seemed to actually precipitate the progression to the stimulants (cocaine and methamphetamine) and even to heroin, in certain individuals. So, you still don’t care. Well, I’ve saved the worst for last. The following is a partial list of the complications associated with the chronic use of marijuana: toxic psychosis (in susceptible individuals), increased heart rate and pain, decreased lung function, impaired fetal growth and development, decreased immune function (important for fighting infections and cancers), weight gain, bronchitis, and more.

Finally, a brief word about “medical marijuana.” The medical marijuana initiative passed by California voters, basically provides for the legalization of marijuana. This is because the initiative states that in addition to several serious illnesses, marijuana may be prescribed for “any other illness for which marijuana provides relief.” There was also no restriction on the age of the patient. Many physicians have no problem with the administration of marijuana to a patient with a terminal illness — but did the people of California really intend (as one United States Supreme Court justice put it) that marijuana be used for “anyone with a stomach ache” or for any reason at all?

I, for one, am not willing to sacrifice the one in eight individuals who are now at increased risk for developing an addiction to this drug due to its significantly increased availability.

I know that this article will raise deeply felt issues with some people. It is not my intention to offend anyone. I have attempted to provide factual information that can be reviewed, and hopefully, help you formulate an opinion about the use of marijuana. If you think that you have an addiction to marijuana, or you have further questions about it, the folks at Marijuana Anonymous can be an excellent source of information and assistance. You could also consult with a specialist in chemical dependency or one of the many local chemical dependency programs.

Dr. Kevin Costello is the chief of the medical division of Chemical Dependency Services for Kaiser in Santa Rosa.

By Jim McDonough Malcolm

The marijuana normalizers – as in, “let’s make marijuana use normal, or acceptable” – loved it; so did some of the press. Both were quick to misportray the study, so much so that the author of the study himself was dismayed.

Andrew Morral of RAND believes he did everything he could to explain he did not disprove the gateway theory but, as he told me, “The story about it misrepresented both our findings and my comments about the relevance of our findings to US drug policy. RAND and I have taken pains to emphasize that we do not believe we have disproved the gateway theory.”

The study did say that a high incidence of progression from marijuana to heroin and cocaine use is apparent; that the younger you are when you start using marijuana, the more likely you are to end up using cocaine and heroin; that the more often you use marijuana, the more likely you will use cocaine and heroin.

In short, the study shows the correlation between marijuana and other drug abuse to be high.

Indeed, the study accepts previous studies that have demonstrated the probability that heroin and cocaine use increases 85 times for marijuana users when compared with those who are not marijuana users; that early teen use of marijuana is even more highly correlated with other drug use than late teen marijuana use; and that the more puffs of marijuana you take, the more likely you move on to injections and snorting of even more dangerous drugs.

But here’s where the misunderstanding begins. The study says that maybe these terrible things happen because the people who use all these nasty drugs do it because they have a propensity for drug use, and marijuana is the first illegal drug to present itself to the young.

Dr. Morral calls that the “common factor” theory.

In other words, all drug users like all drugs; marijuana just comes along first. He suggests that this theory might be more accurate than the gateway theory.

But is a gateway not a gateway because it happens to present itself in front of where you want to go?

Perhaps this study’s findings appear trivial. They aren’t. If marijuana is merely the door through which those inclined to use drugs pass because it is convenient, all the more reason to keep that door locked.

I’m convinced that’s the best way to view Morrall’s findings, because the pro-marijuana lobby and much of what the press missed in this study, as well as other careful studies, were findings that suggest:

• There is a strong correlation between marijuana and other drug abuse, with marijuana almost always occurring first.
• Marijuana, all by itself, is a dangerous drug.
• There is a strong correlation between marijuana use and schizophrenia.
• Marijuana itself is addictive.
• Youth marijuana use correlates highly with violence, truancy, and other behavioral problems.
• The younger the marijuana user, the more psychological and physiological damage done, and the more likely that other drugs will follow.
• Smoking three marijuana joints a day can cause the equivalent respiratory damage associated with 20 cigarettes a day. Marijuana smokers show significantly more respiratory symptoms than people who don’t smoke it.
• Prolonged use can cause attention deficit and deterioration in memory.

As we do more studies, we might turn to these people for insight.

So what of the utility of the “common factor” theory over the “gateway” theory? A weed by any other name still smells the same.

* Jim McDonough is director of the Florida Office of Drug Control. He previously served as director of strategic planning at the Office of National Drug Control Policy.

Source: Christian Science Monitor December 16, 2002

By Malcolm Ritter, Associated Press

NEW YORK — Can Prozac help you kick cocaine? Can Ritalin? How about a blood pressure pill or medicine for muscle spasms?

If you’re an alcoholic, could you get help staying sober by taking an anti-nausea drug used by cancer patients?

Scientists are exploring those questions right now. In fact, in the field of addiction medicine, one of the hottest sources of new drugs is … old drugs.

