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Tom P. Freeman, Peggy van der Pol, Wil Kuijpers, Jeroen Wisselink,Ravi K. Das, Sander Rigter, Margriet van Laar, Paul Griffiths, Wendy Swift,Raymond Niesink and Michael T. Lynskey

ABSTRACT:

Background

The number of people entering specialist drug treatment for cannabis problems has increased considerably in recent years. The reasons for this are unclear, but rising cannabis potency could be a contributing factor. Methods Cannabis potency data were obtained from an ongoing monitoring programme in the Netherlands. We analysed concentrations of δ -9-tetrahydrocannabinol (THC) from the most popular variety of domestic herbal cannabis sold in each retail outlet (2000–2015). Mixed effects linear regression models examined time-dependent associations between THC and first-time cannabis admissions to specialist drug treatment. Candidate time lags were 0–10 years, based on normative European drug treatment data.

Results

THC increased from a mean (95% CI) of 8.62 (7.97–9.27) to 20.38 (19.09–21.67) from 2000 to 2004 and then decreased to 15.31 (14.24–16.38) in 2015. First-time cannabis admissions (per 100 000 inhabitants) rose from 7.08 to 26.36 from 2000 to 2010, and then decreased to 19.82 in 2015. THC was positively associated with treatment entry at lags of 0–9 years, with the strongest association at 5 years, b = 0.370 (0.317–0.424), p < 0.0001. After adjusting for age, sex and non-cannabis drug treatment admissions, these positive associations were attenuated but remained statistically significant at lags of 5–7 years and were again strongest at 5 years, b = 0.082 (0.052–0.111), p < 0.0001.

Conclusions

In this 16-year observational study, we found positive time-dependent associations between changes in cannabis potency and first-time cannabis admissions to drug treatment. These associations are biologically plausible, but their strength after adjustment suggests that other factors are also important.

Source: https://www.researchgate.net/publication/322830280_Changes_in_cannabis_potency_and_first-time_admissions_to_drug_treatment_A_16-year_study_in_the_Netherlands January 2018

Science Spotlight

New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Columbia University.

The investigators analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions, which interviewed more than 43,000 American adults in 2001-2002, and followed up with more than 34,000 of them in 2004-2005. The analysis indicated that respondents who reported past-year marijuana use in their initial interview had 2.2 times higher odds than nonusers of meeting DSM-IV diagnostic criteria for prescription opioid use disorder by the follow-up. They also had 2.6 times greater odds of initiating prescription opioid misuse, defined as using a drug without a prescription, in higher doses, for longer periods, or for other reasons than prescribed.

A number of recent papers suggest that marijuana may reduce prescription opioid addiction and overdoses by providing an alternate or complementary pain relief option. That suggestion is partly based on comparisons of aggregate data from states that legalized marijuana for medical use vs. those that didn’t. In contrast, the current study focuses on individual marijuana users vs. nonusers and their trajectories with regard to opioid misuse and disorders. These findings are in-line with previous research demonstrating that people who use marijuana are more likely than non-users to use other drugs and develop problems with drug use.

For a copy of the paper, go to – “Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States” – published in the American Journal of Psychiatry.

For information about the link between marijuana use and increased risk of addiction to other drugs, go to: www.drugabuse.gov/news-events/latest-science/marijuana-use-raises-sud-risk.

For more information, contact the NIDA press office at media@nida.nih.gov or 301-443-6245. Follow NIDA on Twitter and Facebook

Source: https://www.drugabuse.gov/news-events/news-releases/2017/09/marijuana-use-associated-increased-risk-prescription-opioid-misuse-use-disorders September 2017

For those who are still concerned about ‘evidence based science’ and ‘best medical and pharmaceutical practice’…the following ‘open letter’ with attachments was sent to all Federal Senators, NSW and Victorian Premiers last week. 

Dear Senator,
 
In the coming weeks/months, you will no doubt be presented with a Bill to consider changing both law and process to permit a new version of ‘medical marijuana’. On behalf of our Institute and a concerned public I would like you to carefully consider the following.

Firstly I write with some concerns about the consultation conducted on behalf of Victorian State government by the VLRC in Melbourne on May 6th this year and the now subsequent recommendations that have emerged from this very small Melbourne meeting (Less than 60 people in attendance! – This issue was directly raised with Victorian Health Minister earlier this year).

Whilst we gleaned from radio interviews with VLRC representatives prior to the consultation that the public discussions on the potential introduction of a new form ‘medical marijuana’ (different to existing medicinal forms of cannabis derived pharmaceuticals already in the Australian market) were not for changing laws to suit a particular agenda. It was instead implied that the purpose was to look at potential redundancies that might hinder best practice.  It was to be, for all intents and purposes an unbiased mechanism to: glean evidence, perspectives, opinions and ideas from the general public for consideration in the higher and more important discussion of wise, evidence based, best healthcare practice before making any move on the release of another version of therapeutic cannabis.

Conversely, our affiliate/colleagues experience of the very small Melbourne consultation did not reflect any of the above expectation. Rather those of our affiliates who attended observed the following:

  1. A seemingly deliberately emotively charged atmosphere, in favour of getting cannabis legalised for medical purposes. The tone seemed to be set to that end from the outset.
  2. The meeting was facilitated by representatives of the VLRC who appeared to have a bias toward the legalisation of ‘medical marijuana’ in manner that suited the self-medicating option, regardless of evidence based science.
  3. When attempts were made to present evidence contrary to the seemingly predetermined agenda of these facilitators, they were either quickly shut down (if they dared to speak in the first place) or continually ignored; apparently, dissenting opinions were not welcome. Whilst at the same time, proponents for ‘self-medication’ use of cannabis were given complete and unfettered access to the floor, producing statements such as:“Many, many people have been cured – from just about anything and everything.”
    “What would you rather have – infertility or 35 seizures a day?”
    “Random workplace drug testing is wrong.”Not only are these statements (now on record) outrageous, they are also utterly unsubstantiated by any legitimate clinical trial. This very small contingent of pro-cannabis lobbyists were permitted to simply spruik anecdotes with no evidence based presentation yet also had their evidenced-deprived opinions affirmed and validated by the facilitators.
  4. The facilitators appeared to infer that the Government (of Victoria, at least) already has legislation in place with this current ‘consultation’ process simply in play to validate those changes and therefore it is in essence a forgone conclusion. There was also a strong indication that either the A.M.A. or T.G.A. recommendations or processes would be ignored and negated wherever possible by simple legal changes.

Senator, it is a concern that if this particular experience of ours was repeated in other consultations with the same consensus manufacturing agenda, then this consultative process is a travesty.

If a government negates not only good evidence based science, but also established protective, best practice medical processes to enable a legal rite of passage for self-medication, it is placing itself at an extremely high risk of litigation. Future law-suits are likely, from the ‘victims’ of self-medicating regimes who will cite the changes in law that were NOT based on proper clinical trial or TGA and AMA recommendations and protocols.  When emotionally charged vitriol combines with vote chasing and misguided sympathies, it is the recipients of these untested substances that will be the final casualties – especially children! Compassion and wisdom dictate that all fair and democratic processes be engaged to maximise help and minimise harm, especially to children who will be the ones at greatest risk of an ill-advised self-medicating regime.

Senator, for purposes of clarification about the possible national legalisation of ‘another’ route/process/protocol for medicines are you able to confirm or deny that:

  1. The representations by the facilitators at the Melbourne consultation are in fact reflective of the pre-ordained intent of the public consultation documented above in not only Victoria, but other States and Territories?
  2. If not, will a review of the practice/method/behaviours be made into this particular process and subsequently the clearly questionable recommendations that have emerged from such narrow, non-evidence based and seemingly biased processes?
  3. A fair and proper representation of all views on this matter be gleaned from these meetings/consultations and interpreted and represented fairly without prejudice?
  4. A.M.A. and T.G.A. processes and protocols for best practice on medicines will be upheld and engaged, or simply ignored and by-passed?

Finally Senator, it is of grave concern that a pattern seems to be emerging from this ‘populist’ process, that best practice, evidence based protocols may simply be ignored and by passed.  If this is indeed the plan and the use of VLRC type agencies is the vehicle to do so, then the following must be raised.

The Dalgarno Institute ask:

  • Do you want your government and your ministerial role to be linked with a poorly considered and non-evidenced based process that enables a self-medicating policy – particularly for the ones the State has greatest responsibility to protect – the children?
  • Will your government and ministerial role be the ones who in so ignoring proper clinical processes facilitate a quasi-health regime that will precipitate immediate and long term unwanted side effects that can then be later subject to litigation and class-actions?
  • If an unqualified and unproven self-medicating mechanism is sanctioned and approved by government, and the inevitable damage (particularly to children) emerges, will the taxpayers of Australia have to fund the damages of an ill-conceived and non-TGA/AMA approved medical practice? Or will there be iron-clad caveats in place that ensure those who chose to use their own version of ‘medicine’ be the only ones liable for the outcomes of it, and not place further healthcare and monetary burden on the vast majority of tax-payers who have sought to follow best evidence-based and prescriptive practices?
  • If proper clinical trials and T.G.A and A.M.A. processes and protocols are negated or circumvented and a ‘new’ or ‘alternative’ process for registering, manufacturing, prescribing and dispensing marijuana as medicine be put in place, then how will you/your government  address the following important questions.
    • Who will be ‘growing’ and preparing this ‘medicine’?
    • Who will monitor content and quality of ‘medicine’?
    • Who will determine dosage rates and quantities?
    • What mechanisms will be in place to ensure quality control is followed?
    • What mechanisms will be in place to ensure, movement, dispensing and use of this ‘medicine’ is done without risk to non-patients?
    • Who will be able to prescribe this ‘medicine’ – Doctors, pharmacists, naturopaths, nurses, and counsellors? Who will monitor this process and ensure total safety?
    • What community safe-guards will be in place to ensure this new ‘medicine’ will not be misused?
    • Will the ‘medicine’ come in edible or smoked form and what safeguards will be in play around such a ‘medicine delivery’ system?
    • Will there be advertising and public promotion of this new form of ‘medicine’? Will that be strictly monitored to ensure no misinformation will mislead the public?
    • Which government department will oversee this process and how many more new protocols, processes, staff and finance will be required to set up this new vehicle for ‘medicine’ identification and management?
    • Who will be paying for this new and added cost?

We at Dalgarno Institute and its growing coalition remain very concerned for the overwhelming majority of Australians who are being kept in the dark about this new and illegitimate push to change evidence based processes and the laws that ensure those processes are protected. We are looking to you, in your role, to ensure that there is a genuine and robust pursuit of best medical and health practice outcomes for all Australians, particularly the most vulnerable – the young, very sick and disadvantaged – and that any mechanism that seeks to undermine that platform not be permitted to emerge under any circumstance.  Science and best health practice, NOT lawyers should determine pharmaceutical best practice.

I have also attached just a very small sample of the volumes of evidence-based data currently in the scientific space that raise clear warnings about a ‘new’ and untested version of cannabis as medicine. Please avail yourself of them and consult the people who do know better, compassion and good government demands it.
We look forward to receiving your response.

Sincerely Yours, 

Shane Varcoe
Executive Director
Dalgarno Institute

You can read our compassionate policy stance on M.M titled ‘CANNABIS AS MEDICINE? CAUTION NEEDED’!

https://dalgarnoinstitute.org.au/index.php/advocacy/dalgarno-aod-policy/86-open-letter-to-all-australian-politicians-regarding-new-version-of-medicinal-cannabis

Source: Email from Dalgarno Institute

September 2017

Drug Free America Foundation launched its new Marijuana and the Workplace Tool Kit this morning at a forum co-sponsored with Drug Free Manatee and the Manatee Chamber of Commerce at Pier 22 in Bradenton FL.  The forum featured a presentation by Amy Ronshausen, Deputy Director of Drug Free America Foundation who unveiled the Tool Kit and discussed how the implementation of Florida’s medical marijuana program will affect employers in the state. The forum also included a panel discussion with a group of experts that includes healthcare and labor attorneys, insurance representatives and a state legislator.

            As marijuana legalization efforts gain traction around the country as it has in Florida, the business community needs to be prepared.  “Employers must be diligent and proactive in understanding how the use of marijuana affects individuals, the overall influence to their business, and the level of financial liability that is acceptable,” according to Calvina Fay, executive director of Drug Free America Foundation.  “It is critical that an evaluation be completed based upon legitimate science, the safety-sensitive nature of the business, and risk analysis as opposed to perception and emotion,” she said.

Employees that use marijuana and other drugs negatively impact the bottom line for employers due to increased workplace accidents, injuries, and other effects, increasing the cost of doing business.  “The safety of all employees, vendors, customers, other drivers, pedestrians, or generally anyone encountering an employee while driving under the influence of pot could be impacted,” said Fay.

The tangled web of conflicting and diverse laws and statutes being drawn across the country varies from state to state, from jurisdiction to jurisdiction, making this issue very confusing for all concerned.  No two states’ marijuana laws are identical, further complicating the issue.

Identifying and defining liability related to marijuana use is perhaps one of the most evolving areas of risk management and insurance practices.  “From the viewpoint of an insurer, the conflicting laws are particularly troublesome for insuring a business against unexpected loss with no clear best practice and can potentially impact workers compensation claims and well as health, life and other business insurance coverage and premiums,” Fay suggested.

A smart approach for employers is to implement workplace practices that encourage safe, healthy lifestyles, and discourage behaviors that are counter-productive, both from a personal and a business standpoint. “In this tumultuous time of conflicting laws, confusion, and change, employers are encouraged to stay the course where a drug-free workplace is concerned,” continued Fay.  “We also encourage employers to remain consistent and fair in the application of workplace rules and procedures and to regularly review their program in relation to applicable laws, regulations and statutes that may have changed,” she concluded.

The Marijuana and the Workplace Tool Kit can be found at http://www.ndwa.org/resources/marijuana-in-the-workplace-toolkit/ 

Source: Email from Drug Free American Foundation

September 2017

Since the mid-1990s, the percentage of prime-age American men who don’t have a job — and aren’t looking for one — has risen dramatically. Over the same time period, per-capita sales of opioid painkillers in the United States has more than quadrupled. A new study suggests that there may be a relationship between these two facts.

In a paper published by the Brookings Institution on Thursday, Princeton economist Alan Krueger compares county-level data on opioid-prescription rates and labor-force participation, and finds that the more opioids were prescribed in a given region, the more likely that region was to have seen a significant decline in workforce participation.

The correlation was so dramatic, Krueger estimates that rising opioid prescriptions could plausibly account for one-fifth of the decline in the labor-force participation among American men between 1999 and 2015.

In previous research, Kreuger revealed that nearly half of all American men between the ages of 25 and 54 who were not in the labor force took pain medication on a daily basis. For two-thirds of those men, that daily pain medication was the kind that requires a prescription.

Critically, Krueger’s new research suggests that the counties where opioids are most widely prescribed aren’t, necessarily, places where the population is exceptionally ill or disabled. Rather, they are places where doctors seem to be exceptionally comfortable writing opioid prescriptions to treat pain.

Currently, America’s overall labor-force participation rate is 62.9 percent, unchanged from three years ago, and well below the 67 percent level that was typical in the late 1990s. Most of this decline can be attributed to benign factors — the retirement of the baby boomers, and a rising percentage of young Americans delaying work to pursue higher education. But the drop in participation by prime-age men has been sharp — right now, America has the second-lowest such rate among OECD countries — and very much malign: Krueger finds that prime-age men who have dropped out of the labor force are significantly less happy than their employed and unemployed peers.

There is still some ambiguity in Krueger’s findings. It’s possible that, to some extent, labor-force detachment increases demand for prescription opioids, rather than vice versa. Nonetheless, his paper offers compelling evidence that America’s painkiller habit isn’t just producing 100 overdose deaths in our country each day, but also impairing our economy’s capacity to grow.

Notably, the prescription opioid industry has achieved all this without actually reducing the levels of pain that Americans report.

“Despite the massive rise in opioid prescriptions in the 2000s,” Krueger notes in his paper, “there is no evidence that the incidence of pain has declined.”

http://nymag.com/intelligencer/2017/09/the-opioid-crisis-is-taking-a-toll-on-the-american-workforce.html

Thomas M. Nappe, DO* and Christopher O. Hoyte, MD

Abstract

Since marijuana legalization, pediatric exposures to cannabis have increased. To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed.

Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

INTRODUCTION

Since marijuana legalization, pediatric exposures to cannabis have increased, resulting in increased pediatric emergency department (ED) visits. Neurologic toxicity is most common after pediatric exposure; however, gastrointestinal and cardiopulmonary toxicity are reported. According to a retrospective review of 986 pediatric cannabis ingestions from 2005 to 2011, pediatric exposure has been specifically linked to a multitude of symptoms including, but not limited to, drowsiness, lethargy, irritability, seizures, nausea and vomiting, respiratory depression, bradycardia and hypotension.Prognosis is often reassuring. 

Specific myocardial complications related to cannabis toxicity that are well documented in adolescence through older adulthood include acute coronary syndrome, cardiomyopathy, myocarditis, pericarditis, dysrhythmias and cardiac arrest. To date, there are no reported pediatric deaths from myocarditis after confirmed, recent cannabis exposure. The authors report an 11-month-old male who, following cannabis exposure, presented in cardiac arrest after seizure and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Analyses of serum cannabis metabolites, post-mortem infectious testing, cardiac histopathology, as well as clinical course, support a potential link between the cannabis exposure and myocarditis that would justify preventive parental counseling and consideration of urine drug screening in this reported setting.

CASE REPORT

An 11-month-old male with no known past medical history presented to the ED with central nervous system (CNS) depression and then went into cardiac arrest. The patient was lethargic for two hours after awakening that morning and then had a seizure. During the prior 24–48 hours, he was irritable with decreased activity and was later retching. He was noted to be healthy before developing these symptoms. Upon arrival in the ED, he was unresponsive with no gag reflex. Vital signs were temperature 36.1° Celsius, heart rate 156 beats per minute, respiratory rate 8 breaths per minute, oxygen saturation 80% on room air.

Physical exam revealed a well-nourished, 20.5 lb., 11-month-old male, with normal development, no trauma, normal oropharynx, normal tympanic membranes, no lymphadenopathy, tachycardia, clear lungs, normal abdomen and Glasgow Coma Scale rating of 4. He was intubated for significant CNS depression and required no medications for induction or paralysis. Post-intubation chest radiograph is shown in Image 2. He subsequently became bradycardic with a heart rate in the 40s with a wide complex rhythm. Initial electrocardiogram (ECG) was performed and is shown in Image 1.

He then became pulseless, and cardiopulmonary resuscitation was initiated. Laboratory analysis revealed sodium 136 mmol/L, potassium 7.7 mmol/L, chloride 115 mmol/L, bicarbonate 8.0 mmol/L, blood urea nitrogen 24 mg/dL, creatinine 0.9 mg/dL, and glucose 175 mg/dL Venous blood gas pH was 6.77. An ECG was repeated (Image 3). He received intravenous fluid resuscitation, sodium bicarbonate infusion, calcium chloride, insulin, glucose, ceftriaxone and four doses of epinephrine. Resuscitation continued for approximately one hour but the patient ultimately died.

Initial electrocardiogram demonstrating wide-complex tachycardia.

Post-intubation chest radiograph. Measurement indicates distance of endotracheal tube tip above carina.

Repeat electrocardiogram showing disorganized rhythm, peri-arrest.

Further laboratory findings in the ED included a complete blood count (CBC) with differential, liver function tests (LFTs), one blood culture and toxicology screen. CBC demonstrated white blood cell count 13.8 K/mcL with absolute neutrophil count of 2.5 K/mcL and absolute lymphocyte count of 10.7 K/mcL, hemoglobin 10.0 gm/dL, hematocrit 34.7%, and platelet count 321 K/mcL. LFTs showed total bilirubin 0.6 mg/dL, aspartate aminotransferase 77 IU/L, and alanine transferase 97 IU/U. A single blood culture from the right external jugular vein revealed aerobic gram-positive rods that were reported two days later as Bacillus species (not Bacillus anthracis). Toxicology screening revealed urine enzyme-linked immunosorbent assay positive for tetrahydrocannabinol-carboxylic acid (THC-COOH) and undetectable serum acetaminophen and salicylate concentrations. Route and timing of exposure to cannabis were unknown.

Autopsy revealed a non-dilated heart with normal coronary arteries. Microscopic examination showed a severe, diffuse, primarily lymphocytic myocarditis, with a mixed cellular infiltrate in some areas consisting of histiocytes, plasma cells, and eosinophils. Myocyte necrosis was also observed. There was no evidence of concomitant bacterial or viral infection based on post-mortem cultures obtained from cardiac and peripheral blood, lung pleura, nasopharynx and cerebrospinal fluid. Post-mortem cardiac blood analysis confirmed the presence of Δ-9-carboxy-tetrahydrocannabinol (Δ-9-carboxy-THC) at a concentration of 7.8 ng/mL. Additional history disclosed an unstable motel-living situation and parental admission of drug possession, including cannabis.

DISCUSSION

As of this writing, this is the first reported pediatric death associated with cannabis exposure. Given the existing relationship between cannabis and cardiovascular (CV) toxicity, as well as the temporal progression of events, post-mortem analysis, and previously reported cases of cannabis-induced myocarditis, the authors propose a relationship between cannabis exposure in this patient and myocarditis, leading to cardiac arrest and ultimately death. This occurrence should justify consideration of urine drug screening for cannabis in pediatric patients presenting with myocarditis of unknown etiology in areas where cannabis is widely used. In addition, parents should be counseled regarding measures to prevent such exposures.

The progressive clinical presentation of this patient during the prior 24–48 hours, including symptoms of somnolence, lethargy, irritability, nausea, seizure and respiratory depression are consistent with previously documented, known complications of recent cannabis exposure in the pediatric population. It is well known that common CV effects of cannabis exposure include tachycardia and decreased vascular resistance with acute use and bradycardia in more chronic use. These effects are believed to be multifactorial, and evidence suggests that cannabinoid effect on the autonomic nervous system, peripheral vasculature, cardiac microvasculature, and myocardial tissue and Purkinje fibers are all likely contributory. The pathogenesis of myocarditis is not fully understood. In general, myocarditis results from direct damage to myocytes from an offending agent such as a virus, or in this case, potentially a toxin. The resulting cellular injury leads to a local inflammatory response. Destruction of cardiac tissue may result in myocyte necrosis and arrhythmogenic activity, or cellular remodeling in chronic myocarditis.

Autopsy findings in this patient were consistent with noninfectious myocarditis as a cause of death. The histological findings of myocyte necrosis with mature lymphocytic mixed cellular infiltrate are consistent with drug-induced, toxic myocarditis.The presence of THC metabolites in the patient’s urine and serum, most likely secondary to ingestion, is the only uncovered risk factor in the etiology for his myocarditis. This is highly unlikely attributable to passive exposure.

It is difficult to extrapolate a specific time of cannabis ingestion given the unknown dose of THC, the individual variability of metabolism and excretion, as well as the lack of data on this topic in the pediatric population and post-mortem redistribution (PMR) kinetics. However, the THC metabolite detected in the patient’s blood, Δ-9-carboxy-THC, is known to peak in less than six hours and be detectable for at least a day, while the parent compound, tetrahydrocannabinol (THC), is expected to rapidly metabolize and distribute much more quickly, being potentially undetectable six hours after exposure in an infrequent user. 

The parent compound was below threshold for detection in this patient’s blood. In addition, if cannabis ingestion occurred the day of presentation, it would have been more likely that THC would have been detected with its metabolite after PMR. Given this information, the authors deduce that cannabis consumption occurred within the recent two to six days, assuming this was a single, acute high-potency ingestion. This time frame would overlap with the patient’s symptomatology and allow time for the development of myocarditis, thus supporting cannabis as the etiology.

The link between cannabis use and myocarditis has been documented in multiple teenagers and young adults. In 2008 Leontiadis reported a 16-year-old with severe heart failure requiring a left ventricular assist device, associated with biopsy-diagnosed myocarditis.The authors attributed the heart failure to cannabis use of unknown chronicity. In 2014 Rodríguez-Castro reported a 29-year-old male who had two episodes of myopericarditis several months apart.Each episode occurred within two days of smoking cannabis.In 2016, Tournebize reported a 15-year-old male diagnosed with myocarditis, clinically and by cardiac magnetic resonance imaging, after initiating regular cannabis use eight months earlier. There were no other causes for myocarditis, including infectious, uncovered by these authors, and no adulterants were identified in these patients’ consumed marijuana.Unlike our patient, all three of these previously reported patients recovered.

In the age of legalized marijuana, children are at increased risk of exposure, mainly through ingestion of food products, or “edibles.”These products are attractive in appearance and have very high concentrations of THC, which can make small exposures exceptionally more toxic in small children.

Limitations in this report include the case study design, the limitations on interpreting an exact time, dose and route of cannabis exposure, the specificity of histopathology being used to classify etiology of myocarditis, and inconsistent blood culture results. The inconsistency in blood culture results also raises concern of a contributing bacterial etiology in the development of myocarditis, lending to the possibility that cannabis may have potentially induced the fatal symptomatology in an already-developing silent myocarditis. However, due to high contaminant rates associated with bacillus species and negative subsequent blood cultures, the authors believe this was more likely a contaminant. In addition, the patient had no source of infection on exam or recent history and was afebrile without leukocytosis. All of his subsequent cultures from multiple sites were negative.

CONCLUSION

Of all the previously reported cases of cannabis-induced myocarditis, patients were previously healthy and no evidence was found for other etiologies. All of the prior reported cases were associated with full recovery. In this reported case, however, the patient died after myocarditis-associated cardiac arrest. Given two rare occurrences with a clear temporal relationship – the recent exposure to cannabis and the myocarditis-associated cardiac arrest – we believe there exists a plausible relationship that justifies further research into cannabis-associated cardiotoxicity and related practice adjustments. In states where cannabis is legalized, it is important that physicians not only counsel parents on preventing exposure to cannabis, but to also consider cannabis toxicity in unexplained pediatric myocarditis and cardiac deaths as a basis for urine drug screening in this setting.

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965161/ March 2017

Libby Stuyt, MD spoke at the Oregon Health Forum with Drs. Esther Choo of OHSU and Katrina Hedberg who is the State Epidemiologist and State Health Officer at the Oregon Public Health Division, and at the Oregon Law & Mental Health Conference in June 2017 on the unintended consequences of marijuana legalization.

Stuyt is an addictions psychiatrist and medical director at the Colorado State Hospital in Pueblo. She is also the president of the National Acupuncture Detoxification Association.

Stuyt has a unique and expert view on the effect of increased marijuana availability and use, and as Colorado is about two years ahead of Oregon in the process of legalization and regulation of marijuana.

Stuyt’s data is from information collected by the state of Colorado and from her experience as a clinician and researcher.

  • Colorado has had significant increase in marijuana use by people under 18 years old. All use by under-age persons is illicit use. Most Colorado youth get marijuana from adults they know – not from retail stores.
  • Pueblo Colorado, with a population of 106,000 has over 7000 homeless people (Portland with a population of 583,000 has about 4500); many are people who arrived seeking employment in the marijuana industry.
  • 13% of children given CBD for seizure disorders have had “really bad” reactions; the CBD made seizures worse.
  • Estimates of marijuana addiction at 9-10% is from research on low-potency THC; this data should no longer be used. Scientists don’t know addiction rate to high potency THC, but use by youth is increasing, for daily users addiction rate is about 50%, withdrawal is harder, and violence associated with high potency THC is higher.
  • Stuyt calls marijuana addiction a “learning disorder.”
  • Marijuana use significantly reduces neurogenesis in the brain.
  • Doctors are seeing more psychosis related to high-potency THC marijuana.
  • 75% of Stuyt’s patients have PTSD. 83% of her patients are seeking treatment for marijuana addiction. Marijuana masks symptoms of marijuana, it does not treat or cure PTSD. PTSD is treatable and curable – but not with active marijuana use.
  • Increased correlation – not causation – of suicide in adolescents who use marijuana

Source: http://www.mentalhealthportland.org/report-on-marijuana-use-in-colorado/ August 2017

  • US Department of Veteran Affairs found an increase in PTSD symptoms from veterans who used medical marijuana 
  • Among patients who use medical marijuana, 80% use it for chronic pain and 33% for PTSD
  • Use for chronic pain can lead to increased risk of motor vehicle accidents and short-term cognitive impairment, experts warn
  • Medical marijuana is allowed in 30 states including DC 
  • The NFL is looking into medical marijuana use for its players for pain relief

There is no conclusive evidence that marijuana helps with chronic pain and post-traumatic stress disorder, experts say.

Since legalization, 80 percent of medical marijuana patients use it for chronic pain and about 33 percent use it for PTSD.

However, experts warn that there isn’t enough research to confirm it is effective for users.

Researchers around the country are scrambling to find evidence of the harms and benefits of patients using medical marijuana as it becomes legalized in more states.

And now they have found that there is still an insufficient amount of evidence to prove if medical marijuana can help with chronic pain and PTSD.

Researchers from the US Department of Veterans Affairs analyzed data into the treatment of chronic pain and PTSD in patients.

With chronic pain, the results in one clinical trial showed only 28 percent of participants feeling a change when using nabiximols, which is a mixture THC and CBD.

Also, there was 16 percent of participants who felt a change when taking a placebo.

This suggests psychological symptoms are possible when someone thinks they are feeling pain.

Experts also warn the use of marijuana for chronic pain could lead to an increase risk of harm such as motor vehicle accidents, psychotic symptoms and short-term cognitive impairment.