Despite years of research, there is no drug approved in the United States for treating cocaine dependence. To find such a treatment, the National Institute on Drug Abuse is sponsoring human studies of 21 medicines already on the market for something else. That’s about two-thirds of all the potential cocaine drugs being tested in people, says Frank Vocci, director of NIDA’s pharmacotherapy division.

Over at the National Institute on Alcohol Abuse and Alcoholism, nearly all the potential alcoholism drugs tested in people under institute sponsorship over the past 10 years were previously approved for some other use, says Raye Litten, co-leader of the institute’s medications development team.

While the strategy is hardly new, “it’s been going on maybe just a bit below the radar screen” for most of the public, Vocci said.

It can certainly work. In 1997, for example, the government approved a stop-smoking pill called Zyban, which was in fact the older antidepressant Wellbutrin.

To be sure, experts haven’t given up on developing new drugs. Most NIAAA-funded drug studies for alcoholism that are in early-stage testing — not yet tried on people — are brand-new drugs, Litten said.

But the notion of examining current drugs for addiction-breaking potential holds several advantages. It’s a lot cheaper to get federal approval for a new use of an old drug than to bring a completely new medicine to market. And experience with an existing drug gives an idea of its safety and dose range for possible anti-addiction effects, Vocci said.

He and others caution that people who happen to have medications on hand that show promise in such studies shouldn’t give them to friends and family with addiction problems. That must be left to professionals. Experts also say that even effective anti-addiction medicines usually can’t work by themselves, but must be used along with nondrug therapy.

The most straightforward approach to testing an existing drug is to follow its approved purpose, but in a different way. For example, some scientists are studying how to prolong the effects of naltrexone, now usually given as a daily pill for treating dependence on alcohol or opiates like heroin and morphine.

Dr. David Gastfriend of Massachusetts General Hospital and Harvard Medical School and other researchers recently reported that specially formulated naltrexone helped alcoholic men cut down on their drinking for a month when they received the drug as a shot in the buttocks.

Why is a monthly visit to a doctor better than just taking a pill every day?

“The pill requires a daily awareness that this is a dangerous disease and a rational decision to take the pill,” Gastfriend said. “The problem with this illness is that on any given day, a person can feel, No, it would be better if I could drink. So you take the pill the first day and you have to make 29 more decisions” the rest of the month.

“But if you received an injection the first day, those 29 decisions have already been made,” said Gastfriend, a paid consultant to Alkermes Inc., which is developing the formulation he studied, called Vivitrex.

More striking than just reformulating a drug is finding a new and apparently unrelated use for it. Here, scientists are guided by emerging knowledge about how addiction hijacks the brain.

Addicts apparently suffer from a combination of unusually strong desire for a drug and a weak inhibition against using it, Vocci said.

“These people essentially have a revved-up engine and thin brake pads,” he said.

In the brain, scientists have found that cocaine produces euphoria by stimulating nerve circuits that communicate with a substance called dopamine. So they’ve looked for medications that can affect the activity of this dopamine system.

One is a decades-old old drug called Baclofen (pronounced BAK-loe-fen), used to treat spasms, cramps and muscle tightness in people with multiple sclerosis or spinal problems. Steven Shoptaw, a researcher at the University of California, Los Angeles, recently published a preliminary, federally funded study that suggested it can cut cocaine use in addicts. A much larger study is now under way to confirm that, but for now the drug looks promising, Shoptaw said.

Other drugs that work in a similar way and that are being tested in cocaine addicts include the anti-seizure medications tiagabine, topiramate and a drug sold overseas as Vigabatrin.

Cocaine withdrawal symptoms might be eased by boosting the brain’s depleted dopamine levels. So scientists are studying dopamine-boosting drugs like Ritalin, used for attention deficit hyperactivity disorder, and amantadine, used for flu and Parkinson’s disease.

But addiction is complicated enough to involve many brain circuits, which in turn provide many targets for anti-addiction drugs. Inderal, a blood-pressure medicine, may reduce cocaine craving during early abstinence by interfering with the actions of another brain substance, norepinephrine. The antidepressants Prozac and Effexor, which boost levels of yet another brain chemical called serotonin, are also under study in cocaine dependence.

Then there’s Ondansetron (pronounced on-DAN-se-tron), which is normally used to prevent nausea and vomiting after cancer chemotherapy or surgery. Scientists are studying it for both cocaine and alcohol abuse, again for its action in the serotonin circuitry.

It might seem logical that a single drug could help in multiple kinds of addiction, but even that situation can come with a twist. Consider Antabuse, the anti-alcohol drug that works by making users sick if they drink alcohol. Scientists recently found, unexpectedly, that Antabuse also helps cocaine-dependent people cut back on cocaine, though not by making them sick.

Just how it does that isn’t clear, says researcher Dr. Thomas Kosten of Yale University. Antabuse hampers the normal breakdown of cocaine by the body, and boosts dopamine levels while reducing norepinephrine levels, he said. The net effect may be to reduce both withdrawal symptoms and desire to seek cocaine, he said.