Dr Thomas O’Brien, who has run his own medical marijuana office in New York City for the past year-and-a-half, told Daily Mail Online that he’s seen high success rates from his patients dealing with chronic pain.

The type of marijuana he gives to his patients is high in CBD, so he says it doesn’t have the psychotic symptoms that critics worry about.

‘My patients do not feel sleepy or experience memory loss when they take it,’ Dr O’Brien said.

The marijuana he prescribes is from an indica-dominant strain. This means there is high CBD and low THC, which he says won’t give patients the same ‘high’ feeling that is felt from recreational marijuana.

NFL says it WILL study marijuana in terms of pain relief for players

Early this month, the NFL confirmed with Daily Mail Online that it will look into using medical marijuana for its players.

The NFL has had a strict stance against their players using marijuana.

But a report came out saying 50 percent of NFL players admitted to using marijuana to relieve pain.

The league usually prescribes highly addictive opioid painkillers to help players deal with game-related injuries and pain.

This change comes after player Calvin Johnson retired due to chronic pain and injury.

He said the players were given opioids from doctors ‘like candy’.

Currently, a player caught with THC in their system will face a fine and full-season suspension.

Source: Bleacher Report

He will prescribe a dose with a higher level of THC only if his patient’s symptoms are so bad that they can’t sleep.

He works with his patients to figure out the best mixture for them and their symptoms based on a spectrum level.

‘They are in pain and suffering from their conditions,’ Dr O’Brien said. ‘This is not recreational.’

Dr O’Brien has worked with more than 600 patients and claims that close to 90 percent have seen success.

‘The key is to educate the community that it is not like you’re going out back and sneaking a puff.’

In a large observational study of veterans, the researchers found an increase in participants who experienced a heightening of their PTSD symptoms when using medical marijuana.

The study looked at evidence from 47,000 veterans dealing with PTSD from 1992 to 2011.

From this group of veterans, the researchers could not conclusively say that medical marijuana has benefits when dealing with people with PTSD.

US Secretary of Veterans Affairs David Shulkin said: ‘My opinion is, is that some of the states that have put in appropriate controls, there may be some evidence that this is beginning to be helpful. And we’re interested in looking at that and learning from that.’

But the VA does not prescribe medical marijuana to its veterans currently.

‘Until the time that federal law changes, we are not able to be able to prescribe medical marijuana for conditions that may be helpful,’ Shulkin said.

Marijuana is legal for medical and recreational use in eight states: Massachusetts, Colorado, Washington, Alaska, Oregon, Nevada, California and Maine.

It is also legal for strictly medical use in the District of Columbia and 21 states: Montana, North Dakota, Arizona, New Mexico, Arkansas, Louisiana, Florida, Illinois, Minnesota, Michigan, Ohio, New York, Pennsylvania, Maryland, Vermont, New Hampshire, New Jersey, Rhode Island, Connecticut, Delaware and Hawaii.

How is THC used and what its effects

Tetrahydrocannabinoil (THC) is a natural element found in a cannabis plant. It is the most common cannabinoid element found in the cannabis plant. THC is found in the recreational form of marijuana.

THC is psychoactive:

This means that the drug has a significant effect on the mental processes of the person taking it.

Effects on people taking it:

  • Produces the ‘high’ feeling
  • Relaxation
  • Altered senses
  • Fatigue
  • Hunger

How it helps medically: 

Marijuana with THC are used to help with chemotherapy, multiple sclerosis and glaucoma.

Medical marijuana practitioners can diagnose a mixture of THC and CBD to the patient for treatment.

How is CBD used and what its effects

Cannabidiol (CBD) is a natural element found in a cannabis plant. It is lesser known than THC and does not produce the same ‘high’ that people experience when they have recreational marijuana.

CBD is an antipsychotic:

This means that the drug helps manage psychosis such as hallucinations, delusions or paranoia. Antipsychotic drugs are used for bipolar disorder and schizophrenia.

Effects on people taking it:

  • Reduces anxiety and paranoia
  • Boosts energy
  • Helps with pain and inflammation

How it helps medically: 

Marijuana with CBD strains are used to help with chronic pain, PTSD and epilepsy

Medical marijuana practitioners can diagnose a mixture of THC and CBD to the patient for treatment.

The study notes that there is still a lack of evidence and clinical trials to conclusively say there are benefits or harms to medical marijuana.

Former Surgeon General Dr Vivek Gupta released a report in November saying: ‘Marijuana is in fact addictive.’

But he supported the idea of easing up restrictions on marijuana studies to help better understand the drug since its legalization is moving fast through the US.

Dr O’Brien said part of the issue was people not understanding the difference between the use of THC and the use of CBD.

‘It is very safe [CBD],’ he said. ‘We need to study it for other medical conditions that haven’t been approved by the states yet.’

The restrictions on marijuana studies are partly due to the Drug Enforcement Agency’s hesitation on allowing medical marijuana across the US.

Last year, the DEA said it would accept applications for new growers to be used for clinical trials and other studies.

Currently, there is only one federally regulated operation that studies marijuana use and it is at the University of Mississippi.

There have been 25 applicants so far to host a new grow operation but none have been approved yet, according to Scientific American.

This has led to many critics saying that the DEA is still trying to slow down the research into medical marijuana to prevent its use federally.

Source: http://www.dailymail.co.uk/health/article-4789388/Medical-marijuana-does-not-help-chronic-pain-PTSD.html August 2017

  • In California, illegal marijuana farms are taking over thousands of acres of land as toxic wastes are increasingly corrupting ecosystems
  • California is responsible for the majority of illegal U.S. marijuana farming
  • New data says the state holds ‘731,000 pounds of solid fertilizer, 491,000 ounces of concentrated liquid fertilizer and 200,000 ounces of toxic pesticides.’
  • The United States Environmental Protection Agency announced in 2011 its planned to ban toxic fertilizers like zinc phosphide 
  • Chemicals of the kind have been linked to serious health effects in both animals and humans

Illegal marijuana farms are taking over thousands of acres of land as toxic waste continues to corrupt ecosystems in areas along the West Coast.

According to a new report accessed by Reuters, the state of California, which is responsible for more than ’90 percent of illegal U.S. marijuana farming,’ has shown a drastic increase in the use of nationally restricted fertilizers and pesticides such as carbofuran and zinc phosphide, ecologists say.

‘Increasingly, dangerous, unregistered pesticides are being encountered by law enforcement officers who investigate illegal marijuana grows,’ Special Agent-in-Charge of the Environmental Protection Agency criminal enforcement program, Jay M. Green, announced in a public release.

  • Illegal marijuana farms are corrupting ecosystems on the West Coast

  • Thousands of used butane cans used to process concentrated marijuana dumped in the forest in Humboldt County, California

  • Fertilizer seen in a makeshift pond with irrigation hoses attached in order to funnel water to grow sites in Mendocino County is California

‘Through their indiscriminate application, these unregistered pesticides pollute our lands and waters, create a significant safety risk to humans and animals, and present a mounting cleanup expense for taxpayers.’

Expert ecologist Mourad Gabriel, who reports over the issue for the U.S. Forest Service, said California is utilizing ’41 times more solid fertilizers and 80 times more liquid pesticides’ than the state’s initial reported cited in 2013.

Chemicals of these kind have been linked to health defects and death in both animals and humans.

The agency cited ‘a single swallow can be fatal to a small child, and carbofuran to be ‘highly toxic to vertebrates and birds. In granular form, a single grain will kill a bird; for humans, one quarter of a teaspoon is a sufficient dose to be fatal.’

  • Blue tinted water with fertilizer at an illegal marijuana growing site in Mendocino County, California

The Environmental Protection Agency announced in 2011 the department would ban the inorganic chemical compound zinc phosphide.

Included in the unpublished data accessed by Reuters, Gabriel said federal land in California currently holds ‘731,000 pounds of solid fertilizer, 491,000 ounces of concentrated liquid fertilizer and 200,000 ounces of toxic pesticides.’

Illegal pot growers could face jail time and numerous charges for growing illegally, while taxpayers could expect to be left with hefty bills to aid in the sterilization of the toxic waste sites.

  • A pot growing greenhouse is nestled into a clearing in Shelter Cove

  • Taxpayers could expect to be left with hefty bills to aid in the sterilization of toxic waste sites

Since marijuana was legalized in the state of California, officials have been pushing to properly license growers and carefully supervise the production, testing and distribution of hemp.

Supervisor of Trinity County Keith Groves said there are roughly 4,000 illegal growers in the region currently.

‘I’ll be happy if we can get 500 of them to become licensed,’ he told Reuters.

The expense and danger of cleanup has created a backlog of 639 illegal marijuana farms awaiting restoration in California, according to U.S. Forest Service data compiled for Reuters. Each farm covers up to 50 acres.

 ‘We’re getting contamination over and over again at those locations,’ said Gabriel, as toxins move from unsafe containers into the soil and water.

At sites that state officials said they had cleaned up completely, his team found 30-50 percent of the chemicals were still there.

‘They are like superfund sites,’ said Assistant U.S. Attorney Karen Escobar,

Source: https://www.dailymail.co.uk/news/article-4768664/Marijuana-farms-forming-toxic-waste-dumps-California.html August 2017

LONDON (Reuters) – People who smoke marijuana have a three times greater risk of dying from hypertension, or high blood pressure, than those who have never used the drug, scientists said on Wednesday. The risk grows with every year of use, they said. The findings, from a study of some 1,200 people, could have implications in the United States among other countries. Several states have legalized marijuana and others are moving toward it. It is decriminalized in a number of other countries.

“Support for liberal marijuana use is partly due to claims that it is beneficial and possibly not harmful to health,” said Barbara Yankey, who co-led the research at the school of public health at Georgia State University in the United States. “It is important to establish whether any health benefits outweigh the potential health, social and economic risks. If marijuana use is implicated in cardiovascular diseases and deaths, then it rests on the health community and policy makers to protect the public.” Marijuana is also sometimes used for medicinal purposes, such as for glaucoma. 

The study, published in the European Journal of Preventive Cardiology, was a retrospective follow-up study of 1,213 people aged 20 or above who had been involved in a large and ongoing National Health and Nutrition Examination Survey. In 2005–2006, they were asked if they had ever used marijuana.

For Yankey’s study, information on marijuana use was merged with mortality data in 2011 from the U.S. National Center for Health Statistics, and adjusted for confounding factors such as tobacco smoking and variables including sex, age and ethnicity. The average duration of use among users of marijuana, or cannabis, was 11.5 years. The results showed marijuana users had a 3.42-times higher risk of death from hypertension than non-users, and a 1.04 greater risk for each year of use. There was no link between marijuana use and dying from heart or cerebrovascular diseases such as strokes.

Yankey said were limitations in the way marijuana use was assessed ― including that researchers could not be sure whether people had used the drug continuously since they first tried it. But she said the results chimed with plausible risks, since marijuana is known to affect the cardiovascular system. “Marijuana stimulates the sympathetic nervous system, leading to increases in heart rate, blood pressure and oxygen demand,” she said.

Experts not directly involved in the study said its findings would need to be replicated, but already raised concerns. “Despite the widely held view that cannabis is benign, this research adds to previous work suggesting otherwise,” said Ian Hamilton, a lecturer in mental health at Britain’s York University.

Reporting by Kate Kelland, editing by Jeremy Gaunt

Source: https://www.huffpost.com/entry/marijuana-use-holds-three-fold-blood-pressure-death-risk_n_598b4b2be4b0d793738c2917 September 2017

  • The rapper is suing insurance company, claiming it is refusing to pay him after he was forced to cancel shows in November last year
  • In legal documents Lloyd’s suggest marijuana may have led to Kanye’s mental health issues in a bid to invalidate the performer’s insurance claim
  • Psychosis affects the mind and causes the sufferer to lose touch with reality
  • Dr Lucy Troup, from Colorado State University, explained it cannabis use could cause a psychotic breakdown
  • She said there are a variety of factors that influence it, but research shows it is linked to psychosis and other mental health issues 

By Abigail Miller

Kanye West is suing his tour’s insurer after the company allegedly refused to pay for his canceled shows in November – and blamed his cannabis use.

The rapper was forced to cancel the last 21 shows of his North American tour after he had a mental breakdown and had to be checked into a hospital.

While his insurer Lloyd’s of London would normally cover the costs, the company said they don’t have to pay because his marijuana use caused the breakdown.

The 40-year-old is asking for $10 million in damages from Lloyd’s, claiming the company has yet to pay him out for his cancelled shows, and has no intent to do so.

His company said in a legal document filed on Tuesday that insurers have yet to pay and is ‘implying that Kanye’s use of marijuana may provide them with the basis to deny the claim’.

Here, Daily Mail Online takes a closer look at how marijuana use could cause psychosis and potentially cause a mental breakdown, as Lloyd’s claims.

Marijuana legalization began in the United States in 1996, when California legalized the drug for medical use.

That sparked a wave.

In the next decade, 14 states followed suit: Oregon, Alaska, Washington, Maine, Hawaii, Nevada, Colorado, Montana, Vermont, New Mexico, Michigan, New Jersey, Arizona and Massachusetts.

Then in 2012, Colorado and Washington state legalized the drug for recreational use.

Now, just five years later, marijuana is legal for medical and recreational use in eight states: Massachusetts, Colorado, Washington, Alaska, Oregon, Nevada, California and Maine.

It is also legal for strictly medical use in the District of Columbia and 21 states: Montana, North Dakota, Arizona, New Mexico, Arkansas, Louisiana, Florida, Illinois, Minnesota, Michigan, Ohio, New York, Pennsylvania, Maryland, Vermont, New Hampshire, New Jersey, Rhode Island, Connecticut, Delaware and Hawaii.

The wave has given rise to a booming industry of edibles, dispensaries, cannabis healthcare professionals, and paraphernalia.

Marijuana is the national favorite according to a report published by Addictions.com, making up more than 70 percent of all drug use in the United States.

But experts warn researchers are struggling to keep up with the pace of legalization, and there are still many gaps in our knowledge.

However, some experts warn people are using the drug to self medicate for things like depression and anxiety despite research showing it does more harm than good.

In fact, there research shows that increased risk of depression as a result of frequent marijuana use is thought to be behind psychosis’ onset. The two mental health conditions have previously been linked.

‘A number of people choose to self medicate, but it could actually make things like anxiety and depression worse,’ Dr Lucy Troup, a professor of cognitive neuroscience at Colorado State University told Daily Mail Online.

‘We can’t fully understand yet the brain mechanisms that cause mental illness, but we’ve seen a clear link between marijuana use and users who report psychotic breaks. But again, it’s different for every person.’

In California medical marijuana can be used as a treatment for anxiety. In the other states and DC, someone suffering from anxiety or depression can apply for a medical marijuana license if their conditions are considered to be severe and debilitating.

COULD CANNABIS TREAT MIGRAINES?

Chemicals in cannabis could be effective at treating painful migraines, research revealed last month.

Cannabinoids, the compounds in marijuana that make you feel high, may be better at treating pain than recommended migraine medication, a study found.

Researchers from the Interuniversity Center in Florence found that pills containing the chemicals reduce the pain felt by migraine sufferers by 43.5 per cent.

The drug also had a number of additional effects, including stopping stomach aches and muscle pain, according to the researchers.

Previous research has found cannabis reduces migraines by targeting cells in the body that control pain relief and inflammation.

CAN MARIJUANA USE CAUSE A PSYCHOTIC BREAK?

Psychosis is defined as a condition that affects the mind and causes the sufferer to lose touch with reality.

Symptoms include:

  • delusions and hallucinations
  • feelings of paranoia and suspiciousness
  • disorganized thinking and speaking
  • loss of or decreased motivation
  • loss of or decreased ability to initiate or come up with new ideas
  • difficulties expressing emotion

Studies have found that marijuana is thought to cause psychosis-like experiences by increasing a user’s risk of depression. The two mental health conditions have been linked.

Frequently abusing the substance also significantly reduces a user’s ability to resist socially unacceptable behavior when provoked, research suggests.

‘We don’t understand the precise mechanisms for psychosis, but there is clear research that supports that cannabis use can lead to it,’ Dr Lucy Troup, a professor of cognitive neuroscience at Colorado State University told Daily Mail Online.

‘I can’t comment particularly on Kanye West’s case, because I don’t know a lot about him other than what the media says. But there are different variables that could have made it more likely such as how long it’s been used, when someone first started, how concentrated or potent the drug is that they are using, how they are taking it, and their specific genotype.’

Drug-induced psychosis is most commonly associated with LSD or amphetamines, but can also be caused by marijuana, cocaine and alcohol.

Results of a study by the University of Montreal revealed that going from being an occasional marijuana user to abusing the substance once a week or as often as every day, increases the risk of psychosis-like experiences by 159 percent.

The results also demonstrated that marijuana use reduces a person’s ability to resist socially unacceptable behavior in response to a particular stimulus.

KANYE WEST’S PAST MARIJUANA USE: COULD THE DRUG HAVE CAUSED THE RAPPER’S MENTAL BREAK?

In the past Kanye has been candid about his weed habit. He’s made multiple references in his songs. He also admitted to smoking before the 2015 Video Music Awards where he infamously announced his 2020 presidential candidacy.

Dr Troup explained that while she doesn’t know much about the rapper’s circumstance in particular, she was surprised to hear that Lloyd’s of London isn’t paying out.

She said that if a bank makes that claim about anyone, be it Kanye or someone less well known, the process to support that claim is long and complicated.

‘There isn’t enough knowledge about his [Kanye’s] medical history for anyone but his doctor to say for sure what caused his mental break,’ Dr Troup explained. ‘It would be a long and complicated process because they would have to look at his blood work, a hospital report, and a number of other things.’

‘I’m guessing when you insure a rock star you have to expect these kinds of things,’ she added.

A source has also told InTouch that Kim and Kanye are now worried footage taken by the rapper’s team in days prior to the tour’s cancellation could be used against him in court.

The video allegedly shows his mental state deteriorating before he broke down in the days leading up to his hospitalization.

Source: https://www.dailymail.co.uk/health/article-4758542/Could-marijuana-caused-Kanye-s-mental-breakdown.html
August 2017

By Mark Gold, MD

Knowing is not enough; we must apply. Willing is not enough; we must do. —Johann Wolfgang von Goethe

The Harvard Review of Psychiatry has recently chronicled important advances in understanding mental health disorders and, to a lesser extent Substance Use Disorder (SUD). This clinical review highlights the important contributions of Harvard experts over the past 25 years.

Addiction Research: What Have We Learned

Through my nearly 40 years of work in translational research and through the work of my colleagues, I have seen tremendous advances that changed how we understand the etiology and pathophysiology of SUD. Specifically, establishing the neurobiological basis of SUD, and the development of new and novel evidence-based pharmacologic and behavioral treatments including the discovery of the game changing and lifesaving drug, naltrexone, and thus establishing the neurobiological foundations for Medically Assisted Treatment (MAT), which resulted in important changes in the DSM.

As research established risk factors for SUD, we discovered that this disease is largely determined (40-60%) by genetic factors. Certainly, the Human Genome Project has unlocked the door to the field of epigenetics and the recognition that subtle variants in genetic transcription and coding are associated with numerous diseases, including SUD. The neuro-mechanisms and environmental stressors that conspire to “switch on” particular genes that increase the risk for SUD are not well established. Yet, our understanding of how specific neuronal circuitry mediates substance-induced reward, drug craving, compulsions and withdrawal is becoming clear. For example, when hedonically driven dopaminergic and opioidergic systems are disrupted, via the chronic use of intoxicants, neuroadaptation results in drug seeking, craving, anhedonia, depression, and chronic deficits in mood, memory and self-control. In other words, addiction.

Most recently, the discovery of ketamine’s efficacy in acute suicidality and treatment resistant depression represents a new and novel direction for research and the development of new therapeutics via the NDMA system. This discovery may supplant the 50-year-old catecholamine hypothesis for understanding addiction, mood disorders, pain and perhaps more.
But knowing is never enough in medicine—we must do.

So, in spite of all we have learned in the past few decades, the neurobiology and epigenetic risks for addiction remain underestimated and virtually unaddressed in current clinical guidelines for treating SUD. For example, we now know that early childhood trauma produces potentially heritable epigenetic changes that are highly correlated with SUD and other psychopathologies in adolescence and early adulthood. In addition, survey data reveals that approximately 70% of women in SUD treatment have suffered trauma, yet only a few of the top centers are professionally equipped to treat trauma as a comorbid disorder. Unaddressed, trauma almost always results in relapse.

Challenges

The increasing prevalence and severity of SUD and the lack of available treatment is a formidable gap that is widening. By treatment, we do not mean SUD CPR or Naloxone, but rather prevention and when that fails, treatment that is safe and effective for five years. Efforts to close this gap involve many nonclinical variables (cost, access, harm reduction vs. medical model, politics, etc.), over which we have little control–but this is not to say we don’t have influence.

These are exciting times, as there is much to be learned about addictive disease and its numerous comorbidities. But, unless much more of the 23+ million currently addicted people in the US get help, research will remain simply academic.

Source: https://www.rivermendhealth.com/resources/addiction-research/ July 2017

Filed under: Addiction,Latest News :

Psychology of Addictive Behaviors journal makes corrections, SAM calls on media to correct stories

A prominent journal article about marijuana and health which resulted in media outlets reporting on marijuana’s harmlessness has now been corrected. A recheck of the statistics has now found that the incidence of psychotic disorders trended toward a 2.5-fold increase in marijuana users, a difference that went beyond a trend to reach significance in a one-tailed statistical test. This degree of impact matches very well the results of many prior studies involving marijuana use and psychosis though falls short of the five-fold increase in psychosis risk for marijuana users seen with the high strength strains that are more recently available.

Dr. Christine Miller, a former schizophrenia researcher from Johns Hopkins University and now Director of SAM Maryland, first alerted the journal, Psychology of Addictive Behaviors, last December. Some media outlets have already corrected their original story. 

“We commend the Washington Post’s Ariana Cha for now updating her story, and hope many more will follow her lead,” remarked Dr. Miller. “The flaw in the original University of Pittsburgh report were certain correction factors applied to the raw data, factors which are strongly affected by psychosis rather than being causes of such a disorder. These inappropriate corrections overpowered the marijuana effect. We’re glad the corrections have been made.”

SAM urges other media outlets to correct their headlines and stories.

The new data comes on the heels of a major report released by the State of Vermont’s Health Department which found that marijuana worsened conditions ranging from mental illness to motor vehicle accidents to negative pregnancy effects – and almost all of them are found to be worsened by marijuana:

Source: Email from SAM (Smart Approaches to Marijuana) <info@learnaboutsam.org>, January 2016

Link to clarification:

https://psycnet.apa.org/record/2015-58335-001

Abstract

BACKGROUND

Cannabis is one of the most abused drugs worldwide, with more than 20 million users in the United States (US). As access to cannabis products increases with expanding US legislation and decriminalization of marijuana, emergency physicians must be adept in recognizing unintentional cannabis toxicity in young children, which can range from altered mental status to encephalopathy and coma.

CASE REPORT

     We report the case of a 13-month-old female presenting with self-limiting altered mental status and lethargy, with a subsequent diagnosis of tetrahydrocannabinol exposure on confirmatory urine gas chromatography-mass spectrometry.

Why Should an Emergency Physician Be Aware of This?

         Considering caretakers rarely report possible cannabis exposure, history-taking must review caretakers’ medicinal and recreational drug exposures to prevent inadvertently missing the diagnosis. In the young child with altered mental status, prompt urine screening for cannabinoid detection can prevent further invasive and costly diagnostic investigations, such as brain imaging and lumbar puncture.

CASE REPORT
               A healthy 13-month-old, 12-kg female presented to the ED with injected conjunctiva and inappropriate staring for 2 h, followed by a half-hour period of somnolence. The mother denied any possible ingestions, fevers, vomiting, seizures, or head trauma. Birth and medical history were unremarkable.
        Growth and development were age appropriate. On presentation, patient was somnolent, but arousable with stimulation. Vital signs were: temperature 36.6C, heart rate of 127 beats/min, respiratory rate of 39 breaths/min, blood pressure of 98/66mmHg, and an SpO2 of 100% on room air. Pupils were equal and dilated to 6mm bilaterally.
Physical examination was otherwise unremarkable. Computed tomography of the head, chest x-ray study, electrocardiogram, complete blood count, comprehensive metabolic panel, and serum toxicology were unremarkable.
       The mother appeared intoxicated, with slurred speech and injected conjunctiva. Maternal cannabinoid intoxication was suspected and urine cannabinoids on the child were sent and returned positive. Upon result disclosure, the mother stated that the child recently consumed hemp seed milk. Urine gas chromatography-mass spectrometry (GC-MS) confirmatory test was positive for d-9- tetrahydrocannabinol (THC). Within 8 h, the child returned to baseline without any medical interventions other than observation. Poison control, social work, and child protection services were all notified and involved.

DISCUSSION
           Cannabis is one of the most abused drugs worldwide. Cannabis formulations, such as marijuana (dried, leaves), hashish (resin), and hashish oil (concentrated resin extract) can be inhaled or ingested. THC is the main psychoactive ingredient that binds to brain cannabinoid receptors, producing dose- and time-dependent stimulant, hallucinogenic, or sedative effects. Effects of inhaled cannabis occur within minutes after ingestion, peak within 15–30 min, and last up to 4 h post ingestion.

INTRODUCTION
          Cannabis is a psychoactive plant composed of more than 500 chemical components called cannabinoids, which exert their psychoactive effect by activating specific receptors in the central nervous system and immune system. Cannabinoids are among the most abused drugs worldwide, with an estimated 22.2 million users in the United States. Since 2017, medical marijuana has been legalized in 31 states, and 9 states have decriminalized recreational marijuana. In such states, emergency department (ED) visits and poison center calls for accidental cannabis intoxication have increased. With these changes, emergency physicians must be adept in recognizing unintentional cannabis toxicity in young children, as intoxication can result in encephalopathy and coma.

     Orally consumed cannabis has delayed effects, with onset ranging from 30 min to 3 h, lasting up to 12 h post ingestion. With the increased bioavailability of cannabis concentrates and the smaller body mass in children, toddler cannabis ingestion results in high serum THC levels, despite a small amount ingested.

     Pediatric cannabis intoxication has variable presentations, ranging from mentation changes to encephalopathy and coma. The most common symptoms are central nervous system depression (i.e., lethargy, coma), confusion, agitation, hypotonia, bilateral reactive mydriasis, and ataxia. Nausea and vomiting have been reported, along with bradycardia, bradypnea, hypotension, and respiratory depression necessitating mechanical ventilation. Other symptoms include tremor, hallucinations, nystagmus, slurred speech, and muscle weakness. With such nonspecific symptomatology, cannabis toxicity can mimic postictal states, encephalitis,or sepsis, which lead to unnecessary diagnostic evaluations.
    Prompt urine screening can prevent further invasive and costly workups, such as brain imaging and lumbar puncture, and may thwart the need for mechanical ventilation or i.v. antibiotics/antivirals for presumed meningoencephalitis. Initial urine screening is typically performed with the highly sensitive enzyme multiplied immunoassay technique, but can have false-positive results, as many drug metabolites can influence the test, including hemp seed products. The confirmatory test, GC-MS, will only test positive for THC, making it highly specific for cannabis ingestion.

       Hemp is derived from a strain of the cannabis sativa plant species that contains a much lower concentration of the psychoactive component, THC, and higher concentrations of cannabidiol. Due to the increased availability in natural grocery stores, hemp products have become increasingly popular as health supplements in children. In order for hemp products to be commercially sold in the United States, strict regulations enforce the THC component to be < 0.3% of the total product weight. Despite these strict regulations on THC content, a recent study byYang et al. demonstrated that hemp products, in fact, have a variable THC component and may contain up to 12 times the legal THC limit. Therefore, prolonged use of hemp seed oil may induce neurologic symptoms of THC.

       A recent case by Chinello et al. described a case of a 2-year-old child who developed neurologic symptoms after taking 2 teaspoons of hemp seed oil per day for 3 weeks. No antidote exists for cannabis toxicity and activated charcoal is not effective. Management is largely supportive and most pediatric patients are observed and return to baseline within 8–12 h. Pediatric cannabis intoxication should be reported to child protection services to identify neglect and at-risk families and enhance child safety.

       Pediatric cannabis ingestions are more frequent due to rising marijuana use in the United States (US). In a comparison of state trends in unintentional pediatric marijuana exposures, as measured by call volume to US poison centers, call rates in states that had passed legislation prior to 2005 were increased by 30%, juxtaposed to non-legal states, where call volume remained unchanged. Despite its increasing availability, reports of unintentional pediatric cannabis ingestion leading to toxicity are uncommon. History taking must review both medicinal and recreational drug exposures to prevent missing the diagnosis. Knowledge of substances that can lead to false positives is imperative. Pertinent to our case, hemp product consumption will not result in a positive cannabinoid urine confirmatory test, as hemp does not contain enough THC to induce toxicity. However, recent data show hemp seed oil products may have substantially more THC than the level acceptable for commercial hemp use, and with prolonged exposure may induce toxicity. Our case involved an acute exposure and is therefore unlikely to cause any related toxicities.

      Lastly, with the growing popularity of edible marijuana products, which typically resemble candy and may be alluring to the exploratory toddler, emergency physicians must be vigilant when considering potential cannabis toxicity.

WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?
As access to cannabis increases, emergency physicians must recognize pediatric unintentional cannabis toxicity. Prompt cannabinoid urine screening can prevent further invasive diagnostic investigations.