Shoptaw thinks that, within the next five years, some drug will win approval for treating cocaine dependence. Baclofen, Topiramate and Antabuse lead his list of candidates. Each may find a use in a different phase of cocaine dependence, such as getting off the drug or staying off, he said.

And addiction specialists are eagerly looking beyond today’s medicine cabinet toward a drug that isn’t approved for anything in the United States yet. Rimonabant blazed into the headlines in March when researchers reported evidence that it might help people battle both cigarette smoking and obesity.

But why stop there?

Rimonabant blocks the brain’s docking sites for its own marijuana-like substances, part of the “cannabinoid” system that might play a role in addictions beyond food and nicotine, says Dr. Herbert Kleber of Columbia University.

Once the drug is approved for either smoking or obesity, he expects researchers will jump in and test it for things like heroin and cocaine.

And the strategy of squeezing new uses of out existing drugs may score another success. Inside here are some medicines being studied for their potential to stop drug addiction. They are already on the market for these uses:

Prozac and Effexor; prescribed for depression.

Amantadine; flu and Parkinson’s disease.

Baclofen; spasms, cramps and muscle tightness in people with multiple sclerosis or spinal problems.

Ritalin; attention deficit hyperactivity disorder.

Ondansetron; prevention of nausea and vomiting after cancer chemotherapy or surgery.

Tiagabine, Topiramate and a drug sold overseas as Vigabatrin; seizures.

Source:http://www.dailynews.com/Stories/0,1413,200~20954~2380825,00.html

By Susan Greenfield

Oxford, England — Across Europe and America, the legalization of cannabis for personal use generates intense debate.

Britain has, to all intents and purposes, practically decriminalized marijuana usage.

As a neuroscientist, I am concerned. One common justification for legalization or decriminalization of cannabis centres around the idea that it does not involve a victim. At least four reports in major medical journals — Ramstrom (1998), Moskowitz (1985), Chesher (1995) and Ashton (2001) — show the contrary.

Costs to the community include accidents at work or at home, educational under-attainment, impaired work performance and health-budget costs.

Another argument is over that cannabis is nonaddictive. Of course, defining addiction is hard. But if one regards it as an inability to give up, then there is strong evidence that cannabis incites dependence. Recent scientific papers report many users in the United States, United Kingdom and New Zealand now seek treatment for dependence. Other papers show that 10 percent of users want to stop or cut down but have difficulty doing so. A paper in 1998 reported that 10 to 15 percent of users become dependent on pot.

It was shown recently that withdrawal symptoms were experienced after only three days of light use. Heavy users confront a worse situation. Dr. Bryan Wells, a rehabilitation expert, says that for the first time he’s beginning to see in heavy cannabis users the withdrawal symptoms produced by hard drugs.

Another argument is the beneficial effect of marijuana on pain. So far, that evidence is anecdotal; it is hard to exclude placebo effects. The results from clinical trials are awaited.

But distinctions should be drawn between recreational drugs and medicines, as they are for opiates. If cannabis is a painkiller, then it must have a huge impact on the physical brain.

Indeed, widespread reports exist of the impact of cannabis on the brain, in particular areas concerned with memory (hippocampus), emotion (mesolimbic system) and movement (basal ganglia). Cannabis affects a variety of chemical systems and it works via its own receptor — its own molecular target.

The fact that there is a naturally occurring analogue of cannabis in the body, as there is for morphine, provides a basic reason to differentiate it from alcohol.

For an agent that affects a variety of transmitter systems, it is as though it were a transmitter itself. This is not surprising, for cannabis has a clear effect on psychology. Not only does it produce euphoria, but the effects, often overlooked, may also include anxiety, panic and paranoia. Disorders in psychological performance, attention impairments and memory deficits are well known.

More disturbing — and less frequently acknowledged — is the fact that these effects can be long-term.

In one recent study, the attention spans of ex-users were compared to those of current users, short-term and long-term. The abstainers, who had been users for at least nine years, had quit from three months to six years before the study. Of the current users, one group had at least 10 years of dependence; the other, about three years. Everyone in the study had used cannabis from 10 to 19 days per month.

Although the quitters did better than users, all had attention impairments in comparison with nonusers in a control group. The impairment was related to the duration of use. Most disturbing was the fact that no improvement in performance occurred with increasing abstinence.

It was no surprise, then, that because these long-term effects seem to be irreversible, there is an effect on brain pathology. Because much of this data comes from work with isolated systems, and therefore on all brains, an obvious criticism is that you can’t extrapolate from such data. Yet, the evidence suggests that the long-term effects must have a physical basis. Is there a safe dose of cannabis, with no effect on the brain? Even a dose comparable to one joint, and analogous levels of the active THC ingredient to that in plasma, can kill 50 percent of neurons in the hippocampus (an area related to memory) within six days. People are unaware that the THC in cannabis remains in the body for more than five days. For someone using cannabis routinely, the dose carried in the body is higher than they imagine. It is easy to underestimate the dose because of the wide range in the strength of cannabis. Individual variations in body fat and, worryingly, variations in one’s disposition to psychosis, mean that you cannot predict how much cannabis will affect any person at any time.