Source: https://www.ncbi.nlm.nih.gov/pubmed/30340924 January 2019

 

The new 2016-2017 National Survey on Drug Use and Health State Estimates is out this week. The graphs above illustrate a few of the findings from this annual survey conducted by the Substance Abuse and Mental Health Services Administration. Numbers in graphs are percentages. The graphs can be downloaded starting Thursday, December 6 here. National Families in Action grants permission to reproduce them for educational purposes.

Source: Email from National Families in Action’s The Marijuana Report <nfia@nationalfamilies.org>  December 2018

Researchers at the Centre for Addiction and Mental Health (CAMH) have identified 428 distinct disease conditions that co-occur in people with Fetal Alcohol Spectrum Disorders (FASD), in the most comprehensive review of its kind.

The results were published today in The Lancet.

“We’ve systematically identified numerous disease conditions co-occurring with FASD, which underscores the fact that it isn’t safe to drink any amount or type of  at any stage of pregnancy, despite the conflicting messages the public may hear,” says Dr. Lana Popova, Senior Scientist in Social and Epidemiological Research at CAMH, and lead author on the paper. “Alcohol can affect any organ or system in the developing fetus.”

FASD is a broad term describing the range of disabilities that can occur in individuals as a result of alcohol exposure before birth. The severity and symptoms vary, based on how much and when alcohol was consumed, as well as other factors in the mother’s life such as stress levels, nutrition and environmental influences. The effects are also influenced by genetic factors and the body’s ability to break down alcohol, in both the mother and fetus.

Different Canadian surveys suggest that between six and 14 per cent of women drink during pregnancy.

The 428 co-occurring conditions were identified from 127 studies included in The Lancet review. These disease conditions, coded in the International Classification of Disease (ICD-10), affected nearly every system of the body, including the central nervous system (brain), vision, hearing, cardiac, circulation, digestion, and musculoskeletal and respiratory systems, among others.

While some of these disorders are known to be caused by alcohol exposure – such as developmental and cognitive problems, and certain facial anomalies – for others, the association with FASD does not necessarily represent a cause-and-effect link.

Problems range from communications disorders to hearing loss

However, many disorders occurred more often among those with FASD than the general population. Based on 33 studies representing 1,728 individuals with Fetal Alcohol Syndrome (FAS), the most severe form of FASD, the researchers were able to conduct a series of meta-analyses to establish the frequency with which 183 disease conditions occurred.

More than 90 per cent of those with FAS had co-occurring problems with conduct. About eight in 10 had communications disorders, related to either understanding or expressing language. Seven in 10 had developmental/cognitive disorders, and more than half had problems with attention and hyperactivity.

Because most studies were from the U.S., the frequency of certain co-occurring conditions was compared with the general U.S. population. Among people with FAS, the frequency of hearing loss was estimated to be up to 129 times higher than the general U.S. population, and blindness and low vision were 31 and 71 times higher, respectively.

“Some of these other co-occurring problems may lead people to seek professional help,” says Dr. Popova. “The issue is that the underlying cause of the problem, alcohol exposure before birth, may be overlooked by the clinician and not addressed.”

The benefits of screening and diagnosis

Improving the screening and diagnosis of FASD has numerous benefits. Earlier access to programs or resources may prevent or reduce secondary outcomes that can occur among those with FASD, such as problems with relationships, schooling, employment, mental health and addictions, or with the law.

“We can prevent these issues at many stages,” says Dr. Popova. “Eliminating alcohol consumption during pregnancy or reducing it among alcohol-dependent women is extremely important. Newborns should be screened for , especially among populations at high risk. And alerting clinicians to these co-occurring conditions should trigger questions about prenatal .”

“It is important that the public receive a consistent and clear message – if you want to have a healthy child, stay away from alcohol when you’re planning a pregnancy and throughout your whole pregnancy,” she says.

It’s estimated that FASD costs $1.8 billion annually in Canada, due largely to productivity losses, corrections and health care costs, among others.

In addition to this review, Dr. Popova has been part of an expert group of leading FASD researchers and clinicians working with the Ontario Ministry of Children and Youth Services on its new FASD strategy. Her team is also undertaking a study to determine how common FASD is in Canada, as well as in other countries in Eastern and Central Europe and Africa.

Provided by: Centre for Addiction and Mental Health

Source: https://m.medicalxpress.com/news/2016-01-conditions-co-occur-fetal-alcohol-spectrum.html January 2016

  • Cannabis interferes with a user’s ability to recognize, process and empathize with human emotions including happiness, sadness and anger
  • Pot smokers were shown faces depicting different emotions in tests
  • They were hooked up to brain monitoring device, looking at activity levels 
  • Cannabis users showed greater response to negative emotions 
  • And those smoking marijuana showed lower response to happy emotions 

Smoking cannabis alters a person’s ability to perceive and judge emotions, a study has found.

The drug interferes with user’s capacity to recognize, process and empathize with human emotions, including happiness, sadness and anger.

But the results also suggest that the brain may be able to counteract these effects depending on whether the emotions are directly, or indirectly detected.

The complex biochemistry of marijuana and how it affects the brain is only beginning to be understood.

Dr Lucy Troup, assistant professor of psychology at Colorado State University, has set out to answer specifically how, if at all, cannabis use affects a person’s ability to process emotions.

She has long been fascinated by the psychology of drugs and addiction.

‘We’re not taking a pro or anti stance, but we just want to know, what does it do? It’s really about making sense of it,’ she said. 

For almost 20 years Dr Troup and her graduate students have been conducting experiments to measure the brain activity of about 70 volunteers.

They all identified themselves as chronic, moderate or non-users of cannabis.

They were all vetted as legal users of cannabis, and were either medical marijuana users aged 18 or older, or recreational users aged 21 or older.

The experiments involved the participants looking at faces depicting four separate expressions: neutral, happy, fearful and angry, while they were hooked up to an electroencephalogram (EEG), which shows the electrical activity of the brain.

Cannabis users showed a greater response to faces showing negative expressions, especially angry faces, when compared with a control group of non-cannabis users. In contrast, those who used the drug showed a smaller response to positive expressions – happy faces – compared with the control group

Cannabis users showed a greater response to faces showing negative expressions, especially angry faces, when compared with a control group of non-cannabis users.

In contrast, those who used the drug showed a smaller response to positive expressions – happy faces – compared with the control group.

Those taking part in the study were also asked to pay attention to the emotion and identify it.

Researchers noted in those cases, users and non-users of cannabis could not be told apart.

But, when they were asked to focus on the sex of the face, and then identify the emotion, cannabis users scored much lower than non-users.

This signified a depressed ability to ‘implicitly’ identify emotions.

Cannabis users were also less able to empathize with the emotions, the scientists found.

They said their findings seem to suggest the brain’s ability to process emotion is affected by cannabis, but there may be some compensation that counteracts those differences.

The study is published in the journal PLOS ONE.

Source: https://www.dailymail.co.uk/health/article-3472039/Cannabis-DOES-alter-brain-s-ability-process-emotions-experts-warn.html  March 2016

By Dean A. Dabney

The United States has been waging a war on drugs for nearly 50 years . Hundreds of billions of dollars have been spent on this long campaign to thwart the production, distribution, sale and use of illegal drugs.

This sustained investment has resulted in millions of drug offenders being processed through the American criminal justice system. It has also influenced crime control strategies used by American police.

Under President Barack Obama, there was a period of reform and moderating of tactics.

But President Donald Trump’s attorney general, Jeff Sessions, is announcing plans to return to “law and order” approaches, such as aggressive intervention by law enforcement and use of mandatory minimum sentences by prosecutors.

I recently co-authored a book with University of Louisville criminal justice professor Richard Tewksbury on the role of confidential informants . In my view, a return to a “law and order” approach would undo recent gains in reducing crime rates as well as prison populations and would further strain tense police-community relations .

Drugs are different

Unlike violent or property crimes – which usually yield cooperative victims and witnesses – police and prosecutors are at a disdvantage when fighting drugs. Drug users don’t see themselves as crime victims or their dealers as criminals. Police thus have limited options for identifying offenders.

Alternatives include the use of undercover operations or conducting aggressive crackdown operations to disrupt the market in real time.

But sneaking up on or infiltrating secretive and multilayered drug organizations is not easy to do, and usually produces only low-level offenders . Poor police-community relations don’t help. Heightened enforcement and punishments have made matters worse by increasing the secrecy and sophistication of the illegal drug market and forcing police to develop criminal intelligence on offenders.

So how do police gather criminal intelligence on drug crimes?

The most honorable way is to rely on law-abiding sources who see the criminal activity and feel compelled to report it to the police in order to stop the problem.

The second option is for police to turn to a paid informant who is familiar with the drug operations to set up a buy or inform on the criminal activities of others in exchange for money.

A third option is to apprehend known drug offenders and coerce them into divulging information on higher-ups in exchange for a lighter sentence. We call these folks “indentured informants” because they “owe” the police information. If they don’t follow through on their end of the deal, they face the weight of criminal prosecution, often through heavy mandatory minimum sentences.

As police-community relations have eroded over time, police have slowly but surely increased their reliance on criminal informants – especially to develop cases on higher-level criminals.

The consequences of coercive tactics

Mandatory minimum sentences serve as a strong motivator to snitch. It has become the “go-to move” for authorities.

Not surprisingly, drug dealers fight back against this coercive method of getting evidence with a “stop snitchin'” campaign. Retaliatory violence often erupts , and it becomes harder for police to get evidence from both criminal and civic-mindedinformants who fear reprisals from drug dealers. Anger grows against police who are perceived as not following through on promises to protect witnesses or clean up neighborhoods.

There exists yet another wrinkle in the equation. Reliance on harsh drug sentences and confidential informants has become part and parcel to how other types of criminal cases are solved.

Witnesses or persons privy to information in homicide or robbery cases are routinely prodded into cooperating only after they find themselves facing a stiff penalty due to their involvement in an unrelated drug case.

Here again, this produces short-term gains but long-term complications for criminal justice authorities as states move to decriminalize or legalize drugs. What happens when prosecutors working violent or property crime cases can no longer rely on the threat of mandatory minimum sentences to compel individuals to provide information?

By exploiting intelligence sources and putting them at risk, the war on drugs has pitted the police against residents in drug-ridden communities. This runs contrary to the ideals of community policing, in which trust and legitimacy are essential to members of the community and law enforcement collaborating to prevent and combat crime.

The past decade has witnessed significant reforms within the criminal justice system, particularly as it relates to drug enforcement. Authorities have sought to integrate apublic health approachinto the long-standing criminal justice model and adopt a more patient and long-term view on the drug problem.

In the end, the reliance on informants and mandatory minimum sentences creates numerous unanticipated negative consequences which will continue to grow if we revert back to them.

Dean A. Dabney is an associate professor of justice and criminology at Georgia State University. He wrote this piece for The Conversation where it first appeared.

Source: https://articles.pennlive.com/opinion/2017/08/reviving_the_war_on_drugs_isnt.amp August 2017

By Robert DuPont

Abstract

The current narrative describing the national opioid epidemic as the result of overprescribing opioid pain medicines fails to capture the full dimensions of the problem and leads to inadequate and even confounding solutions. Overlooked is the fact that polysubstance use is nearly ubiquitous among overdose deaths, demonstrating that the opioid overdose death problem is bigger than opioids. The foundation of the nation’s opioid overdose crisis – and the totality of the nation’s drug epidemic – is widespread recreational pharmacology, the use of drugs for fun or “self-medication.” The national focus on opioid overdose deaths provides important new opportunities in both prevention and treatment to make fundamental changes to the way that substance use disorders and related problems are understood and managed.

The first-ever US Surgeon General’s report on addiction provides a starting point for systemic changes in the nation’s approach to preventing, treating and managing substance use disorders as serious, chronic diseases. New prevention efforts need to encourage youth to grow to adulthood not using alcohol, nicotine, marijuana or other drugs for reasons of health. New addiction treatment efforts need to focus on achieving long-term recovery including no use of alcohol, marijuana and other drugs.

Source: http://www.sciencedirect.com/science/article/pii/S0361923017302927  June 2017

Narcotics experts are warning against dangerous drugs being mis-sold as MDMA.

According to reports from the UK, this substance can lead to psychosis and some users claim it has the ability to keep them awake for up to three days. These undesired side effects are not typical of MDMA or “Molly.”

Instead, this “fake MDMA” — drug N-Ethyl-Pentylone — is made three times as strong. It was first discovered in the US in 2016, which spread to Australia in 2017 and most recently has been found at the Manchester music festival, Parklife.

This drug has been linked to mass casualties around the world. Dr. David Caldicott, an expert in emergency medicine, explained the dangers of N-Ethyl-Pentylone as follows:

“It has been clearly responsible for the deaths of people overseas, and a rather unfortunate phenomenon known as ‘mass casualty overdoses’, where 10-20 people drop simultaneously. So, it’s of great concern to the music festival environment.”

While this was discovered in the UK, it’s possible for partakers to happen upon this in North America too, so please exercise every caution if you do take the risk of doing drugs at a show or festival this summer.

Source:  https://www.youredm.com/2018/06/10/mdma-lookalike-drug-makes-its-way-into-festivals/   June 2018

Dear David,

I am sending you below a copy of a letter I have sent to the Premiers of Canada – and other members of the worldwide drug prevention community, plus an email to UN HQ in New York.   Since they get so many letters I thought it would be sensible to send you a copy direct as it might take time for you to receive it through UN internal mail.

Dear Premiers,

As members of the worldwide drug prevention community we have been reading with increasing concern and disbelief the way that Canada seems to be bulldozing through legislation that can only damage the citizens of your country – not the least the children.

The Rights of the Child Treaty, under article 33 of the international drug conventions, would be breached if this legislation is allowed to be ratified.

Under the terms of the convention, governments are required to meet children’s basic needs and help them reach their full potential. Since it was adopted by the United Nations in November 1989, 194 countries have signed up to the UNCRC,

United Nations Convention on the Rights of the Child (CRC) is an important international legal instrument that obligates States Parties to protect children and youth from involvement with illicit drugs and the drug trade.

Canada is a signatory to the CRC – which is a legally binding document.  Should your country go ahead with the decision to legalise marijuana – against all the evidence from respected scientists and Health authorities worldwide Canada would be an outcast by those 193 nations who have agreed and signed to Article 33.

We find it astonishing that the wealth of evidence and opinion in Canada and  worldwide,  on the harmfulness of marijuana would seem to have been totally ignored by your parliamentarians.   Indeed new evidence relating to the epidemic of gastrochisis was submitted in good time by our Australian colleague Dr. Stuart Reece and was not allowed to be presented.   Instead you have been persuaded by groups that want marijuana to be ‘the new tobacco’ – headed of course by George Soros, that this will not be harmful to your citizens, that it will bring in tax revenues and that it would destroy the black market. 