Cannabis could well be having a serious effect on the mind, which I define as the personalization of brain circuits that reflect an individual’s experiences. A transmitterlike substance, with such powerful effects, must affect those circuits. So blowing your mind might be exactly what marijuana users are doing.

Source: San Francisco Chronicle (CA): Pubdate: Sun, 6 Jan 2002

Note: Susan A. Greenfield, the Fullerian Professor of Physiology at Oxford University, is director of the Royal Institution of Great Britain. This article was written for Project Syndicate, based in Prague.

By Joel Becker, Associate Editor

As methamphetamine makes a larger impact in western Wisconsin, more and more people are making an effort to find out just how bad the drug really is.

As a part of an Elk Mound inservice for school staff, Tim Schultz of the Division of Narcotics Enforcement gave a presentation to those 60 staff members and another 160 or so community members.

Schultz’ presentation wasn’t something that was humorous or entertaining. Rather it was more apropos for a Halloween spook show.

In fact, portions of the presentation, that included videos and photos, were simply gruesome.

Schultz told the audience that he gives the same presentation to high school students and some find it too graphic.

Early in the presentation on meth, Schultz showed a video with pictures of a 4-year-old girl who had been slowly bloodied, scarred and burned before being scalded to death in a bathtub by her parents who were meth users and cookers.

And the most disturbing portion of the presentation were pictures of people who couldn’t escape their homes when their meth labs exploded.

Schultz touched on marijuana as a gateway drug, but focused on meth because “that is the biggest problem we have right now.”

Schultz has been a presenter for 17 years and said the Polk and Barron county areas are the worst places for methamphetamine in the state of Wisconsin.

He said 90 percent of crime in those counties can be attributed to meth use as users search for ways to acquire the money they need to keep up their habit.

He noted that meth is different from any other drug out there because every other drug is natural. Meth is totally manmade and is the most potent drug there is.

When smoked or injected, he cited a report that said that 90 out of 100 users will become addicts by the second time they use.

“There’s no such thing as a recreational meth user,” Schultz said.

He said people start to use meth (crystal, crank, speed, lith-fluff, ice, glass shards) for a couple of reasons. Schultz said people use it because meth causes dramatic weight loss. It gives users incredible energy and keeps them awake for days or weeks at a time.

It also gives the user a euphoria beyond anything else because it forces the brain to release all of its dopamine, the body’s feel-good drug (except that with all of the dopamine in use, the feeling is 40,000 times stronger than any release the body gives naturally). The brain usually recycles the dopamine, but meth keeps the dopamine in the system for a long high (four to 16 hours) and eventually destroys it.

So no high is as good as the first, but the addict will continually try to recreate that feeling, destroying all dopamine in the body, which meth then simulates. The person can have no feeling of pleasure on their own after continued abuse and rely on meth to feel good.

But, as Schultz said in the nearly two-hour presentation, addicts basically turn into paranoid schizophrenics. He said the “meth monsters” make addicts unable to grasp reality.

Schultz told stories of how addicts believe law enforcement officers were always watching them and out to get them. They even believed they could see them peeking in their windows or watching them with night-vision goggles from a roof across the street.

Another user said he thought he was driving 60 miles an hour in his car and saw a relative running along side, so he opened his door to let him in.

Addicts also get “crank bugs,” which cause them to scratch and pick at their skin.

The cuts and scabs are just one indication of a meth user. They also usually have bad teeth and gums, bad breath, body odor, sunken in eyes, gaunt faces and a haggard appearance.

Since methamphetamine is relatively new in Wisconsin (there’s more in Polk and Barron counties than in Madison and Milwaukee combined) Schultz said the recently-enacted law that puts pseudophedrine (a key meth ingredient) behind the counter will have little affect. Thirty-seven states have similar laws.

When the law was enacted in Iowa, meth-related arrests dropped 70 percent. But Schultz says 90 percent of the meth in Wisconsin comes from Mexicans, much of which comes from Mexico.

Though every meth addict is a victim, children are the innocent victims.

“Meth users care more about the drug than their children,” Schultz said.

Children are constantly exposed to the chemicals necessary to making meth and are often harmed by the toxins or die in meth lab fires.

“Living in a home with a meth lab is like living in a toxic waste dump,” he said.

Schultz said those trying to recover often reoffend. He said the only way for users to break the meth habit is by participating in a long-term program.

 Source: www.dunnconnect.con Nov. 2005

By Janet C. Greenblatt

Introduction

The National Household Survey on Drug Abuse (NHSDA), sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services, has shown that since 1992, the rate of past month marijuana use among youth has more than doubled, going from 3.4 % in 1992 to 7.1 % in 1996. Similar trends are evident among both boys and girls; among whites, blacks and Hispanics; and in metropolitan and non metropolitan areas (SAMHSA 1997a). Other studies have also shown a doubling of marijuana use between 1992 and 1995 among 8th graders, and significant increases among 10th and 12th graders (NIDA 1997). At the same time, the rate of 12 to 17 year olds perceiving great risk in using marijuana has decreased. In the 1992 NHSDA, 39% of youths reported that smoking marijuana once a month is of great risk to people compared with 33% in 1996. Similarly, in 1992, 64% of youths reported smoking marijuana once or twice a week was of great risk to people compared with 57% in 1996 (SAMHSA 1997b).

The National Institute on Drug Abuse (NIDA) has reported that marijuana can be harmful both from immediate effects and damage to health over time. Specifically, studies have shown that marijuana can hinder the users’ short term memory and ability to handle difficult tasks (Schwartz et al. 1989). Students may find it difficult to study and learn. While many of the long-term effects of marijuana use are not yet known, studies have shown that daily marijuana smokers who did not use tobacco had more sick days and doctor visits for respiratory problems than a similar group who did not smoke either substance. A person who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers have (Tashkin et al. 1987). Other studies have shown that the regular use of marijuana may play a role in cancer and problems of the respiratory, immune and reproductive systems. Heavy marijuana use can affect hormones in both males and females. Both animal and human studies have shown that marijuana impairs the ability of T-cells in the lungs’ immune defense system to fight off some infections. Because of the drug’s effects on perceptions and reaction time, users could be involved in automobile accidents (NIDA 1995). According to the 1996 NHSDA, nearly one million 16-18 year olds (11%) reported driving at least once within two hours of using an illicit drug in the past year (most often marijuana) (SAMHSA 1998).

Although it is not yet known how the use of marijuana relates to mental illness, some scientists maintain that regular marijuana use can lead to chronic anxiety, personality disturbances, and depression (NIDA 1995). Some frequent long-term marijuana users show signs of lack of motivation and tend to perform poorly in school (Pope 1996). A recent study demonstrated similarities between marijuana’s effect on the brain and those produced by such addictive drugs as cocaine, heroin, alcohol, and nicotine (Volkow 1996).

There is substantial interest in the co-occurrence in the general population of illicit drug use with other kinds of behavioral patterns, mental syndromes, and psychiatric disorders (Bourden et al. 1992, Kandel et al. 1997, Kessler et al. 1996, SAMHSA 1996). A number of descriptive studies have demonstrated that people who use drugs are more likely to have mental disorders, physical health problems, and family problems (NIDA 1991). In addition, a recent study (Crowley 1998) was conducted with 165 boys and 64 girls between the ages of 13 and 19 who had been referred by social service or criminal justice agencies to a university-based treatment program for delinquent substance-involved adolescents. Based on interviews, medical examinations, social history, and psychological evaluations, the study showed that marijuana use by teenagers who have prior serious antisocial problems can quickly lead to dependence on the drug. Most of the youths reported that their behavioral problems predated, and were not initially caused by, their drug use.

The 1994, 1995, and 1996 NHSDA incorporated the widely used Youth Self-Report (YSR) Checklist which ranks adolescents on a variety of clinically validated scales of behavioral and emotional problem behaviors (Achenbach 1991). In this paper, the relationship between marijuana use among those age 12-17 and various problem measures, as reported on the YSR, is shown. This paper concentrates primarily on the reported frequency of marijuana use and its relationship with self-reported behaviors.

Methods

The NHSDA, currently conducted by SAMHSA, has provided estimates of the prevalence, consequences, and patterns of drug use and abuse in the United States periodically since 1971. It is the primary source of statistical information on the use of illegal drugs by the United States population age 12 and older. The survey collects data by administering questionnaires to a representative sample of persons living in the U.S. (SAMHSA, 1998).

The respondent universe includes residents of non institutional group quarters such as shelters, rooming houses, dormitories and residents of civilian housing on military bases. Persons excluded from the universe include the homeless not found in shelters, residents of institutional quarters, such as jails and hospitals, and active military personnel. The survey employs a multistage area probability sample design that includes over-sampling of young people, African-Americans, and Hispanics. In 1993, 1994, and 1995, cigarette smokers age 18-34 were also over-sampled.

The household interview takes about an hour to complete, and includes a combination of interviewer-administered and self-administered questions. With this procedure, the answers to sensitive questions (such as those on illicit drug use) are recorded on separate answer sheets by the respondent and are not seen by the interviewer. After the answer sheets are completed, they are placed by the respondent in an envelope, which is sealed and mailed with no name or address information included.

A concern of NHSDA data users is that the data are based on self-reports of drug use, and their value depends on respondents’ truthfulness and memory. Although many studies have generally established the validity of self-report data and the NHSDA procedures were designed to encourage honesty and recall, some underreporting may have taken place (Harrell 1986). The methodology used in the NHSDA has been shown to produce more valid results than other self-report methods such as interviews by telephone (Turner et al. 1992). However, comparisons of NHSDA data with data from surveys conducted in classrooms suggest that underreporting of drug use by youths in their homes may be substantial (Gfroerer 1997).