However, there was a study done a few weeks ago by the Canadian Centre on Substance Abuse and Addiction finding that just in Canada alone, a much smaller country than the U.S. in population, marijuana-related car crashes cost a billion dollars. That’s just the car crashes, and those were directly related to marijuana. And the report came from a government think tank, not any kind of anti-drug group.

We heard many of these same promises in 2012 when Colorado legalized recreational marijuana. Yet  in the years since, Colorado has seen an increase in marijuana related traffic deaths, poison control calls, and emergency room visits. The marijuana black market has increased in Colorado, not decreased. And, numerous Colorado marijuana regulators have been indicted for corruption.

New reports out of Colorado indicate that legal marijuana  is posing real risks to the safety of young people. As Colorado rethinks marijuana, the rest of the nation should watch carefully this failing experiment.

Healthcare officials representing three hospitals in Pueblo, Colorado, issued a statement on April 27 in support of a ballot measure that would end Marijuana commercialization in the city and county of Pueblo. “We continue to see first-hand the increased patient harm caused by retail marijuana, and we want the Pueblo community to understand that the commercialization of marijuana is a significant public health and safety issue,” said Mike Baxter, president and CEO of Parkview Medical Center.

Among their concerns are  a 51 percent increase in number of children under 18 being treated in Parkview Medical Center emergency rooms.  Furthermore, of newborn babies at St. Mary-Corwin Hospital, drug tested due to suspected prenatal exposure, nearly half tested positive for marijuana.

Having read the above, how can Canadian legislators possibly believe that legalising marijuana would, in any way, be advantageous for their country ?

Yours faithfully,

Peter Stoker,  Director,  National Drug Prevention Alliance  (UK)

Source: A letter forwarded by Peter Stoker to David Dadge, spokesperson for UN Office ON Drugs and Crime (UNODC), originally sent to the Premiers of Canada  September 2017

A three-month-old baby boy died after being left alone overnight while his mother smoked cannabis, a serious case review has found.

Social services dealt repeatedly with the child’s family before his death but closed the case after the woman said she had stopped using drugs.

A police investigation into potential neglect is currently ongoing. The review found the level of support provided to the family was “a proportionate response”.

The baby, who can be identified only as Child E, suffered a cardiac arrest in September 2017 after being found unresponsive with a blanket over his head at a home in Rochdale.

His mother, who also cannot be named, subsequently told police she had been using cannabis on the night before his death and had left the house between 01:00 and 02:00 BST to go to a local garage. The baby had been left lying in his pram for 12 hours without being checked.

Substance misuse

A serious case review by the Rochdale Borough Safeguarding Children Board found the family had interacted with police and health and social care workers repeatedly in the months before his death.

An anonymous referral made to Children’s Social Care also raised concerns about the mother’s substance misuse and the state of the home in which the family were living, the Board found.

The Board’s report said the mother “reported cannabis to be her drug of choice and cocaine less frequently.”

“It is true that many parents’ use of drugs does not present a risk of harm to their children. It is also true that many parents who use drugs have chaotic and unpredictable lifestyles that do impact on their ability to maintain stability and safe parenting of their children,” it said.

Despite this, the case was closed after the mother said she had stopped using drugs.

Risk

“This review therefore begs the question about how well professionals can be reassured that substance misuse that impacts on parenting is ever really resolved or whether some level of risk will always remain,” the report said.

It also found that the mother had been given detailed advice on safe sleeping guidelines for babies on three occasions.

“The learning from this review will be important to all agencies and will result in changes to procedures in line with the recommendations,” said the Board’s independent chair, Jane Booth.

Source: https://www.bbc.co.uk/news/uk-england-manchester-45970026 24th October 2018

OCTOBER 25, 2018 BY PARTNERSHIP NEWS SERVICE STAFF

A new study finds traffic accidents are increasing in states that have legalized recreational marijuana, Bloomberg reports.

Crashes have risen by as much as 6 percent in Colorado, Nevada, Oregon and Washington, compared with neighboring states that haven’t legalized marijuana for recreational use, according to research from the Insurance Institute for Highway Safety (IIHS) and Highway Loss Data Institute (HLDI).

“The new IIHS-HLDI research on marijuana and crashes indicates that legalizing marijuana for all uses is having a negative impact on the safety of our roads,” IIHS-HLDI President David Harkey said in a news release. “States exploring legalizing marijuana should consider this effect on highway safety.”

In a separate study, IIHS examined police-reported crashes before and after retail marijuana sales began in Colorado, Oregon and

Washington. The study found the three states combined saw a 5.2 percent increase in the rate of crashes per million vehicle registrations, compared with neighboring states that did not legalize marijuana.

Source: https://drugfree.org/learn/drug-and-alcohol-news/traffic-accidents-rising-in-states-with-legalized-recreational-marijuana Oct. 2018

Anybody wondering what happens to the 8 per cent of the skunk-smoking population who develop mental illness should visit any psychiatric hospital in Britain or speak to somebody who has done so What is really needed in dealing with cannabis is a “tobacco moment”, as with cigarettes 50 years ago, when a majority of people became convinced that smoking might give them cancer and kill them. Since then the number of cigarette smokers in Britain has fallen by two-thirds.

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

Anybody wondering what happens to this 8 per cent of the skunk-smoking population should visit any mental hospital in Britain or speak to somebody who has done so. Dr Humphrey Needham-Bennett, medical director and consultant psychiatrist of Cygnet Hospital, Godden Green in Sevenoaks, explained to me that among his patients “cannabis use is so common that I assume that people use or used it. It’s quite surprising when people say ‘no, I don’t use drugs’.”

The connection between schizophrenia and cannabis was long suspected by specialists but it retained its reputation as a relatively benign drug, its image softened by the afterglow of its association with cultural and sexual liberation in the 1960s and 1970s.

This ill-deserved reputation was so widespread that even 20 years ago, the possible toxic side effects of cannabis were barely considered. Zerrin Atakan, formerly head of the National Psychosis Unit at the Maudsley Psychiatric Hospital and later a researcher at the Institute of Psychiatry,

said: “I got interested in cannabis because I was working in the 1980s in an intensive care unit where my patients would be fine after we got them well. We would give them leave and they would celebrate their new found freedom with a joint and come back psychotic a few hours later.”

She did not find it easy to pursue her professional interest in the drug. She recalls: “I was astonished to discover that cannabis, which is the most widely used illicit substance, was hardly researched in the 1990s and there was no research on how it affected the brain.” She and fellow researchers made eight different applications for research grants and had them all turned down, so they were reduced to taking the almost unheard of course of pursuing their research without the support of a grant.

Studies by Dr Atakan and other psychiatrists all showed the connection between cannabis and schizophrenia, yet this is only slowly becoming conventional wisdom. Perhaps this should not be too surprising because in 1960, long after the link between cigarettes and lung cancer had been scientifically established, only a third of US doctors were persuaded that this was the case.

A difficulty is that people are frightened of mental illness and ignorant of its causes in a way that is no longer true of physical illnesses, such as cancer or even HIV. I have always found that three quarters of those I speak to at random about mental health know nothing about psychosis and its causes, and the other quarter know all too much about it because they have a relative or friend who has been affected.

Even those who do have experience of schizophrenia do not talk about it very much because they are frightened of a loved one being stigmatised. They may also be wary of mentioning the role of cannabis because they fear that somebody they love will be dismissed as a junkie who has brought their fate upon themselves.

This fear of being stigmatised affects institutions as well as individuals. Schools and universities are often happy to have a policy about everything from sex to climate change, but steer away from informing their students about the dangers of drugs. A social scientist specialising in drugs policy explained to me that the reason for this is because “they’re frightened that, if they do, everybody will think they have a drugs problem which, of course, they all do”.

The current debate about cannabis – sparked by the confiscation of the cannabis oil needed by Billy Caldwell to treat his epilepsy and by William Hague’s call for the legalisation of the drug – is missing the main point. It is all about the merits and failings of different degrees of prohibition of cannabis when it is obvious that legal restrictions alone will not stop the 2.1 million people who take cannabis from going on doing so. But the legalisation of cannabis legitimises it and sends a message that the government views it as relatively harmless. The very fact of illegality is a powerful disincentive for many potential consumers, regardless of the chances of being punished.

The legalisation of cannabis might take its production and sale out of the hands of criminal gangs, but it would put it into the hands of commercial companies who would want to make a profit, advertise their product and increase the number of their customers. Commercialisation of cannabis has as many dangers as criminalisation.

A new legal market in cannabis might be regulated and the toxicity of super-strength skunk reduced. But the argument of those who want to legalise cannabis is that the authorities are unable to enforce regulations when the drug is illegal, so why should they be more successful in regulating it when its production and sale is no longer against the law?

The problem with these rancorous but sterile arguments for and against legalisation and decriminalisation is that they divert attention from what should and can be done: a sustained campaign to persuade people of all ages that cannabis can send them insane. To a degree people are learning this already from bitter experience. As Professor Murray told me five years ago, the average 19- to 23-year-old probably knows more about the dangers of cannabis than the average doctor “because they have a friend who has gone paranoid. People know a lot more about bad trips than they used to.”

Patrick Cockburn is the co-author of Henry’s Demons: Living With Schizophrenia, A Father and Son’s Story

A depressing aspect of the present debate about cannabis is that so many proponents of legalisation or decriminalisation have clearly not taken on board that the causal link between cannabis and psychosis has been scientifically proven over the past ten years, just as the connection between cancer and cigarettes was proved in the late 1940s and 1950s.

The proofs have emerged in a series of scientific studies that reach the same grim conclusion: taking cannabis significantly increases the risk of schizophrenia. One study in The Lancet Psychiatry concludes that “the risk of individuals having a psychotic disorder showed a roughly three times increase in users of skunk-like cannabis, compared with those who never used cannabis”. As 94 per cent of cannabis seized by the police today is super-strength skunk, compared to 51 per cent in 2005, almost all those who take the drug today will be vulnerable to this three-fold increase in the likelihood that they will develop psychosis.

Home Secretary Sajid Javid: The government will carry out a review of the scheduling of cannabis for medicinal use

Mental health professionals have long had no doubts about the danger. Five years ago, I asked Sir Robin Murray, professor of psychiatric research at the Institute of Psychiatry in London, about them. He said that studies showed that “if the risk of schizophrenia for the general population is about one per cent, the evidence is that, if you take ordinary cannabis, it is two per cent; if you smoke regularly you might push it up to four per cent; and if you smoke ‘skunk’ every day you push it up to eight per cent”.

According to a Colorado Springs Gazette editorial about legalization in Colorado there has been a doubling of drivers involved in fatal crashes testing positive for marijuana. [1]

Marijuana significantly impairs driving including time and distance estimation and reaction times and motor coordination. [2] The National Highway Traffic Safety Administration lists marijuana as the most prevalent drug in fatally injured drivers with 28 % testing positive for marijuana. [3]

It is true that the crash risk for a driver on alcohol is higher than on marijuana. But to suggest it is safe to drive after using marijuana is irresponsible. An even greater danger is the combination of alcohol and marijuana that has severe psychomotor effects that impair driving. [4]

What about our kids? Vehicle crashes are the leading cause of death among those aged 16-25. [5] Weekend nighttime driving under the influence of marijuana among young drivers has increased by 48%. [6] About 13 % of high school seniors said they drove after using marijuana while only 10 % drove after having five or more drinks.[7] Another study showed about 28,000 seniors each year admitted to being in at least one motor vehicle accident after using marijuana. [8]

The marijuana industry is backing legalization. Do we want more dangerous drivers on our roads and dead kids so the industry can make money from selling marijuana?

References regarding DUI

[1] http://gazette.com/editorial-the-sad-anniversary-of-big-commercial-pot-in-colorado/article/1614900

[2] NHTSA, Use of Controlled Substances and Highway Safety; A Report to Congress (U.S. Dept. of Transportation, Washington, D.C., 1988)

[3] http://cesar.umd.edu/cesar/cesarfax/vol19/19-49.pdf

[4] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a1.htm?s_cid=mm6448a1_w

[5] Ibid.

[6] Ibid

[7] https://archives.drugabuse.gov/news-events/news-releases/drug-impaired-driving-by-youth-remains-serious-problem

[8] “Unsafe Driving by High School Seniors: National Trends from 1976 to 2001 in Tickets and Accidents After Use of Alcohol, Marijuana and Other Illegal Drugs.” Journal of Studies on Alcohol. May 2003

LEGALIZING POT WILL CAUSE MORE OPIATE USE

Legalizing marijuana will cause more marijuana use. Marijuana use is associated with an increased risk for substance use disorders. [1] The interaction between the opioid and the cannabinoid system in the human body might provide a neurobiological basis for a relationship between marijuana use and opiate abuse.[2] Marijuana use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder. [3] In 2017, the National Academy of Sciences (NAS) landmark report written by top scientists concluded after a review of over 10,000 peer-reviewed academic articles, that marijuana use is connected to progression to and dependence on other drugs, including studies showing connections to heroin use. [4]

New research suggests that marijuana users may be more likely than nonusers to misuse prescription opioids and develop prescription opioid use disorder. The investigators analyzed data from more than 43,000 American adults. The respondents who reported past-year marijuana use had 2.2 times higher odds than nonusers of meeting diagnostic criteria for prescription opioid use disorder. They also had 2.6 times greater odds of initiating prescription opioid misuse. [5]

Marijuana used as a medicine is being sold as reducing the need for other medicines. However, a new study shows that medical marijuana users were significantly more likely to use prescription drugs in the past 12 months. Individuals who used medical marijuana were also significantly more likely to report nonmedical use in the past 12 months of any prescription drug with elevated risks for pain relievers, stimulants and tranquilizers. [6]

References regarding opiates

[1] JAMA Psychiatry. 2016 Apr;73(4):388-95. doi: 10.1001/jamapsychiatry.2015.3229.

Cannabis Use and Risk of Psychiatric Disorders: Prospective Evidence From a US National Longitudinal Study. Blanco C1, Hasin DS2, Wall MM2, Flórez-Salamanca L3, Hoertel N4, Wang S2, Kerridge BT2, Olfson M2. https://www.ncbi.nlm.nih.gov/pubmed/26886046

[2] Cadoni C, Pisanu A, Solinas M, Acquas E, Di Chiara G. Behavioural sensitization after repeated exposure to Delta 9-tetrahydrocannabinol and cross-sensitization with morphine. Psychopharmacology (Berl). 2001;158(3):259-266. Available from: https://www.researchgate.net/publication/11640927_Behavioral_sensitization_after_repeated_exposure_to_D9-tetrahydrocannabinol_and_cross-sensitization_with_morphine

[3] Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States, Mark Olfson, M.D., M.P.H., Melanie M. Wall, Ph.D., Shang-Min Liu, M.S., Carlos Blanco, M.D., Ph.D. Published online: September 26, 2017at: https://doi.org/10.1176/appi.ajp.2017.17040413

[4] Health Effects of Cannabis and Cannabinoids: Current State of Evidence and Recommendations for Research. See: http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-highlights.pdf

[5] https://www.drugabuse.gov/news-events/news-releases/2017/09/marijuana-use-associated-increased-risk-prescription-opioid-misuse-use-disorders

[6] Journal of Addiction Medicine, http://www.newswise.com/articles/view/693004/?sc=dwtn

MARIJUANA USE BEFORE, DURING OR AFTER PREGNANCY CAN CAUSE SERIOUS MEDICAL CONDITIONS, LEARNING PROBLEMS, AND BIRTH DEFECTS

Legalizing marijuana will cause more marijuana use among women of child bearing age. Prenatal marijuana use has been linked with:

1. Developmental and neurological disorders and learning deficits in children.

3. Premature birth, miscarriage, stillbirth.

4. An increased likelihood of a person using marijuana as a young adult.

5. The American Medical Association states that marijuana use may be linked with low birth weight, premature birth, behavioral and other problems in young children.