For this study, data from the 1994, 1995, and 1996 NHSDA datasets were combined, dividing the analytic weights by 3 to produce average annual yearly estimates for the combined dataset. Questionnaires and data collection and estimation methodologies were essentially the same in those three years. The household screening completion rate for the 1994-6 surveys was 94%. This study is restricted to those age 12-17. In 1994, 83% of sample persons age 12-17 completed the interview resulting in a sample size of 4,698. The 1995 NHSDA achieved a response rate of 85% for the 4,595 respondents age 12-17; the 1996 response rate was 82 % for a sample size of 4,538. Three-fourths of the interviews (in the combined dataset) among those age 12-17 were completed in complete privacy or with minor distractions.

In 1994, SAMHSA began collecting mental health data on the NHSDA. A youth mental health module for the age group 12-17 was adopted from work by Thomas M. Achenbach and colleagues (1991a) to obtain youths’ reports of their competencies and problems in a standardized format. The module was designed to measure depression, anxiety, social withdrawal, somatic complains, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior during the past 6 months. Psycho-social problem behaviors in the past 6 months were measured using a module composed of 118 items from the Youth Self-Report (YSR) which has been used extensively in studies of adolescents. Scores that sum up responses to the YSR have been shown to distinguish adolescents typically seen in clinical settings for counselling or psychotherapy from those seldom referred for treatment, in other words, to identify individuals who are likely to have clinically significant levels of functional, cognitive, or emotional problems. For this study, the responses to each of the 118 items were analyzed separately.

Results

Characteristics of Past Year Marijuana Users Age 12-17

Youths were asked how often in the past 12 months they used marijuana (Table 1). The majority of 12, 13, and 14 year olds (64%, 59%, and 52%, respectively) who used marijuana used less often than monthly (1-11 days in the past year) compared with 47% of 15 year olds and 39% of 16-17 year olds. More than 27% of users age 16 to 17 used marijuana 1 to 7 days a week in the past year compared with 12% of 12 year old users and 21-24% of 13-15 year old users.

The teenagers using monthly or more often were more likely to be older (age 16 to 17). The monthly or more often users were also more likely to be male than those who used less frequently. Those who used monthly or more often were more likely than less frequent users to live in the West and to have moved 2 or more times in the past year. The weekly users were 1.7 times more likely than nonusers to be living in other than a 2-parent family (55% and 33% respectively). As the frequency of use increased, the % of 12-17 year olds living in a 2-parent family decreased.

Self-reported Problem Behaviors Associated With Marijuana Use

In completing the YSR, youths were asked to read the list of 118 statements and indicate if the statement was not true, somewhat or sometimes true, or very or often true for them. Although causal conclusions about the relationship between substance use and problems cannot be drawn from the NHSDA data alone, these data provide a useful complement to other studies. While the reported behaviors are not necessarily caused by the use of marijuana or, conversely, the cause of marijuana use, there appears to be a strong positive correlation between the reporting of certain behaviors and reported frequency of marijuana use. The more frequent the use, the more likely the 12-17 year olds were to report problem behaviors.

Withdrawal:

There were 7 measures that comprised the withdrawal category .+ There was a strong correlation between the reporting of withdrawal items and the frequency of reported marijuana use. Those who used marijuana on 1-7 days a week in the past year were nearly twice as likely as non-users to report they refuse to talk (25% vs. 16%), they don’t have much energy (47% vs. 25%), and they are unhappy, sad or depressed (40% vs. 23%). Those who used marijuana at least monthly in the past year reported being more likely than nonusers to say they were secretive or kept things to themselves.

Somatic Complaints:

Those age 12 to 17 who used marijuana in the past year were more likely than nonusers to report feeling dizzy, overtired, and nauseous or sick. There appeared to be little correlation between frequency of marijuana use and certain reported somatic complaints with the more frequent users being as likely as less frequent users to report symptoms such as having headaches, rashes or other skin problems.

Anxiety/Depression:

Those who used marijuana at least once a month in the past year were nearly 3 times as likely as nonusers to say they think about killing themselves (24% vs. 8%). Those who used marijuana in the past year were more likely than nonusers to report that they deliberately try to hurt or kill themselves, feel lonely and that no one loves them, that other people are out to get them, and they are worthless and inferior. For some items, as the frequency of use increased, the % of adolescents reporting these feelings also increased. For example, weekly users were more likely than less frequent users to feel “others are out to get me”, “I am worthless or inferior” or “I am unhappy or sad”.

Social Problems:

Those who used marijuana in the past year were more likely than nonusers to report that they do not get along with other kids and weekly users were nearly twice as likely as nonusers to report this (33% vs 19%) . The weekly users were less likely than nonusers to report they act too young for their age (27% vs. 36%), they prefer younger kids as friends (15% vs. 22%), and they get teased a lot (17% vs. 25%). However, weekly users were more likely than nonusers to say they are not liked by other kids (25% vs. 18%).

Thought Problems:

Past year marijuana users age 12 to 17 were more likely than nonusers to report four thought problems: “I can not get my mind off certain thoughts”, “I repeat certain actions over and over”, “I do things other people think are strange”, and “I have thoughts people would think are strange”. In addition, monthly or more often users were more likely than nonusers to say they see and hear things that other people think are not there.

Attention Problems:

Those who used marijuana in the past year were more likely than nonusers to report they have trouble concentrating (72% vs. 51%), they feel confused or in a fog (41% vs. 24%), they daydream a lot (68% vs. 52%), they act without stopping to think (63% vs. 44%), and their school work is poor (59% vs. 30%) . As before, the % of those reporting attention problems generally increased with frequency of use.

Delinquent Behavior:

Differences of the greatest magnitude between users and nonusers were found in measures of delinquent behavior . Those who used marijuana weekly were 9 times as likely as nonusers to say they use alcohol or drugs for nonmedical purposes (76% vs. 8%), 6 times as likely to say they had run away from home (24% vs. 4%), nearly 6 times as likely to say they had cut classes or skipped school (60% vs. 11%), 5 times as likely to say they stole from places other than home (34% vs. 6%), and 3 times as likely to say they steal at home (17% vs. 5%). Moreover, a higher proportion of past year marijuana users reported these behaviors than did nonusers. Past year users were also more likely than nonusers to report they do not feel guilty after doing something they shouldn’t, they hang around with kids who get into trouble, and they lie and cheat. As noted elsewhere, the proportion saying these statements were somewhat, very or often true about them generally increased with frequency of marijuana use. For example, weekly marijuana users were about twice as likely as those who used fewer than 12 times in the past year to say they had run away from home or they had cut classes or skipped school in the past 6 months.

Aggressive Behavior:

Past year marijuana users were more likely than nonusers to report all aggressive behaviors . For many items, the percentage reporting the behavior increased as frequency of use increased. Weekly users were nearly 4 times as likely as nonusers to report they physically attack people (26% vs. 7%), and 3 times as likely to report they destroy things that belong to others (22% vs. 7%), they threaten to hurt people (38% vs. 13%), and they get in many fights (37% vs. 14%). The weekly users were also twice as likely as nonusers to report they disobey at school (59% vs. 24%) and they destroy their own things (22% vs. 10%). On average, past year marijuana users, regardless of frequency of use, were twice as likely as nonusers to report they destroy things that belong to others, they disobey at school, they get in many fights, and they threaten to hurt people.

Criminal Behavior:

In addition to the YSR module, the NHSDA included questions about some past-year activities that may have been illegal. In each comparison adolescents age 12 to 17 who used marijuana in the past year were 3 or more times more likely than nonusers to report past-year involvement in these activities. Past year marijuana users were more likely than nonusers to report that in the past year, they were on probation, and they had 1) taken something from a store without paying, 2) purposely damaged property that wasn’t theirs, 3) driven under the influence of alcohol or drugs, 4) hurt someone enough to need a bandage, and 5) sold illegal drugs. As before, in most cases, the %age reporting these behavioral problems increased with the frequency of marijuana use. In particular, weekly users of marijuana were more than 5 times as likely as those who used only 1 to 11 times in the past year to have driven under the influence of drugs (29% vs. 4%) or to have sold illegal drugs in the past year (29% vs. 6%). Weekly users were also 2-3 times more likely than those who used less often than monthly to be on probation (20% vs. 7%), to have driven under the influence of alcohol (20% vs. 9%), or to have purposely damaged property that was not theirs (35% vs. 18%).

Conclusion

This report shows that among those age 12-17, past year marijuana users were more likely than nonusers to report problem behaviors in the past 6 months. Further, for the majority of items measured, the more frequent the use, the more likely the youths were to report problem behaviors.

The more frequent users were more likely to be the older youths (6 out of 10 were age 16-17), white, male, to live in a metropolitan area and the West. They were more likely than less frequent users to have moved in the past year and are less likely to live in a 2-parent family. Frequent marijuana users were more likely than less frequent users to report delinquent behaviors such as running away from home, stealing, and cutting classes or skipping school. They were also more likely than less frequent users to report aggressive behaviors such as destroying things that belong to others and physically attacking people. Monthly or more often users were more likely than less frequent users to have driven under the influence of alcohol or drugs or sold illegal drugs in the past year. From a psychological view, youths who used marijuana in the past year reported many behaviors symptomatic of anxiety and depression. Users were 2 to 4 times more likely than nonusers to report they think about killing themselves or that they deliberately try to hurt or kill themselves. They were more likely than nonusers to say they were unhappy, sad or depressed and that they feel “no one loves me”. The users were more likely than nonusers to report that “others are out to get me” and “I am suspicious”.