6. Birth defects and childhood cancer.

7. Reproductive toxicity affecting spermatogenesis which is the process of the formation of male gamete including meiosis and formation of sperm cells.

Moderate concentrations of THC, the main psychoactive substance in marijuana, when ingested by mothers while pregnant or nursing, could have long-lasting effects on the child, including increasing stress responsivity and abnormal patterns of social interactions. THC consumed in breast milk could affect brain development.

References regarding pregnancy

Volkow ND, Compton WM, Wargo EM. The risks of marijuana use during pregnancy. JAMA. 2017;317(2):129-130.

https://www.drugabuse.gov/publications/research-reports/marijuana/letter-director

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation

AMA pushes for regulation on pot use during pregnancy

http://omr.bayer.ca/omr/online/sativex-pm-en.pdf

https://www.cdc.gov/marijuana/pdf/marijuana-pregnancy-508.pdf

Risk of Selected Birth Defects with Prenatal Illicit Drug Use, Hawaii, 1986-2002, Journal of Toxicology and Environmental Health, Part A, 70: 7-18, 2007

Maternal use of recreational drugs and neuroblastoma in offspring: a report from the Children’s Ocology Group., Cancer Causes Control, 2006 Jun:17(5):663-9, Department of Epidemiology, University of North Carolina at Chapel Hill.

DO YOU CARE?

Do you care…about our Environment? Marijuana growing creates environmental contamination. [1]

Do you care…about Pedestrian and Motor Vehicle Deaths caused by marijuana impaired drivers?

Increased marijuana impaired driving due to the increased potency of THC creates more risk.[2]

Do you care…about Freedom of Choice? Cannabis Use Disorder destroys freedom of choice. [3]

Do you care…about Violence, Domestic Abuse and Child abuse? Oftentimes marijuana is reported in incidents of violence. Continued marijuana use is associated with a 7-fold greater odds for subsequent commission of violent crimes. [4]

Do you care…about Safety in the Workplace? Numerous professions and trades require alertness that marijuana use can impair. Employers experience challenges to requirements for drug free workplaces, finding difficulty in hiring with many failing marijuana THC drug tests. [5]

Do you care…about Substance Use Disorders and the growing Addiction Epidemic? Recent data suggest that 30% of those who use marijuana may have some degree of marijuana use disorder. That sounds small? 22,000,000 US marijuana users x 30% = over 6,000,000 with a marijuana use disorder. There is a link between adolescent pot smoking and psychosis. [6]

Do you care…about Suicide Prevention? Marijuana use greatly increases risk of suicide especially among young people. [7]

Do you care…about your Pets? Vets report increases in marijuana poisoned pets since normalizing and commercializing of marijuana. [8]

Do you care…about our Students and Schools? Normalization of marijuana use brought increased use to schools. Edibles and vaping have made use harder to detect. Colorado has had an increase in high school drug violations of 71% since legalization and school suspensions for drugs increased 45%. [9]

Do you care…about Racial Inequality? Marijuana growers and sellers typically locate in poorer neighborhoods and degrade the quality of the areas. Arrests of people of color have increased since drug legalization while arrests of Caucasians have decreased. [10].

Do you care…about Our Kids and Grandkids, the Next Generations? Help protect them by advocating for their futures. [11] Please oppose increasing the use of marijuana

References

[1] https://silentpoison.com/

[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a1.htm?s_cid=mm6448a1_w

[3] https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive

[4] https://www.psychologytoday.com/blog/the-new-brain/201603/marijuana-use-increases-violent-behavior

https://www.researchgate.net/publication/297718566_Continuity_of_cannabis_use_and_violent_offending_over_the_life_course

https://www.omicsonline.org/open-access/marijuana-violence-and-law-2155-6105-S11-014.pdf https://www.healthychildren.org/English/ages-stages/teen/substance-abuse/Pages/legalizing-marijuana.aspx http://www.poppot.org/wp-content/uploads/2018/02/020518-Child-dangers-fact-sheet-FINAL_updated.pdf?x47959

[5] http://www.questdiagnostics.com/home/physicians/health-trends/drug-testing.html

[6] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2464591

https://www.drugabuse.gov/publications/research-reports/marijuana/what-scope-marijuana-use-in-united-states https://www.drugabuse.gov/publications/drugfacts/marijuana https://www.drugabuse.gov/publications/drugfacts/marijuana

https://www.scientificamerican.com/article/link-between-adolescent-pot-smoking-and-psychosis-strengthens/

[7] https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20170

http://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(14)70307-4.pdf

[8] http://www.petpoisonhelpline.com/poison/marijuana/

[9] http://gazette.com/editorial-the-sad-anniversary-of-big-commercial-pot-in-colorado/article/1614900

https://youtu.be/BApEKGUpcXs Weed Documentary from a high school in Oregon

[10] https://learnaboutsam.org/comprehensive-study-finds-marijuana-legalization-drives-youth-use-crime-rates-black-market-harms-communities-color/

[11] https://www.healthychildren.org/English/ages-stages/teen/substance-abuse/Pages/legalizing-marijuana.aspx

Legalization

http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-chapter-highlights.pdf

MARIJUANA EXPOSURES AMONG CHILDREN INCREASE BY UP TO OVER 600%

The rate of marijuana exposures among children under the age of six increased by 610% in the “medical” marijuana states according to a study published in Clinical Pediatrics. The data comes from the National Poison Data System. 75% percent of the children ingested edible marijuana products such as marijuana-infused candy. Clinical effects include drowsiness or lethargy, ataxia [failure of muscle coordination], agitation or irritability, confusion and coma, respiratory depression, and single or multiple seizures.

http://journals.sagepub.com/doi/full/10.1177/0009922815589912

MORE FACTS

Today’s marijuana is very high in potency and can reach 99% THC. It is very destructive and causes addiction, mental illness, violence, crime, DUIs and many health and social problems.

https://herb.co/marijuana/news/thc-a-crystalline

FACTS FROM COLORADO

The people who are pushing marijuana legalization paint Colorado as a pot paradise. This is not true according to Peter Droege who is the Marijuana and Drug Addiction Policy Fellow for the Centennial Institute a policy think tank in Lakewood Colorado. In a April 20, 2018 opinion article he states that:

According to the 2016 National Survey on Drug Use and Health (NSDUH), Colorado is a national leader among 12-17-year-olds in (1) Last year marijuana use; (2) Last month marijuana use; and (3) The percentage of youth who tried marijuana for the first time.

A 2017 analysis by the Denver Post showed Colorado had experienced a 145% increase in the number of fatal crashes involving marijuana-impaired drivers between 2013 and 2016. While the analysis stresses that the increase cannot definitively be attributed to the legalization of marijuana, it reports that the number of marijuana-impaired drivers involved in fatal crashes has more than doubled since 2013, the year before the state legalized recreational marijuana use.

A July 20, 2016 article in Westword magazine reports that increased homelessness, drugs, and crime are causing local residents and convention visitors to shun Denver’s 16th Street Mall, once one of the most vibrant tourist destinations in the region.

A group of concerned scientists from Harvard University and other institutions wrote a letter to Governor Hickenlooper on March 10, 2017, seeking to correct the record after his Feb. 26, 2017, interview on Meet the Press in which he told Chuck Todd that Colorado had not seen a spike in youth drug use after the legalization of recreational marijuana, and that there was “anecdotal” evidence of a decline in drug dealers – claims he repeated in Rolling Stone.

In the letter, the scientists reference numerous studies, including the NSDUH survey, that report a dramatic increase in youth marijuana use, emergency room visits, mental health issues and crime tied to the legalization of marijuana in Colorado. They quote an official from the state’s attorney general’s office saying legalization “has inadvertently helped fuel the business of Mexican drug cartels … cartels are now trading drugs like heroin for marijuana, and the trade has since opened the door to drug and human trafficking.”

Today’s high-potency “crack weed” is marketed to youth through vapes, candies, energy drinks, lip balms and other products easy to conceal in homes and schools. Most dispensaries in Colorado are located in low-income neighborhoods, targeting young people who do not need another obstacle in fulfilling their great potential in life. *

* https://www.usatoday.com/story/opinion/2018/04/20/colorado-governor-marijuana-hickenlooper-column/53

3731002/

MARIJUANA RELATED SUICIDES OF YOUNG PEOPLE IN COLORADO

Marijuana is the Number 1 substance now found in suicides of young people in Colorado who are 10-19 years old. Go to the below Colorado website and click on the box that lists “methods, circumstances and toxicology” and then click on the two boxes for 10-19 years olds. The marijuana data will appear.

https://cohealthviz.dphe.state.co.us/t/HSEBPublic/views/CoVDRS_12_1_17/Story1?:embed=y&:showAppBanner=false&:showShareOptions=true&:display_count=no&:showVizHome=no#4)

55% OF COLORADO MARIJUANA USERS THINK IT’S SAFE TO DRIVE WHILE HIGH

55% of marijuana users surveyed by the Colorado Department of Transportation last November said they believed it was safe to drive under the influence of marijuana. Within that group, the same percentage said they had driven high in the past 30 days, on average 12 times. A recent analysis of federal traffic fatality data by the Denver Post found that the number of Colorado drivers involved in fatal crashes who tested positive for marijuana has doubled since 2013.

CDOT survey: More than half of Colorado marijuana users think it’s safe to drive while high

TODDLERS WITH LUNG INFLAMMATION

In Colorado one in six infants and toddlers hospitalized for lung inflammation are testing positive for marijuana exposure. This has been a 100% increase since legalization (10% to 21%). Non-white kids are more likely to be exposed than white kids.

https://www.sciencedaily.com/releases/2016/04/160430100247.htm

TEEN ER VISITS

Marijuana related emergency room visits by Colorado teens is substantially on the rise. They see more kids with psychotic symptoms and other mental health problems and chronic vomiting due to marijuana use.

https://www.reuters.com/article/us-health-marijuana-kids/marijuana-related-er-visits-by-colorado-teens-on-the-rise-idUSKBN1HO38A

LOW BIRTH WEIGHTS

The Colorado School of Public Health reports that there is a 50% increase in low birth weights among women who use marijuana during pregnancy. Low birth weight sets the stage for future

health problems including infection and time spent in neonatal intensive care.

https://www.sciencedaily.com/releases/2018/04/180423125052.htm

EMERGENCY CARE

Colorado Cannabis Legalization and Its Effect on Emergency Care

“Not surprisingly, increased marijuana use after legalization has been accompanied by an increase in the number of ED visits and hospitalizations related to acute marijuana intoxication. Retrospective data from the Colorado Hospital Association, a consortium of more than 100 hospitals in the state, has shown that the prevalence of hospitalizations for marijuana exposure in patients aged 9 years and older doubled after the legalization of medical marijuana and that ED visits nearly doubled after the legalization of recreational marijuana, although these findings may be limited because of stigma surrounding disclosure of marijuana use in the prelegalization era. However, this same trend is reflected in the number of civilian calls to the Colorado poison control center. In the years after both medical and recreational marijuana legalization, the call volume for marijuana exposure doubled compared with that during the year before legalization.

Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68:71-75.

https://search.aol.com/aol/search?q=http%3a%2f%2fcolorado%2520cannabis%2520legalization%2520and%2520its%2520effect%2520on%2520emergency%2520care%2e&s_it=loki-dnserror

CONTAMINATION OF MARIJUANA PRODUCTS

There is contamination in marijuana products in Colorado. The Colorado Department of Public Health and Environment claims that “Cannabis is a novel industry, and currently, no recognized standard methods exist for the testing of cannabis or cannabis products.”

https://www.colorado.gov/pacific/cdphe/marijuana-sciences-reference-library

Unified Police Sgt. Melody Gray described the process as similar to making a pipe bomb.

But some marijuana users — and dealers — are willing to take that risk despite potentially dangerous results.

For the past several years, law enforcement in several states have been combating the increasing popularity of something called “dabs.” Dabs, or hash oil concentrate, are made by extracting THC from marijuana plants. Other similar concentrate products include marijuana wax and “shatter.”

While marijuana typically contains about 15 percent THC, a dab has 80 to 90 percent THC, said Unified police detective Orin Neal.

“It’s a greater high, it’s a more intense high,” he said, noting that the potency makes it dangerous.

But in order to get that extraction, a solvent is needed, and dab producers typically use butane, which is why dabs are also referred to as butane hash oil. And sometimes, those attempting to extract THC using butane try to speed up the process by adding a heating element such as a hot plate.

Neal said the combination of butane and heat or an open flame often results in explosions.

“It’s a recipe for disaster, really,” Neal said.

Police say that’s what happened June 26, when a 33-year-old woman was critically injured in an explosion in a basement at 3329 S. Scott Ave.

“In this situation and many other situations, I think it happens accidentally. They’re doing this operation in an area that’s not properly ventilated. And because butane is so combustible and highly flammable, any exposure to any open flame — from a pilot light on a water heater or a furnace in a house to an oven to lighting a cigarette in a house or anything like that — could cause a huge explosion, which is what happened the other day,” he said.

Neal said the result was like a bomb going off inside the small, enclosed basement room.

Dabs have become a nationwide trend. In some states, the drug and the dangerous manufacturing of it have been a problem for law enforcers for several years.

“The use of butane has caused multiple explosions all over the country, including one in a university housing complex near the University of Montana in October of 2014. These explosions have killed and severely burned people of all ages nationwide. The explosions are also causing serious structural damage to property and neighboring properties,” officer Jermaine Galloway wrote in Utah State Trooper magazine in 2017.

Some states have made possession of dabs a felony crime while marijuana possession is a misdemeanor. Utah does not distinguish between the two.

The fad has only recently become an issue in Utah. But police fear as it catches on and more people attempt to manufacture their own dabs, it will become like the meth lab problem of 30 years ago.

Neal said he has seen two or three explosions locally due to THC extraction.

The dab trend “is currently sweeping the country and is overwhelming some law enforcement, educators, safety officials and parents,” Galloway wrote a year ago. “This ‘new’ marijuana is completely different than anything we have dealt with in the past.”

Source: Officer Galloway & The Northwest Alcohol Conference jermaine@tallcopsaysstop.comJuly2018

The medical marijuana market is in a downward spiral as businesses, lured by big money, shift to recreational

At the height of the medical marijuana industry there were 420 dispensaries in Oregon. Now there are only eight.

In 2015, Erich Berkovitz opened his medical marijuana processing company, PharmEx, with the intention of getting sick people their medicine. His passion stemmed from his own illness. Berkovitz has Tourette syndrome, which triggers ticks in his shoulder that causes chronic pain. Cannabis takes that away.

Yet in the rapidly changing marijuana landscape, PharmEx is now one of three medical-only processors left in the entire state of Oregon.

On the retail end, it’s also grim. At the height of the medical marijuana industry in 2016, there were 420 dispensaries in Oregon available to medical cardholders. Today, only eight are left standing and only one of these medical dispensaries carries Berkovitz’s products.

Ironically, Oregon’s medical marijuana market has been on a downward spiral since the state legalized cannabis for recreational use in 2014. The option of making big money inspired many medical businesses to go recreational, dramatically shifting the focus away from patients to consumers. In 2015, the Oregon Liquor Control Commission (OLCC) took over the recreational industry. Between 2016 and 2018, nine bills were passed that expanded consumer access to marijuana while changing regulatory procedures on growing, processing and packaging.

In the shuffle, recreational marijuana turned into a million-dollar industry in Oregon, while the personalized patient-grower network of the medical program quietly dried up.

Now, sick people are suffering.

“For those patients that would need their medicine in an area that’s opted out of recreational sales, and they don’t have a grower or they’re not growing on their own, it does present a real access issue for those individuals,” said André Ourso, an administrator for the Center for Health Protection at the Oregon Health Authority. The woes of the Oregon Medical Marijuana Program (OMMP) were outlined in a recently published report by the Oregon Health Authority. The analysis found the program suffers from “insufficient and inaccurate reporting and tracking,” “inspections that did not keep pace with applications”, and “insufficient funding and staffing”.

Operating outside of Salem, Oregon, PharmEx primarily makes extracts – a solid or liquid form of concentrated cannabinoids. Through his OMMP-licensed supply chain, he gets his high dose medicine to people who suffer from cancer, Crohn’s, HIV and other autoimmune diseases. Many are end-of-life patients.

These days, most recreational dispensaries sell both consumer and medical products, which are tax-free for cardholders. The problem for Berkovitz is that he’s only medically licensed. This means recreational dispensaries can’t carry his exacts. Legally, they can

only sell products from companies with an OLCC license. Since issuing almost 1,900 licenses, the OLCC has paused on accepting new applications until further notice.

Limits on THC – a powerful active ingredient in cannabis products – are also an issue, according to Berkovitz. With the dawn of recreational dispensaries, the Oregon Health Authority began regulating THC content. A medical edible, typically in the form of a sweet treat, is now capped at 100mg THC, which Berkovitz says is not enough for a really sick person.

“If you need two 3000mg a day orally and you’re capped at a 100mg candy bar, that means you need 20 candy bars, which cost $20 a pop,” he said. “So you’re spending $400 a day to eat 20 candy bars.”

“The dispensaries never worked for high dose patients, even in the medical program,” continued Berkovitz. “What worked was people who grew their own and were able to legally process it themselves, or go to a processor who did it at a reasonable rate.”

But with increased processing and testing costs, and a decrease on the number of plants a medical grower can produce, patients are likely to seek cannabis products in a more shadowy place – the black market.

“All the people that we made these laws for – the ones who are desperately ill – are being screwed right now and are directed to the black market,” said Karla Kay, the chief of operations at PharmEx.

Kay, who also holds a medical marijuana card for her kidney disease, said some patients she knows have resorted to buying high dose medical marijuana products illegally from local farmers markets – in a state that was one of the first to legally establish a medical cannabis industry back in 1998.

Moreover, the networks between medical patients, growers and processors have diminished.

The OMMP maintains a record of processors and the few remaining dispensaries, but no published list of patients or grow sites – a privacy right protected under Oregon law, much to the chagrin of law enforcement.

According to the Oregon Health Authority’s report, just 58 of more than 20,000 medical growers were inspected last year.

In eastern Oregon’s Deschutes county, the sheriff’s office and the district attorney have repeatedly requested the location of each medical marijuana grower in their county. They’ve been consistently denied by the Oregon Health Authority.

Recently, the sheriff has gone as far as hiring a detective to focus solely on enforcing marijuana operations.

“There is an overproduction of marijuana in Oregon and the state doesn’t have adequate resources to enforce the laws when it comes to recreational marijuana, medical marijuana, as well as ensuring the growth of hemp is within the THC guidelines,” said the Deschutes sheriff, Shane Nelson. As of last February, the state database logged 1.1m pounds of cannabis flower, as reported by the Willamette Week in April. That’s three times what residents buy in a year, which means the excess is slipping out of the regulated market. To help curb the trend, senate bill 1544 was passed this year to funnel part of the state’s marijuana tax revenues into the Criminal Justice Commission and provide the funding needed to go after the black market, especially when it comes to illicit Oregon weed being smuggled to other states. The program’s priority is “placed on rural areas with lots of production and diversion, and little law enforcement”, said Rob Bovett, the legal counsel with the Association of Oregon Counties, who crafted the bill.

In a May 2018 memo on his marijuana enforcement priorities, Billy J Williams, a US attorney for the district of Oregon, noted that “since broader legalization took effect in 2015, large quantities of marijuana from Oregon have been seized in 30 states, most of which continue to prohibit marijuana.”

As of 1 July, however, all medical growers that produce plants for three or more patients – about 2,000 growers in Oregon – must track their marijuana from seed-to-sale using the OLCC’s Cannabis Tracking System.

Berkovitz, however, is looking to cut out the middle man (namely dispensaries) to keep PharmEx afloat. “The only way the patients are going to have large, high doses of medicine is if we revive the patient-grower networks. They need to communicate with each other. No one’s going to get rich, but everybody involved will get clean medicine from the people they trust at a more affordable rate.”

Source: https://www.theguardian.com/society/2018/jul/31/oregon-cannabis-medical-marijuana-problems-sick-people

Teens who use e-cigarettes may be more likely to try marijuana in the future, especially if they start vaping at a younger age, a new study shows.

More than 1 in 4 teenagers who reported  use eventually progressed to smoking pot, according to the survey of more than 10,000 teens.

That compared with just 8 percent of non-vapers, said lead researcher Hongying Dai, senior biostatistician with Children’s Mercy Hospital in Kansas City, Mo.

Further, teens who started vaping early had a greater risk of subsequent  use.

Kids aged 12 to 14 who used e-cigarettes were 2.7 times more likely to try marijuana than their peers, compared with a 1.6 times greater risk for teens who tried vaping between 15 and 17.

“Our findings suggest that the widespread use of e-cigarettes among youth may have implications for uptake of other drugs of abuse beyond nicotine and tobacco products,” Dai said.

For the study, Dai and her colleagues twice surveyed 10,364 kids aged 12 to 17—once in 2013-2014, and again a year later.

The researchers found that teens who’d reported using e-cigarettes in the first wave were more likely to have tried marijuana for the first time during the subsequent year.

Results also showed that 12- to 14-year-olds who had tried e-cigs were 2.5 times more likely to become heavy marijuana users, smoking pot at least once a week.

Worse still, the researchers found that the more often  used e-cigarettes, the more likely they were to either try marijuana or become a heavy pot smoker.

Dai said the nicotine contained in e-cigarette vapor could be altering the brain chemistry of young teens.

“The brain is still developing during the  years; nicotine exposure might lead to changes in the central nervous system that predisposes teens to dependence on other drugs of abuse,” Dai said.

It’s also possible that experimenting with e-cigarettes might increase a teen’s curiosity about marijuana, and reduce any worries about marijuana use, Dai added.

Additionally, kids who use e-cigarettes could be more likely to run with a crowd that tries other substances, said Dai and Dr. Scott Krakower, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y.

“E-cigarettes are going to be in the same drug culture as other things,” Krakower said.

These findings should be concerning to parents because kids might not stop at trying marijuana, he said.

“If you go to marijuana, is that going to lead to pills? Is that going to lead to something else?” Krakower said. “When we see progression to another substance, it’s like the ‘and then what’ cascade—they went to marijuana, and then what?”

Since this is a survey, it can’t prove a cause-and-effect relationship. And it’s possible that wild, risk-taking teens who try e-cigarettes are predisposed to be adventurous with other drugs, Dai and Krakower said.

“It could be that they have more of that sensation-seeking personality, and if they pick up one they’re going to pick up the other,” Krakower said.

But Dai said her team took that into account, and even after adjusting for sensation seeking, “ever e-cigarette use was still significantly associated with subsequent marijuana use.”

Krakower recommends that parents look for warning signs of e-cigarette use—marked irritability, hiding things, skirting the truth—and put their foot down hard.

“There should be zero tolerance for this kind of behavior,” Krakower said.

Gregory Conley, president of the American Vaping Association, agreed.

“E-cigarettes are adult products and are not intended for youth of any age,” Conley said. “We agree with the authors’ conclusion that more education is needed to help young people understand the consequences of using age-restricted products and illicit drugs.”

The new study was published online April 23 in the journal Pediatrics.

Source: https://medicalxpress.com/news/2018-04-vaping-teens-pot.html April 2018

There are several principal pathways to inheritable genotoxicity, mutagenicity and teratogenes is induced by cannabis which are known and well established at this time including the following.
These three papers discuss different aspects of these effects.

1) Stops Brain Waves and Thinking The brain has both stimulatory and inhibitory pathways.  GABA is the main brain inhibitory pathway. Brain centres talk to each other on gamma (about 40 cycles/sec) and theta frequencies (about 5 cycles/sec), where the theta waves are  used as the carrier waves for the gamma wave which then interacts like harmonics in music.
The degree to which the waves are in and out of phase carries information which can be  monitored externally. GABA (γ-aminobutyric acid) inhibition is key to the generation of the synchronized firing which underpins these various brain oscillations. These GABA transmissions are controlled presynaptically by type 1 cannabinoid receptors (CB1R’s) and CB1R stimulation shuts them down. This is why cannabis users forget and fall asleep.

2) Blocks GABA Pathway and Brain Formation GABA is also a key neurotransmitter in  brain formation in that it guides and direct neural stem cell formation and transmission and development and growth of the cerebral cortex and other major brain areas. Gamma and theta  brain waves also direct neural stem cell formation, sculpting and connectivity.

Derangements then of GABA physiology imply that the brain will not form properly. Thin frontal cortical  plate measurements have been shown in humans prenatally exposed to cannabis by fMRI.
This implies that their brains can never be structurally normal which then explains the long  lasting and persistent defects identified into adulthood.

3) Epigenetic Damage DNA not only carries the genetic hardware of our genetic code but it also carries the software of the code which works like traffic lights along the sequence of DNA bases to direct when to switch the genes on and off. This is known as the “epigenetic code”.

Fetal alcohol syndrome is believed to be due to damage to the software epigenetic code. The long lasting intellectual, mood regulation, attention and concentration defects which have been described after in utero cannabis exposure in the primary, middle and high schools and as college age young adults are likely due to these defects. Epigenetics “sets in stone” the errors of brain structure made in (2) above.

4) Arterial Damage. Cannabis has a well described effect to damage arteries through (CB1R’s) (American Heart Association 2007) which they carry in high concentration (Nature Reviews Cardiology 2018). In adults this causes heart attack (500% elevation in the first hour after smoking), stroke, severe cardiac arrhythmias including sudden cardiac death; but in developing babies CB1R’s acting on the developing heart tissues can lead to at least six major cardiac defects (Atrial- ventricular- and mixed atrio-ventricular and septal defects, Tetralogy of Fallot, Epstein’s deformity amongst others), whilst constriction of various babies’ arteries can lead to serious side effects such as gastroschisis (bowels hanging out) and possibly absent limbs (in at least one series).

5) Disruption of Mitotic Spindle. When cells divide the separating chromosomes actually slide along “train tracks” which are long chains made of tubulin. The tubulin chains are called “microtubules” and the whole football-shaped structure is called a “mitotic spindle”. Cannabis inhibits tubulin formation, disrupting microtubules and the mitotic spindle causing the separating chromosomes to become cut off in tiny micronuclei, where they eventually become smashed up and pulverized into “genetic junk”, which leads to foetal malformations, cancer and cell death. High rates of Down’s syndrome, chromosomal anomalies and cancers in cannabis exposed babies provide clinical evidence of this.

6) Defective Energy Generation & Downstream DNA Damage DNA is the crown jewel of the cell and its most complex molecule. Maintaining it in good repair is a very energy intensive process. Without energy DNA cannot be properly maintained. Cannabis has been known to reduce cellular energy production by the cell’s power plants, mitochondria, for many decades now. This has now been firmly linked with increased DNA damage, cancer formation and aging of the cells and indeed the whole organism. As it is known to occur in eggs and sperm, this will also damage the quality of the germ cells which go into forming the baby and lead directly to damaged babies and babies lost and wasted through spontaneous miscarriage and therapeutic termination for severe deformities.

7) Cancer induction Cannabis causes 12 cancers and has been identified as a carcinogen by the California Environmental Protection agency (2009). This makes it also a mutagen. 4 of these cancers are inheritable to children; i.e. inheritable carcinogenicity and mutagenicity. All four studies in testicular cancer are strongly positive (elevation by three fold). Carcinogen = mutagen = teratogen.

8) Colorado’s Teratology Profile. From the above described teratological profile we would expect exactly the profile of congenital defects which have been identified in Colorado (higher total defects and heart defects, and chromosomal defects) and Ottawa in Canada (long lasting and persistent brain damage seen on both functional testing and fMRI brain scans in children exposed in utero) where cannabis use has become common.

Gastroschisis was shown to be higher in all seven studies looking at this; and including in Canada, carefully controlled studies. Moreover in Australia, Canada, North Carolina, Colorado, Mexico and New Zealand, gastroschisis and sometimes other major congenital defects cluster where cannabis use is highest. Colorado 2000-2013 has experienced an extra 20,152 severely abnormal births above the rates prior to cannabis liberalization which if applied to the whole USA would equate to more than 83,000 abnormal babies live born annually (and probably about that number again therapeutically aborted); actually much more since both the number of users and concentration of cannabis have risen sharply since 2013, and cannabis has been well proven to be much more severely genotoxic at higher doses.

9) Cannabidiol is also Genotoxic and tests positive in many genotoxicity assays, just as tetrahydrocannabinol does.

10) Births defects registry data needs to be open and transparent and public. At present it is not. This looks too much like a cover up.

Source: Email from Dr Stuart Reece to Drug Watch International members May 2018

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