Regardless of whether the problem behaviors preceded marijuana use or marijuana use preceded the behaviors (which we are not able to ascertain from the NHSDA), it is apparent from these data that the marijuana users are exhibiting many signs of anxiety and depression and exhibiting delinquent and aggressive behaviors far in excess of the nonusers. Further, there appears to be a high correlation between the presence of many of these reported behaviors and the frequency of marijuana use.

These findings strengthen the argument that marijuana is not a benign substance. Not only can it be associated with many destructive and aggressive behaviors, it can also be associated with severe symptoms of anxiety and depression. Longitudinal studies are needed to determine if the symptoms and behaviors preceded the marijuana use or vice versa. Whether this can be determined or not, this report shows the importance of preventing the use of marijuana in youths and the need for treatment for marijuana use in conjunction with treatment for co-morbid mental disorders.

References

1)Substance Abuse and Mental Health Services Administration (1997a). Drug Abuse Series: H-3. Preliminary Estimates from the 1996 National Household Survey on Drug Abuse. Office of Applied Studies, July 1997.

2)National Institute on Drug Abuse (1997). Press Release for the Monitoring the Future Study, The University of Michigan Institute for Social Research, December 1997.

3)Substance Abuse and Mental Health Services Administration (1997b). 1996 National Household Survey on Drug Abuse: Preliminary Tables (Unpublished). Office of Applied Studies, June 1997.

4)Schwartz, R.H., Gruenewald, P.J., Klitzner, M., and Fedio, P. (1989) Short-term memory impairment in cannabis-dependent adolescents. American J. of Diseases of the Child 1989; 143:1214-1219.

5)Tashkin, D.P., Coulson, A.H., Clark, V.A., et al. Respiratory system and lung function in habitual, heavy smokers of marijuana alone, smokers of marijuana and tobacco, smokers of tobacco alone, and nonsmokers. Am Rev Respir Dis 1987; 135:209-216.

6)National Institute on Drug Abuse (1995) Marijuana: Facts Parents Should know. Booklet NCADI #PHD712, GPO#017-024-01570-0.

7)Substance Abuse and Mental Health Services Administration (1998). Drug Abuse Series: H-5. National Household Survey on Drug Abuse Main Findings 1996, Office of Applied Studies, May 1998.

8)Pope, HG Jr, Yurgelun-Todd,D. The residual cognitive effects of heavy marijuana use in college students. JAMA 1996 Feb 21; 275(7): 521-7.

9)Volkow, N.D., Ding, Y.-S., Fowler, J.S., & Wang, G.-J. 1996. Cocaine Addiction: Hypothesis Derived from Imaging Studies with PET. J. Addictive Diseases, 1996.

10)Bourden, H., Rae, D., Narrow, W., Manderscheid, R., and Regier, D., National Prevalence and Treatment of Mental and Addictive Disorders, Mental Health, United States, Center for Mental Health Services, DHHS Pub. No. (SMA)92-1942 (1992).

11)Kandel, D.B., Johnson, J.G., Bird, H.R., Canino, G., Goodman, S.H., Lahey, B.B., Regier, D.A., and Schwab-Stone, M. Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Journal of Abnormal Child Psychology 1997, 25(2), pp. 121-132.

12)Kessler, R.C., Nelson, C.B., McGongle, K.A., Edlund, M.J., Frank, R.G., and Leaf, P.J., The Epidemiology of Co-occurring Addictive and Mental Disorders in the National ComorbiditySurvey: Implications for Prevention and Service Utilization. American Journal of Orthopsychiatry 66:17-31 (1996).

13)Substance Abuse and Mental Health Services Administration (1996). Advance Report 15. Mental Health Estimates from the 1994 National Household Survey on Drug Abuse. Office of Applied Studies, July 1996.

14)Crowley, T (1998). Troubled Teens Risk Rapid Dependence on Marijuana. Drug and Alcohol Dependence 50:1.

15)Achenbach, T.M., (1991) Manual for the youth Self-Report and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.

16)Harrell, A.V., Kapsak, K.A., Cisin, I.H., and Wirtz, P.W. (1986). The Validity of Self-Reported Drug Use Data: The Accuracy of Responses on Confidential Self-Administered Answer Sheets. Prepared for the National Institute on Drug Abuse, Contract Number 271-85-8305.

17)Turner, C.F., Lessler, J.T., and Gfroerer, J.C. (1992). Survey Measurement of Drug Use: Methodological Studies. National Institute on Drug Abuse. DHHS Pub No. (ADM) 92-1929..

18)Gfroerer, J.C. (1997). Prevalence of youth substance use: the impact of methodological differences between two national surveys. Drug and Alcohol Dependence 47 (1997) 19-30.

Table 1:Percentage Distribution of Past Year Frequency of Marijuana Use Among Past Year Users by Age, 1994-96

Source:Office of Applied Studies, SAMHSA, National Household Survey on Drug Abuse